Womens Health Blog

The recommendation for early initiation of care is based on the belief that early prenatal care will increase the chances of having a healthy pregnancy and a healthy baby, an outcome that most families now take for granted. In the past, such an outcome was far from guaranteed. In the United States, the maternal mortality rate was 582 deaths per 100,000 births in 1935,4 but has fallen to 7.5 deaths per 100,000 births in 1993.5 The infant mortality rate has fallen from 47 deaths per 1000 births in 19404 to 8.4 deaths per 1000 births in 1995.5 Prenatal care has likely played a role in this dramatic decline in maternal and infant mortality, although other advances such as antibiotics, safe anesthesia, and better treatments for hemorrhage have also made a significant contribution.

It is difficult to measure the efficacy of prenatal care. For one reason, there is a great deal of disagreement on what constitutes a good outcome. Should the goal be to ensure that the woman has a “good” experience or should a good outcome be measured by Apgar scores? There is general agreement, however, that the infant mortality rate is a reasonable measure to use when assessing systems of care. More than 20 countries have lower infant mortality rates than the United States Every one of these countries has an organized system of prenatal care that is readily available. In the United States, women with poor access to prenatal care have the worst outcomes, although analyses are confounded by the coexistence of poverty, poor social supports, and substance abuse that is also found in such populations.

Despite limitations in the ability to prove that prenatal care is effective, there is wide agreement among women and health providers that it is important. Most people also assume that it is safe, although this has not always been the case. The catastrophic fetal malformations caused by thalidomide, which was given to pregnant women as a sleep aid during prenatal care in the 1950s and 1960s, and the long-term problems afflicted on women whose mothers took diethylstilbestrol for the prevention of miscarriages are just two examples of harm caused by prenatal care. Given that. most women will have healthy babies, any intervention introduced into that natural course should be proved effective and safe. Fortunately, the past 15 years have seen an impresive growth in medical literature that critically appraises aspects of hrenatal care. In the realm of childbirth, this effort as been pioneered by a group of British authors who conduct systematic reviews of the evidence of care related to pregnancy and childbirth. Their work, known as the Cochrane pregnancy and childbirth database, was first published in 1989 and is now regularly updated and available on computer disk. Similarly, the United States Preventive Services Task Force Guide to Clinical Preventive Services Report is an established reference source, for evidence-based recommendations, induding many components of prenatal care.

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