Guidelines for Perinatal Care / Edition 8 available in Paperback
Guidelines for Perinatal Care / Edition 8
- ISBN-10:
- 1610020871
- ISBN-13:
- 9781610020879
- Pub. Date:
- 10/01/2017
- Publisher:
- American Academy of Pediatrics
- ISBN-10:
- 1610020871
- ISBN-13:
- 9781610020879
- Pub. Date:
- 10/01/2017
- Publisher:
- American Academy of Pediatrics
Guidelines for Perinatal Care / Edition 8
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Overview
- New section on suggested levels of maternal care from birth centers to Level IV institutions
- New sections on screening for preterm delivery risk added to chapter on antepartum care
- New topics covered include the timing of cord clamping, the need (or not) for bedrest, and updates in hypertension
- Guidance regarding postpartum contraception recommendations has been expanded
- New section on mosquito-borne illnesses (including Zika)
- New section on infections with high-risk infection control issues
- Updated recommendations on neonatal resuscitation, screening and management of hyperbilirubinemia, and neonatal drug withdrawal.
Product Details
| ISBN-13: | 9781610020879 |
|---|---|
| Publisher: | American Academy of Pediatrics |
| Publication date: | 10/01/2017 |
| Edition description: | New Edition |
| Pages: | 691 |
| Product dimensions: | 5.50(w) x 8.40(h) x 1.10(d) |
About the Author
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. The AAP is the largest pediatric publisher in the world, with a diverse list of resources that includes essential clinical and practice management titles and award-winning books for parents.
Read an Excerpt
CHAPTER 1
Organization of Perinatal Health Care
The organization of perinatal health care on a regional basis emerged as a model of health care delivery beginning in the 1970s and 1980s. Regional organization of perinatal care was endorsed in a 1976 report by the March of Dimes Foundation, Toward Improving the Outcome of Pregnancy, which was prepared by the Committee on Perinatal Health, an ad hoc committee of representatives appointed by participating professional organizations with support from the March of Dimes Foundation. The importance of regional organization was further emphasized in the second edition and third editions of Toward Improving the Outcome of Pregnancy, published in 1993 and 2010, respectively. Although a comprehensive, integrated perinatal care delivery system is optimal, this goal has not been attained in many areas of the country, where financial incentives promote competing systems and duplication of services.
Health Care Delivery System
A regionalized system of perinatal care with integrated delivery of services should address the care received by the woman before and during pregnancy, the management of labor and delivery, postpartum care, and neonatal care. A health care system that is responsive to the needs of families, and especially women, requires strategies to:
• ensure access to services
• identify risks early
• provide linkage to the appropriate level of care
• ensure adherence, continuity, and comprehensiveness of care
• promote efficient use of resources
Structural, financial, and cultural barriers to care need to be identified and eliminated. The regionalized organization and integration of perinatal care must evolve within the framework of the general health care delivery system while avoiding unnecessary duplication of services. A successful perinatal health care system has five essential responsibilities: 1) provide access to comprehensive perinatal health care services, 2) embrace a patient-centered and family-centered approach to health care, 3) deliver culturally and linguistically appropriate care, 4) educate the public about reproductive health, and 5) be accountable for all components of the health care delivery system.
Comprehensive Perinatal Health Care Services
The integration of a spectrum of clinical activities, basic care through subspecialty care, within one system or geographic region potentially provides timely access to care at the appropriate level for the entire population. Achieving the primary goal of providing the appropriate level of care is facilitated by early and ongoing risk assessment to prevent, recognize, and treat conditions associated with maternal and neonatal morbidity and mortality. A secondary goal is to improve referral and consultation among institutions that provide different levels of care. When populations that are in need of reproductive health care are widely dispersed, both geographically and economically, a carefully structured, well-organized system of supportive services becomes necessary to ensure access to appropriate care for all pregnant women and newborns. Networks and other forms of vertically integrated systems within a region should be structured to provide all the necessary services, including health care, transportation, public and professional education, research, and outcome evaluations with data organized in a standard format. All components are necessary to minimize perinatal mortality and morbidity while using resources efficiently and effectively.
Patient-Centered and Family-Centered Health Care <-61 <-149
The perinatal health care system should be oriented toward providing patient-centered and family-centered health care because the family often is the primary source of support for individuals receiving health services. The Institute for Patient- and Family-Centered Care importantly notes that the term family is defined by the patient, as is the degree to which the family is involved in care. The term "family" as it is used here includes the expectant woman and her support system, which may include any or all of the following individuals: a spouse or partner, relatives, and friends. Health care providers should strive to engage the family as co-providers and decision-making partners, as long as this is in accordance with the pregnant woman's personal situation, beliefs, and desires. Every encounter should build on the expectant woman's strengths, preserve her dignity, and enhance her confidence and competence. Such an approach incorporates family perspectives, offers real choices, and respects the decisions made by the family for themselves and their children. Hospital and program leaders should communicate the concepts of patient-centered and family-centered care consistently and clearly to staff, students, families, and communities through statements of vision, mission, and philosophy and through institutional policies and actions. Providing an environment that is supportive of the family's key role in promoting the health of its members is important in successful health promotion. This includes respecting the choices, values, and cultural backgrounds of expectant women, new mothers, and other family members; communicating honestly and openly; promoting opportunities for mutual support and information sharing; and collaborating in the development and evaluation of services.
Family-centered practices can help expectant families and new families become nurturing caregivers. Efforts should be made throughout the neonatal course to promote continuous contact between newborns and their families. Economic interests and decisions should never take priority over the best interests of the newborn infant, the woman, the family, and the community in keeping the family together. When separation of the family unit is necessitated by the requirement for a higher level of care for the woman or newborn infant, the responsibility for maintaining communication and involvement of the family in decisions relating to care should be shared by the entire health care team. Whenever medically feasible, a woman whose newborn infant has been transferred to another hospital should be discharged or transferred to the same facility. Staff interactions and unit policies at every level should consistently reinforce the importance of family for the health and well-being of their newborn infant. Families' strengths and capabilities should be the foundation on which to build competency and confidence in caregiving abilities. Preserving an individual sense of personal responsibility and identity is important for the optimum outcome of pregnancy and family life.
Culturally and Linguistically Appropriate Care
In addition to being family-centered, perinatal health care systems should be culturally and linguistically appropriate. Communication with patients can be improved and patient care enhanced if health care providers can bridge the divide between the culture of medicine and the beliefs and practices that make up patients' value systems. These may be based on ethnic heritage, nationality of family origin, age, religion, sexual orientation, disability, or socioeconomic status. Reaching out to community cultural leaders can be enormously beneficial in understanding cultural practices.
Large perinatal health disparities exist in racial and ethnic minority groups and in low-income level groups, compared with white and high-income level groups. The publication of National Standards for Culturally and Linguistically Appropriate Services in Health Care by the Office of Minority Health of the U.S. Department of Health and Human Services emphasizes the need to address these long-standing disparities through the implementation and evaluation of culturally sensitive and competent health care. These recommendations encourage the coordination of the U.S. Department of Health and Human Services agencies, along with other federal agencies, health care organizations, accreditation bodies, patient communities, and private sector organizations to ensure consistent training for health care providers; increase cultural diversity among health care professionals; and empower minority, vulnerable, and underserved patients to participate as equal partners in the health care process and system.
Education of the Public About Reproductive Health and Life Planning
Insight into the broad social and medical implications of pregnancy and awareness of reproductive risks, health-enhancing behaviors, and family-planning options are essential for improving the outcomes of pregnancy. Education about reproductive health, including reproductive life planning, must be integrated more effectively into the health care system and society at large. A recent report emphasizes that in the United States
• a little more than one half of pregnancies are planned and approximately one half of unintended pregnancies end in abortion.
• unintended pregnancies occur in all segments of society.
• a woman with an unintended pregnancy is less likely to seek early prenatal care and is more likely to expose the fetus to potentially harmful substances such as alcohol, tobacco, nonmedical use of drugs, and elevated glucose.
• a newborn of an unwanted pregnancy is at higher risk of having a low birth weight and other complications throughout childhood.
Because pregnancy intention and other behavioral health risks — including the use of alcohol, tobacco, and other drugs — occur across all socioeconomic groups, the target group for reproductive education must be all women of childbearing age. Reproductive health screening should be implemented by all health care providers serving women in their reproductive years (see also Chapter 5 and Chapter 6).
Every encounter with the health care system, including those involving adolescents and men, should be viewed as an opportunity to reinforce awareness of reproductive health issues and to encourage reproductive life planning. New messages and marketing techniques regarding responsible reproductive health practices may be helpful in changing attitudes and behaviors in women and men.
In communicating with the patient and the public, it is important to tailor health messages to the appropriate literacy and language level. Low functional literacy may compromise the quality of care received, contribute to medical errors and poor health outcomes, and increase the risk of medical liability litigation. This problem can be minimized by consistent use of simplified language on written documents, such as consent forms and patient instructions, and in face-to-face conversation.
Language and cultural barriers should be examined and addressed. For those who do not speak English, a family member should not be used as an interpreter, but rather efforts should be made to provide assistance, such as offering appropriately trained interpreters and written translations of forms and patient education materials. In some circumstances, federal and state laws and regulations impose responsibilities on health care providers to accommodate individuals with limited English proficiency. Appropriate measures for overcoming communication barriers will depend on the circumstances of the individual practice and patient population. Various options may be available, including hiring bilingual staff for clerical or medical positions, using appropriate community resources, or using translation telephone services.
Accountability
Accountability for actions is a fundamental principle of health care provision applicable to all components of a health care delivery system and is a valuable attribute of professional practice that benefits all patients. This accountability includes, but is not limited to, the care of individual patients by individual health care providers. Within the perinatal health care delivery system, accountability and responsibility must be required equally of all participants, including patients, families, perinatal health care programs and systems, government agencies, insurers, local communities, and health maintenance organizations, all of whose actions and policies influence the delivery of patient care and, thereby, influence outcomes. Accountability includes developing meaningful quality improvement programs, monitoring medical errors, and working to ensure patient safety. Access to high-quality care for all patients is a responsibility that requires a coordinated system with involvement, commitment, and accountability of all parties.
Clinical Components of Regionalized and Integrated Delivery of Perinatal Services
A regionalized system that focuses on integrated delivery of graded levels of hospital-based perinatal care has been shown to be effective and to result in improved outcomes for women and their newborns. Integrated perinatal care programs can be extended to encompass prepregnancy evaluation and early pregnancy risk assessment in both ambulatory and hospital-based settings.
Prepregnancy Care
Prepregnancy care aims to promote the health of women of reproductive age before pregnancy and improve pregnancy outcomes. Integrated perinatal health care programs and systems should place additional emphasis on prepregnancy care through educational programs. All women of childbearing age should have access to prepregnancy care and reproduction life planning. Health care providers in various disciplines (eg, internal medicine, family medicine, and pediatrics) should be made aware of prepregnancy care recommendations and guidelines. Clinical details of prepregnancy care for perinatal health care providers are presented in Chapter 5.
Ambulatory Prenatal Care
The goals for the coordination of ambulatory prenatal care are to provide appropriate care for all women, to ensure good use of available resources, and to improve the outcome of pregnancies. As recommended by the March of Dimes Foundation in the second edition of Toward Improving the Outcome of Pregnancy, prenatal care can be delivered more effectively and efficiently by defining the capabilities and expertise (basic, specialty, and subspecialty) of health care providers and ensuring that pregnant women receive risk-appropriate care (Table 1-1). Developments in maternal–fetal risk assessment and diagnosis, as well as the interventions to change behavior, make early and ongoing prenatal care an effective strategy to improve pregnancy outcomes (see also "Triage" in Chapter 7).
Early and ongoing risk assessment should be an integral component of perinatal care. Early identification of high-risk pregnancies allows prevention and treatment of conditions associated with maternal and fetal morbidity and mortality. Risk assessment facilitates development of a plan of care, including referral and consultation as appropriate, among health care providers of basic, specialty, and subspecialty prenatal care on the basis of the patient's circumstances and the capability of the individual health care providers.
The content and timing of prenatal care should be varied according to the needs and risk status of the woman and her fetus. Use of communitybased risk assessment tools, such as a standardized prenatal record (see also Appendix A), by all health care providers within a regionalized perinatal care system helps to ensure the integration of care delivery and appropriate implementation of risk assessment and intervention activities. All prenatal health care providers should be able to identify a full range of medical and psychosocial risks and either provide appropriate care or make appropriate referrals (see also Appendix B and Appendix C).
Prenatal care may involve the services of many types of health care providers, including the early involvement of pediatricians and neonatologists as well as other pediatric subspecialists (eg, cardiologists, surgeons, and geneticists). A consultation with a neonatologist and other appropriate specialists to discuss the pediatric implications with the woman and her partner is particularly important when fetal risks or problems have been identified (see also Chapter 7).
In-Hospital Perinatal Care
The conceptual framework of regionalization of perinatal care has focused almost entirely on the newborn. With 39% of hospital births in the United States occurring at hospitals that deliver fewer than 500 newborns each year and an additional 20% occurring at hospitals that deliver between 501 newborns and 1,000 newborns each year, it is likely that the majority of maternal care in the United States is provided at basic care and specialty care hospitals. This likelihood supports recent commentary that noted the need to readdress "perinatal levels of care" to focus specifically on maternal health conditions that warrant designation as high risk, and to define specific clinical and systems criteria to manage such conditions.
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Excerpted from "Guidelines For Perinatal Care"
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Copyright © 2017 American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.
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Table of Contents
Preface Introduction Chapter 1 Organization of Perinatal Health Care Chapter 2 Inpatient Perinatal Care Services Chapter 3 Quality Improvement and Patient Safety Chapter 4 Maternal and Neonatal Interhospital Transfer Chapter 5 Preconception Care Chapter 6 Antepartum Care Chapter 7 Intrapartum Care of the Mother Chapter 8 Postpartum Care of the Mother Chapter 9 Medical and Obstetric Complications Chapter 10 Care of the Newborn Chapter 11 Neonatal Complications and Management of High-Risk Infants Chapter 12 Perinatal Infections Chapter 13 Infection Control Appendixes A. American College of Obstetricians and Gynecologists’ Antepartum Record and Postpartum Form B. Early Pregnancy Risk Identification for Consultation C. Ongoing Pregnancy Risk Identification for Consultation D. Granting Obstetric Privileges E. Midwifery Glossary F. Standard Terminology for Reporting of Reproductive Health Statistics in the United States G. Federal Requirements for Patient Screening and Transfer H. American Academy of Pediatrics Policy Statements and American College of Obstetrician and Gynecologists Committee Opinions and Practice Bulletins I. Website Resources Index