Adequate Prenatal Care: An Integrative Review

Abstract

Introduction Prenatal care (PNC) is a core element of preventive care and is vital in identifying and managing conditions that can put the pregnant person and the fetus at risk. National and international guidelines differ in what is considered adequate or quality PNC. Indices of care adequacy rely only on number of attended PNC visits without regard to factors that affect a patient's ability to obtain care or the quality of the care received. This integrative review explored stakeholders’ perceptions of adequate and quality PNC. Methods Three electronic databases, CINAHL, PubMed, and Web of Science, were searched to identify original research articles published between 2012 and April 2022. Studies conducted in the United States, published in a peer‐reviewed journal, and having a primary focus on the components of adequate or quality PNC were included. The quality of included studies was assessed via the Quality Assessment Tool for Studies with Diverse Designs. Results Thirteen articles met inclusion criteria. The concepts of adequate or quality PNC were not well defined in the literature. Studies revealed a variety of approaches to assessing individual components of PNC with at times conflicting results of what adequate or quality PNC is. Viewpoints regarding adequacy or quality of PNC were limited by the perceptions and interpretations of individual stakeholders, who included researchers, public health officials, insurers, health care providers, and patients. Discussion Ideas of how to redesign PNC were affected by study setting and stakeholders, as well as the emergence and integration of telehealth into PNC delivery. This review is a first step in identifying the gap in the research literature regarding how these concepts are defined and measured. Future research is needed to identify the relevant components of PNC that are necessary to reach consensus definitions of both adequacy and quality of PNC.

Midwifery Practice Leaders’ Experiences of Practice Changes Early in the COVID‐19 Pandemic: A Qualitative Exploration

“…Breman et al, 26 who examined visit schedule changes from the client's perspective, noted that these alterations contributed to clients’ impressions they were receiving subpar care. There is as yet no strong evidence to support the usual schedule of 14 to 15 prenatal visits versus an abbreviated schedule 27,28 . Hence, alternative visit schedules, if adopted, should be thoroughly explained to clients and appropriate reassurance provided, with clear advice on and support for additional contacts upon request.…”

“…There is as yet no strong evidence to support the usual schedule of 14 to 15 prenatal visits versus an abbreviated schedule. 27,28 Hence, alternative visit schedules, if adopted, should be thoroughly explained to clients and appropriate reassurance provided, with clear advice on and support for additional contacts upon request. Although research suggests telehealth prenatal visits are acceptable to clients and providers, 29 there is a need to determine which midwifery visit types can be safely and appropriately conducted via telehealth and to advocate for equitable reimbursement for telehealth visits.…”

Telehealth in the Prenatal and Postpartum Periods

“…Despite the focus on the quantity of visits, debate also exists about what constitutes adequate and quality prenatal care. Michel and Fontenot (2023) proposed that the current prenatal care structure based on the number of in-person visits without discussions of quality of care does not address barriers to access related to socioeconomic, employment, or other circumstances. New, hybrid, prenatal care models have the potential to increase uptake, but they also need to address other barriers to access, including internet and equipment availability.…”

Effects of information-knowledge-attitude-practice health education combined with cluster-based care in patients with gestational hypertension

“…This highlights the importance of prenatal and postnatal care for hypertension during pregnancy. [ 11 ] A separate study revealed that during the latter stages of pregnancy, there exists an inverse relationship between the severity of depression and the duration of walking as a physical activity. Additionally, walking was found to have a positive correlation with anxiety levels.…”