OB-GYNs rethink prenatal care schedules
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The professional association for OB-GYNs is recommending a shift in the way prenatal care is delivered, away from a dozen or more office visits to a more individualized approach built around social needs and patient choice.
Why it matters: The standard recommendation of 12 to 14 visits doesn't ensure that patients receive necessary care when nearly a quarter don't go to their first appointment until after the first trimester and almost half don't receive all the recommended services on time, clinicians say.
Driving the news: The American College of Obstetricians and Gynecologists issued new guidance this month aimed at breaking with models of care for average or low-risk patients that date to the 1930s.
- It calls for a needs assessment ideally prior to 10 weeks of pregnancy, with clinicians screening for factors including race, ethnicity, gender identity, education and employment. That could allow for care to be tailored through referrals to community organizations and other resources.
- The new model wouldn't apply to higher-risk patients who may require more follow-up and potential referrals for subspecialist care.
"Average-risk patients' care can be streamlined around needed services known to improve pregnancy outcomes, but these visits may need to be longer," said Alex Peahl, co-author of the guidance and an assistant professor of obstetrics and gynecology at the University of Michigan.
- "This approach can significantly reduce travel time and burden for patients while maintaining clinician-facing time."
Catch up quick: The standard models of prenatal care delivery call for in-person visits every four weeks until the seventh month, followed by every two weeks until the eighth month, and weekly thereafter.
- The pandemic forced a reevaluation, ACOG said, and put more of an emphasis on in-home monitoring, telemedicine and more targeted visit schedules.
Reality check: The new guidance comes amid a maternal health crisis, in which nearly 6 million women live in areas with no or limited access to maternity care, per the March of Dimes.
- While tailored care has the potential to help reduce health inequities and disparities in care, ACOG noted certain communities may lack the resources and staffing to address patients' unmet needs.
- Some institutions may not have the necessary infrastructure for telemedicine visits, and patients in rural areas also may not have access to reliable broadband.
- The group added, "the current political climate might create barriers for institutions attempting to address structural and social determinants of health and racial health inequities."
