Optimal outcomes and women's positive pregnancy experience: a comparison between the World Health Organization guideline and recommendations in European national antenatal care guidelines

Abstract

BACKGROUND: The publication of the World Health Organization (WHO) recommendations on antenatal care in 2016 introduced the perspective of women as a necessary component of clinical guidelines in maternity care. WHO highlights the crucial role played by evidence-based recommendations in promoting and supporting normal birth processes and a positive experience of pregnancy. This paper aims to explore and critically appraise recommendations of national antenatal care guidelines across European countries in comparison with the WHO guideline. METHODS: We collected guidelines from country partners of the EU COST Action IS1405. Components of the documents structure and main recommendations within and between them were compared and contrasted with the WHO guideline on antenatal care with a particular interest in exploring whether and how women's experience were included in the recommendations. RESULTS: Eight out of eleven countries had a single national guideline on antenatal care while three countries did not. National guidelines mostly focused on care of healthy women with a straightforward pregnancy. The level of concordance between the national and the WHO recommendations varied along a continuum from almost total concordance to almost total dissonance. Women's views and experiences were accounted for in some guidelines, but mostly not placed at the same level of importance as clinical items. CONCLUSIONS: Findings outline convergences and divergences with the WHO recommendations. They highlight the need for considering women's views more in the development of evidence-based recommendations and in practice for positive impacts on perinatal health at a global level, and on the experiences of each family.

Adequate Prenatal Care: An Integrative Review

“…1 Nationally and internationally, multiple guidelines exist that in some instances provide conflicting opinions on the necessary components of PNC. [1][2][3][4][5][6][7][8][9] These inconsistencies lead to questions regarding how health care providers and researchers determine if adequate PNC was received by pregnant persons.…”

“…The goal of PNC is to provide a coordinated approach to health care that includes continuous risk assessment, treatment, and psychosocial support 1 . Nationally and internationally, multiple guidelines exist that in some instances provide conflicting opinions on the necessary components of PNC 1–9 . These inconsistencies lead to questions regarding how health care providers and researchers determine if adequate PNC was received by pregnant persons.…”

“…StatesBlack individuals (n = 190) receiving care in PNC in Detroit, MI, and Columbus, OH Most participants reported their highest level of education as high school diploma (56.9%), were married, living, or involved with the father of their child (78.7%), were insured via Medicaid and/or Medicare (86%), and reported an annual household income of <$10,000 The QPCQ contains 46 questions in 6 subscales: (1) information sharing,(2) anticipatory guidance, (3) sufficient time, (4), approachability, (5) availability, and (6) support and respect.28 (66.7)Cronbach's α for the subscales ranged between .72 and .96, whereas Cronbach's α for the total score was .97, indicating acceptable internal consistency.Removing one item ("My prenatal care provider was abrupt with me") from the approachability subscale could have increased this subscale's internal consistency from α =.72 to α = .80. This indicates an effect of potential differences in social and cultural experiences on this subscale.…”

“…Opportunities to reduce inequities in PNC include(1) identifying ways to proactively shift power dynamics between pregnant persons and their health care providers to foster trust and partnership and help health care team members to recognize and undo their biases;(2) approaching every interaction as an opportunity to build trust, creating less burdensome mechanisms for pregnant persons to communicate their stories across care transitions; (3) structuring each visit around what the individual says they need that day and creating mechanisms for them to easily communicate this with providers; (4) making care and services more valuable and easier to access, especially for those who face the worst outcomes and the most barriers to care; (5) incorporating people with lived experiences as valued members of the health care team who can help others; and (6) using resources to provide more community support, rather than more medical care during pregnancy Access to care, including transportation and wait times at the health care provider's office. The cost of transportation can create a barrier to access PNC services.…”