Delivering maternity services to women at risk for poor pregnancy outcomes: Comparing different service delivery models in Washington D.C

Research Aim: This research compares three different models of organizing and delivering maternity services to pregnant, low-income, African American women in Washington D.C. The research is an initial investigation into how different models of care may be more efficient, appropriate, and cost-effective for a population that exhibits worse birth outcomes than their white and Hispanic counterparts. Research Design: This paper draws on data from a comparative case study of a resident obstetrics clinic at a large city hospital, a birth center operated by nurse-midwives, and a prenatal care service at a safety net clinic staffed by both an obstetrician and a nurse-midwife. Research methodologies include in-depth interviews with providers and facility executive directors, focus groups with women receiving prenatal care, and observations of prenatal care visits. Birth and service cost statistics supplement these methods. Study Population: Each of the three facilities represents a single unit of analysis, or case, but data collection focuses on low-income, African American women who have medically ‘low risk' pregnancies. Findings: Findings show there are similarities and differences between the three models of maternity care – in terms of the content of care, how care is delivered, and women's perception of the services. The research sheds light on: some of the barriers to good birth outcomes in the city; components of each model that appear to successfully address these barriers; and the challenges related to these efforts.