An Urban Perinatal Health Programme of Strategies to Improve Perinatal Health

Abstract

Promotion of a healthy pregnancy is a top priority of the health care policy in many European countries. Perinatal mortality is an important indicator of the success of this policy. Recently, it was shown that the Netherlands has relatively high perinatal death rates when compared to other European countries. This is in particular true for large cities where perinatal mortality rates are 20–50% higher than elsewhere. Consequently in the Netherlands, there is heated debate on how to tackle these problems. Without the introduction of measures throughout the entire perinatal health care chain, pregnancy outcomes are difficult to improve. With the support of health care professionals, the City of Rotterdam and the Erasmus University Medical Centre have taken the initiative to develop an urban perinatal health programme called ‘Ready for a Baby’. The main objective of this municipal 10-year programme is to improve perinatal health and to reduce perinatal mortality in all districts to at least the current national average of l0 per 1000. Key elements are the understanding of the mechanisms of the large health differences between women living in deprived and non-deprived urban areas. Risk guided care, orientation towards shared-care and improvement of collaborations between health care professionals shapes the interventions that are being developed. Major attention is given to the development of methods to improve risk-selection before and during pregnancy and methods to reach low-educated and immigrant groups.

Deprived neighborhoods and adverse perinatal outcome: a systematic review and meta‐analysis

“…Since poor maternal circumstances during pregnancy have both short‐ and long‐term consequences, it makes sense to organize tailor‐made antenatal healthcare that is responsive to women's needs by taking into account deprivation notions, preferably in combination with preconception care. In particular in large cities, this implies involvement of local initiatives and engagement of public health services . A systematic approach in antenatal risk selection for both medical and non‐medical risk factors with subsequent continuity of care might support early detection of potential high risk.…”

Bridging Between Professionals in Perinatal Care: Towards Shared Care in The Netherlands

“…The Rotterdam Reproductive Risk Reduction (R4U) checklist could fulfill these criteria and is based on the concept of risk accumulation [18]. During the first antenatal visit (at the community midwife or obstetrician) risks can be assessed with the R4U and subsequently a (weighed) score can be calculated for the (combination of) risk factor(s) identified.…”

“…In this city some important steps towards shared care have already been taken in the framework of the perinatal health program 'Ready for a Baby'. In this program, health researchers joined hands with municipal policy makers in order to develop a comprehensive program to improve perinatal health in the city [18]. One of the tools that we propose to use for the shared care model, the risk screening instrument R4U, is adopted from the 'Ready for a Baby' program.…”

An instrument for broadened risk assessment in antenatal health care including non-medical issues

“…This so-called risk accumulation is especially observed in deprived geographical areas characterized by overrepresentation of women with low socio-economic status, single parenthood, migrant status and numerous associated risks (medical, non-medical or both) [5–7]. …”

“…The ‘Ready for a baby’ programme, a prior antenatal health care programme in the city of Rotterdam [5], provided the framework to develop and pilot this instrument in the antenatal health care setting [18]. The main purpose of this universally applicable score card is early identification of women with an increased risk for common adverse pregnancy outcomes, notably small for gestational age and prematurity.…”