Date of Award

2014

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Edward Frongillo

Abstract

Background: High rates of adverse birth outcomes persist in the United States despite increased access to individual prenatal care (IPNC). Psychosocial factors influence birth outcomes and affect infant and child development and maternal functioning. Group prenatal care (GPNC) combines individual physical assessments and facilitated group education and support. Studies of GPNC show promising results, including lowered preterm birth rates, but the GPNC psychosocial mechanisms influencing birth outcomes are unclear.

Methods: Surveys at study enrollment (N=248), late pregnancy, and six weeks postpartum assessed psychosocial effects of each PNC model. Multiple regression models and planned moderator analyses tested whether GPNC participants had better outcomes compared to IPNC, as main effects and for at-risk subgroups. Frequent, brief semi-structured interviews with 29 women during pregnancy through six weeks postpartum were conducted and analyzed to describe important PNC functions and how experiences and benefits differed according to the PNC model women selected.

Results: GPNC participants did not demonstrate overall greater improvements in psychosocial outcomes compared to IPNC participants. Among women with low survey 1 social support, GPNC vs. IPNC participants demonstrated greater improvements in late-pregnancy prenatal distress and postpartum negative affect. Among women with high initial prenatal distress, GPNC vs. IPNC participants demonstrated greater improvements in planning-preparation coping in late pregnancy and postpartum depressive symptoms. In the qualitative interviews, women described four PNC functions: confirming baby and mother's health, preventing and monitoring complications, educating and preparing, and building supportive relationships. Benefits included stress reduction, increased confidence, preparation, and motivation to change health behaviors, and informed decision making. While individual experiences varied, GPNC participants described greater educational and psychosocial benefits compared to IPNC participants.

Implications: This study contributes to the existing PNC literature by explicating functions of PNC for women and showing that GPNC confers additional educational and psychosocial benefits compared to IPNC, particularly among women with greater psychosocial risk. Efforts to increase availability of high-quality GPNC can provide women with choices in PNC. The qualitative results indicate functions and benefits important to include in future PNC research. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of GPNC for women.

Rights

© 2014, Emily Heberlein

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