CLINICAL ISSUES
Prenatal Care: Limitations and Opportunities

https://doi.org/10.1111/j.1552-6909.2006.00039.xGet rights and content

Prenatal care is a venerable tradition in the U.S. health care system and one that deserves critical examination. Inordinate amounts of public and personal resources are expended on a tradition of care that has not proven itself equal to current perinatal prevention challenges. In this article, the evolution of prenatal care is reviewed, its efficacy is critiqued, and efforts at restructuring the content and processes of care are examined. Three promising alternatives to the dominant medical model are described: the comprehensive prenatal care approach illustrated by many publicly funded prenatal clinics, the prenatal empowerment model as exemplified by midwifery care, and the prenatal group model as illustrated by CenteringPregnancy. Nurses are called upon to champion prenatal options for women. JOGNN, 35, 278‐285; 2006. DOI: 10.1111/J.1552‐6909.2006.00039.x

Section snippets

History of prenatal care

In 1902, J.W. Ballantyne, a Scottish physician, introduced modern prenatal care when he asserted that prevention, in order to be truly preventive, must be antenatal (Ballantyne, 1902). In the late 19th century, this visionary had observed that while much was done for mothers and babies during labor and birth, these activities did little or nothing to reduce the morbidity and mortality of congenital anomalies, multiple births, and fetal diseases. He identified maternal exposures including

Comprehensive prenatal care

In the 1980s, in response to evidence that increased utilization of prenatal care was associated with lower rates of prematurity (a questionable association as previously discussed), prenatal care for low‐income women was made more accessible by creating a new category of Medicaid, known as Medicaid for Pregnant Women (MPW). Under this Medicaid expansion, a woman could qualify for publicly funded prenatal care at 135% to 185% of the federal poverty level, depending on the option chosen by the

Conclusions

Prenatal care is a tradition that deserves critical examination, but little has occurred since the work of the PHS Expert Panel on the Content of Prenatal Care (PHS, 1989) was published 17 years ago. Inordinate amounts of public and personal resources continue to be expended on a tradition of care that has not proven itself equal to the perinatal health issues of today. Calls to rigorously examine the tradition have received little support from professional groups, and efforts to redesign

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