Health of Pregnant Women

Maternal health encompasses far more than the health of a pregnant woman; it is a complex and involved process that begins before a woman conceives and continues long after the birth of a child. For most women, pregnancy is a major life event that occurs without major incident. However, for some, pregnancy involves a variety of health care issues and concerns that can have a significant and lifelong impact on a woman's health, reproductive future, and parenting capacity. From the inception of Maternal and Child Health (MCH), pregnant women have been a population of primary interest. As a result of maternal public health, major advances have been made in the health status of pregnant women. Still, these advances fall short of the Healthy People 2010 (link to HP 2019 website) objectives of reducing maternal mortality rates to 3.3 maternal deaths per 100,000 live births as well as maternal complications and illness to 24 per 100 live births. Although much work remains to be done, it is believed that Healthy People 2010 objectives are achievable through multifaceted health programs that promote healthy women before, during, and after pregnancy.

Programming

In MCH, we broadly define prenatal care and care for pregnant women to include any programs that enhance the health and well-being of mothers and their infants. Programs such as WIC, which foster continuity of care and services from the prenatal to postpartum period, are an excellent example of MCH activities. Emerging emphasis on preconception care widens the reach of MCH's focus on pregnant women to encompass the months before achieving pregnancy, in an effort to reduce risk factors that could impact future pregnancies.

Prenatal care, routinely recommended by the March of Dimes and American College of Obstetrics and Gynecologists, is an essential component to healthy pregnancy outcomes. However, most pregnancies are not planned and many women, especially higher risk populations, likely delay initiation of prenatal care. Furthermore, payment for prenatal care is not always secure, with only some states including it as part of Medicaid family planning services. Healthy People 2010 objectives aim to increase the proportion of women receiving early and adequate prenatal care from 74% in 1998 to 90% in 2010.

Postpartum hospitalization is, on average, two days for vaginal birth and four days for a cesarean section. This time is truly inadequate to assess many of the postpartum problems and medical conditions that require medical care and advice. Postpartum hospitalization is an important time for physical recovery and stabilization of both the mother and infant. It also provides a time for maternal education, psychological adaptation, and observation of overall health status.

Maternal Health Programs :

• CDC Maternal & Child Health Epidemiology Program
• March of Dimes
• Minnesota Department of Health – Maternal & Child Health Section
• Women's Health USA 2007: Maternal Health

Family Home Visiting

• MDH Family Home Visiting Program

Health Care Access

• Health Care Programs in Minnesota for Pregnant Women and

Nutrition

• MDH Folic Acid Guidelines for the Prevention of Neural Tube Defects
• National Folic Acid Campaign
• Women, Infants, & Children Program - MN
• http://www.fns.usda.gov/wic/aboutwic/

Postpartum Depression

• HRSA: Depression During and After Pregnancy

• Postpartum Depression Education Materials – MDH: Healthy Start and other federally funded programs are beginning to address and improve the identification, referral, and treatment of women experiencing depression during pregnancy and early motherhood.

Reproductive Health

• Planned Parenthood Federation of America Planned Parenthood is a national network of family planning clinics that offer medical services including exams, disease screening, birth control, and health education. The site features links to local chapters/clinics and extensive archives of recent medical journal articles, news stories, and health alerts.

Policies

In the late 1980s and early 1990s, there was an increase in the allowable Medicaid income eligibility for maternity care to 185% of the federal poverty level greatly increased the accessibility of valuable care for pregnant women. Additionally, Medicaid expanded reimbursements to include nonclinical services such as health education, social work, nutrition, home visitation, and case management services. Other policies that have had a significant impact on the health of pregnant women include: