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Evidence-Based PracticePrenatal care is recognized as important for helping to prevent complications in the mother and newborn. Yet some women have not hadprenatal care at the time of delivery. Friedman, Heneghan, and Rosenthal studied a group of 211 such women to determine theircharacteristics and reasons for their lack of care. The reasons fell into six groups:1. Substance Use DisordersThirty percent of the women had substance use problems. All were multiparas and most were older than age 30, unemployed, and had notcompleted high school. Some element of denial was seen in 28% of these women. Fear of losing custody or the child and legal prosecutionwere major issues.2. Pregnancy DenialThis group of women (29%) had no substance use disorders but experienced denial of the pregnancy. They were either completelyunaware they were pregnant or were aware but made no preparation and behaved as though they were not pregnant. Women who wereyounger than age 18 years and those who were students composed 25% of the group. Most had completed high school and many wereemployed. Pregnancy had occurred previously for 75% of the group.3. Financial Problems
Eighteen percent of the women did not seek prenatal care because they had no insurance, had difficulty finding childcare, and did not wantto take time off from work. Most were older than age 18 years, had not completed high school, and had previous pregnancies. The majoritywere unemployed.4. Concealment of PregnancyWomen who concealed the pregnancy (9%) were hiding it from parents, other family members, or friends. Another reason for concealmentwas fear of disapproval of their plan to place the infant for adoption. Most of the women were students and younger than age 29 years, with40% less than 18 years.5. MultiparityThis group of women (6%) did not seek prenatal care because they did not think it was necessary for this pregnancy. Although theirgeneral characteristics were similar to the group with financial problems, this group often had significant additional life stress.6. Other/Unknown ReasonsEight percent of the women had reasons that did not fit the categories, or the reasons were unknown.Each of the women in the study was counseled regarding the importance of prenatal care for a future pregnancy and was referred to socialservices for help. The authors emphasized the need for identifying women who have not sought prenatal care and helping overcomedifficulties that may be the cause.Have you seen women who have not had prenatal care in your clinical practice?What were reasons for their lack of prenatal care?How would you counsel the women in each group?Barriers to Prenatal care for TeensEarly and continuous access to prenatal care and childbirth education are key factors in ensuring healthy outcomes for both mother andinfant. Adolescents who are pregnant can be vulnerable to barriers to early prenatal care due to developmental needs, financial dependency,and unfinished formal education. Children born to teen mothers have higher rates of poverty, health problems and abuse and neglect.