The United States has room for improvement in maternal and child health. Compared to other members of the Organization for Economic Co-operation and Development (OECD), the U.S. has high rates of infant mortality (7 per 1000 live births) and ranks second to last in overall child well-being. While indicators of health such as infant mortality, infant deaths, and preterm births all declined from 2000-2012, the US Department of Health and Human Services’ Office of Disease Promotion and Health Prevention recognized that a continued decline in all these indicators is necessary to meet 2020 goals. In addition to addressing larger social determinants of health within the U.S., taking a more proactive, preventative and participatory approach to prenatal care has potential to improve prenatal health.
As infant health is inextricably connected to maternal health, one of the key components of prenatal care is engagement of the mother in the management of her own health. In the U.S., diabetes, hypertension and obesity are common factors that contribute to pregnancy and birth complications, increased use of medical services and longer hospital stays after delivery. The personalized health planning model could better address these common chronic conditions by engaging mothers in health care decision making through a health self-assessment and shared goal setting process. It is an approach that equips providers to provide recommendations for the next steps in a patient’s care. The patient and provider set goals for the patient’s health that are SMART: specific, measurable, action oriented, realistic and timed to facilitate gradual steps towards improved health outcomes through lifestyle modification. Ideally, a mother’s pregnancy specific goals would be integrated with the primary care provider’s (PCP) health plan. Coordination and continuity of care between a prenatal provider and PCP is key for successful goal achievement and taking full advantage of a personalized health plan.
There is exciting work happening that utilizes this type of participatory and proactive approach to ameliorate birth-related health outcomes and enhance the prenatal health care experience for mothers. One well-documented example is CenteringPregnancy, a model of group pregnancy care from second trimester to birth based on “the belief that health care should be centered or focused on the individuals participating in the care experience at any given time.” In a Centering appointment, expecting mothers first have individual assessments with the provider and use self-assessment tools to practice self-care and prepare for the day’s group activity. During the group activity the provider facilitates discussion around a health topic using hands on activities and drawing from individual experiences and concerns. Several studies indicate that Centering programs may reduce emergency room visits and preterm births while increasing prenatal knowledge as compared to traditional care. Centering programs cover topics included in traditional prenatal care (such as breastfeeding, labor, delivery and infant care) and provide opportunities for the provider to address issues such as gestational diabetes and obesity through organic group discussion and workshops.
CenteringPregnancy is a great example because it incorporates elements like health self-assessments into a clinical model while actively engaging and empowering the patient to manage their health and the health of their child. However, the length of Centering appointments (90 to 120 minutes) and number of patients in each shared appointment may be unsuitable for expectant mothers short on time for appointments or who anticipate pregnancy complications. It is here that tailored health planning during pregnancy, coordinated with primary care and postnatal care, has the most potential for improving health outcomes. Through personalized health planning’s systematic approach to patient-centered care, chronic conditions threatening a healthy pregnancy can be addressed early on by bringing meaningful, focused goal setting and enhanced patient-provider collaboration to prenatal care.
Sierra Reid is an intern for the Duke Center for Research on Personalized Health Care and a senior attending the University of North Carolina at Chapel Hill.