Bearing fruit -- how a public/private partnership to provide prenatal care is making a difference for south Georgia migrant farm workers

Because of the temperate climate, the southernmost counties in Georgia's Southwest Public Health District are major hubs for agriculture and attract large numbers of migrant farm workers. This population is largely undocumented Hispanics and is not eligible for Medicaid, resulting in a significant financial barrier, which impedes access to care. To improve prenatal care access for Hispanic farm workers, the Southwest Public Health District, along with a local private hospital, began a CenteringPregnancy® program at the Ellenton Farm Worker Clinic. CenteringPregnancy®, an evidenced-based group model of prenatal care, was initiated in August 2011 with funding from March of Dimes and in-kind support from the Ellenton Clinic and hospital. Prenatal care is provided by a certified nurse midwife employed by the hospital-based ob/gyn practice, with public health's ob/gyn medical director serving as back-up. The program has a five-county service area. Since its inception, 104 pregnant patients have been admitted. Nearly all are Hispanic, with a mean maternal age of 27. The majority (51%) has less than an 8th grade education and 67% are married. The mean gestational age at the initial visit is 14 weeks and 77% received four or more prenatal visits before transferring to the partnering ob/gyn practice at 36 weeks. Nearly three out of four centering patients initiated breastfeeding; 6.3% had low birth weight infants; 9.4 % had preterm births; and 64% delivered vaginally. These data compare favorably with Georgia's 2011 Southwest Public Health District's Hispanic low birth rate of 7.6% and preterm birth rate of 13.8%.