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Looking for a miracle to improve your prenatal program outcomes? Take another look at what everyone already knows about pregnancy: Expectant moms who eat right and avoid drugs and alcohol deliver healthier babies. And healthy babies consume fewer health care dollars.
A recent study from the Centers for Disease Control and Prevention in Atlanta suggests that teaching these proven principles to expectant moms is more urgent than ever.1 Each year, at least 140,000 pregnant women take more than seven drinks a week. That’s enough to push the incidence of fetal alcohol syndrome as high as 0.2 to 1.0 per 1,000 live births. Full-blown fetal alcohol syndrome causes incurable, lifelong facial abnormalities, central nervous system deficits, and learning and emotional disorders. And it’s 100% preventable.
Prevention is nothing fancy, but how and when you teach the lessons to pregnant women is critical. It took two years to design the hows and whens of Healthy Starts, a prenatal care program at The Women’s Center of Cox Health Systems in Springfield, MO. First, the prenatal coordinators and nurse case managers set goals.
"It gave us a way to look at our improvement. We wanted our prematurity rates to be lower than the national average of 11% for all deliveries," explains Tricia Wagner, RN, BSN, perinatal programs coordinator at The Women’s Center. "We set our goal for below 7%."
In its first full year of operation, ending Sept. 30, 1996, Healthy Starts drew 200 clients from Cox employees. Its performance exceeded the goals, with 6.7% premature deliveries. The groundwork of identifying and tracking performance produced a strategic marketing point selling Healthy Starts to cost-conscious employers.
"Every dollar we spend on prenatal care saves $3.38 in health care costs later," Wagner explains. The major portion of Healthy Starts’ dollars pays the salaries of two bachelor’s-prepared nurse case managers certified in obstetrical and neonatal care. They’re paid about the average rate for the region, approximately $32,000 a year.
Healthy Starts is geared to working women. Basically, the program consists of prenatal classes and individual visits with the nurses. Though participation is voluntary, "we incentivize’ it to keep clients involved through labor and delivery," Wagner says. Clients receive individual health risk assessments and coupons for free prenatal vitamins. On completion, the participant receives a $50 savings bond for the baby.
Nurses are the program’s active ingredient, she says. "They identify client needs and goals for the pregnancy." For example, "a client’s goal might be buying a baby bed, and ours might be good prenatal nutrition and vitamins. Both are important." If a woman has limited income, the nurse helps her budget for both. After comparing a client’s goals with those of Healthy Starts, the goals are sent to the physician with a request for his or her goals and care plan.
"On average, we visit with clients, in person or by phone, ten to 14 times during pregnancy and postpartum. It’s according to their needs. Some require 25 contacts," Wagner says. The most frequent contact is with the 44% of Healthy Starts clients who are considered high-risk.
That’s as you’d expect, says Carol Cada, RN, CCM, patient care manager at MaterniCare in Laguna Hills, CA. Some high-risk clients need weekly contact at the minimum. "The more a patient is seen, the more she’s talked to, the better she’ll do. We find that phone contact is a valid support measure."
Flexibility rules at Healthy Starts. "We make it family-friendly," Wagner says. "We don’t just offer classes in the evenings, because some of our clients work nights [from 11 p.m. to 7 a.m.]. We hold early morning classes for them."
Healthy Starts serves women who are fortunate enough to have health insurance through their jobs. However, "We don’t assume that they’ll come for prenatal care," Wagner cautions. Some are afraid of losing their jobs if they tell their employers they’re pregnant. Other employers make it tough for women to take time for medical appointments. To ease the way for employees, Healthy Starts shows participating companies the economic advantages of early prenatal care.
The prenatal classes take nothing for granted. The nurses explain what to expect at each stage of pregnancy, such as when to anticipate fetal movement. They review warning signs such as vaginal bleeding and premature contractions. "You’d be surprised at how many women don’t know what labor pains feel like," Wagner says.
Other Springfield-area companies are contracting to send their employees to Healthy Starts. No wonder: The program already has reduced the costs of premature births by 61% for participating employers.
"We’re just using what everybody already knows," Wagner says. "We’re not going to prevent all the prenatal problems, but we’re working on the 60% that are preventable."
1. Luman, B. Alcohol consumption among pregnant and childbearing-aged women United States, 1991 and 1995. MMWR 1997; 46:345-350.