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Improved Prenatal Care Could Reduce Racial Disparity in Infant Mortality

Complete prenatal care shouldn't be a privilege, but only some expecting moms get all the health attention they need.

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THIS is how prenatal care should be. Right? Well, not necessarily. Unless and until there is a major upheaval in healthcare financing and staffing patterns, having this kind of prenatal care is a privilege. And I don't mean privilege like “I'm so lucky.” I mean privilege in the sense that I can't have that kind of care unless others are deprived of it.

If everyone woke up tomorrow and realized that they deserved to have every question answered, every fear and concern explored, every test/procedure/diagnosis explained, we would quickly run out of midwives to provide that care. That is, if our solution was to provide one-to-one care on the traditional prenatal schedule. In short, that kind of prenatal care, however great it is, is not scalable to levels that could benefit all women and babies.

The Centering model of prenatal care has been implemented in more than 300 sites throughout the U.S., Canada and other countries and is highly replicable. A hospital or provider practice that decides today to start Centering could be enrolling women in their first groups in just a matter of months. It is appropriate for all prenatal populations -- whether teens, military, community health centers, private practices, Indian Health Services and so on. It has also been adapted to provide well-woman and well-baby care throughout the baby's first year of life, a stark contrast to the traditional fragmented mother-baby care that drops women's wellbeing out of the picture after the 6-week postpartum visit. (A randomized controlled trial of this adaptation is in progress.)

If the birth advocacy community is serious about making childbearing safe, healthy, transformative, and joyful, and connecting mothers in a network of supporting community, we need to broaden our view of what constitutes optimal care. Yes, there are critical problems with how labor and birth are “managed” in this country, and we need to continue to work on that front. But how can we justify not fighting for the widespread implementation of programs that are proven to avert preterm births and close the gap between blacks and whites?

Thank you, Courtroom Mama, for pushing us all out of our comfort zones a little to talk about the bigger reality about birth in this country. I want to issue a challenge to my fellow birth advocates to look at the models of prenatal care, not just birth care, and rally behind those that are effective and empowering.

Amy Romano is a mother, a midwife, and an advocate for mother-friendly maternity care policies. She writes about maternity care research and policy for Lamaze International at Science & Sensibility ( ) and provides social media consulting services to organizations including Lamaze International and the Centering Healthcare Institute.

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