Models Addressing Perinatal Health
Rural programs addressing perinatal health focus on issues affecting woman during pregnancy, delivery, and
immediately after birth. For pregnancy health, the Community Preventive Services Task Force (CPSTF) recommends exercise programs and lifestyle
interventions to reduce the risk gestational hypertension gestational diabetes, respectively.
Current recommendations are that pregnant women take childbirth education
classes. These classes are typically taken during the second or third trimester of pregnancy. However,
some models incorporate prenatal care and childbirth education at the same time and may start during the first
trimester. Studies have shown that childbirth education programs can reduce the fear of childbirth
and increase childbirth-related maternal self-efficacy. Rates of medical interventions were
lower in mothers who participated in childbirth education classes.
There are many methods of childbirth preparation classes. They vary in length of class, method of delivery, philosophies toward birth, and setting.
Which class is selected is largely based on what is available in the expectant woman's community.
visiting programs have been shown to improve birth outcomes, improve maternal health, reduce
maternal postpartum depression, and — when begun during pregnancy — increase use of prenatal care.
Since 2012, the federal Maternal,
Infant, and Early Childhood Home Visiting (MIECHV) Program has been the largest source of funding
for home visiting in the U.S., supporting implementation of four programs: 1) Early Head Start - Home Based
Program Option, (2) Healthy Families America,
(3) Nurse-Family Partnership, and (4) Parents as Teachers. Home
visits from public health nurses or community health workers provide families information, support,
and access to early childhood resources. Families also receive tools for expanding social support networks.
In-home nursing case management
programs aim to prevent preterm births. High-risk pregnant women who are enrolled in these
more likely to give birth to infants with a healthy gestational age and birthweight, leading to
improved health outcomes.
reproductive health clinics are medically equipped vans typically serving low-income or uninsured
individuals in both urban and rural communities. Mobile health clinics provide reproductive health services
such as screening tests, pre- and post-natal care, health education, and referrals.
Doulas are trained professionals who provide emotional
and physical support to pregnant women. They do not provide medical advice, but provide support and explain
medical procedures to families. Doulas are helpful when working with underserved and marginalized
communities, as they can empower families to advocate for themselves. Community-based
doulas can help rural families navigate the healthcare system, particularly if they are feeling some
anxiety around giving birth in a non-local hospital.
Examples of Models Addressing Perinatal Health
Healthy Connections, Inc. is a federally-funded community
that offers in-person prenatal check-ups, education, transportation, well-baby checks, and child
to expectant and young mothers in Arkansas. The program has demonstrated
increase in the rate of first-trimester prenatal care and child immunization as well as a dramatic decrease
confirmed cases of child abuse.
Kid One Transport,
provided rides to medical appointments for pregnant women and their children who have no regular means of
transportation. This programs has shown positive impacts by increasing
ability to continue prenatal care and preventing children from developing life-threatening illnesses.
Some states have passed legislation to ensure services provided by midwives and doulas are covered under
Medicaid. In 2019, Wyoming passed the Midwife
Services Medicaid Act, requiring services covered by licensed midwives to be covered by Medicaid.
Also in 2019, Indiana passed Senate Bill
416 allowing for Medicaid reimbursement of doula services.
CenteringPregnancy is a
group prenatal care model. It convenes eight to ten pregnant women at similar points in their pregnancies
for group discussions, education, health assessments, and support. Evidence suggests the program improves
birth outcomes and the likelihood of receiving adequate prenatal care. The CenteringPregnancy
program has been successfully implemented in rural communities, including the CenteringPregnancy
Prenatal Program at CHI St. Alexius Health Dickinson. CenteringPregnancy may be beneficial in rural
communities where there is limited provider capacity. For example, mothers who participated in the Mountain Area Health
Education Center's Centering Pregnancy program reported spending 12 times more time with their
providers than women in traditional care.
Program Clearinghouse Examples
Considerations for Implementation
Childbirth education classes include information about the birth process, pain management, and variations in
labor. Because of the social determinants of health in rural areas, there is often additional focus in rural
childbirth education classes on logistics
and transportation. Clinics and providers should be aware of childbirth education options available in
their communities and provide information on how to access the classes.
The effectiveness of perinatal interventions may depend upon availability in the community as well as cost.
Healthcare systems and health plans may consider offering low-cost programs to pregnant women. Many perinatal
programs are most effective when they begin early in a pregnancy. Therefore, providers should be aware of
options in their communities and be able to refer women early in their pregnancy.
Resources to Learn More
An international doula organization that offers certification, evidence-based training, continuing education and
resources describing the benefits of, and how to hire, a doula.
Organization: DONA International
Home Visiting Evidence of Effectiveness (HomVEE)
Collection of research literature assessing the effectiveness of home visiting programs. Includes reports
detailing the models studied and their outcomes and measures. Offers implementation guidelines for home visiting
programs and information about related federal grants.
Organization(s): Department of Health and Human Services, Administration for Children &
Maternal Quality Improvement Toolkits
A repository of toolkits developed for healthcare providers addressing the leading causes of preventable death
among women during the perinatal period. Also identifies ways to reduce harm to infants and mothers from the
oversue of obstetric procedures.
Organization(s): California Maternal Quality Care Collaborative
Maternal Safety Bundles
A repository of resources identifying best practices in maternity care shown to significantly reduce severe
maternal morbidity and maternal mortality.
Organization(s): Alliance for Innovation on Maternal Health (AIM), Council on Patient
Safety in Women's Healthcare