Building a Community Collaborative Prenatal Education Model to Improve Birth Outcomes

Background:  Collective community-based efforts are needed to improve maternal and infant health outcomes. One strategy to improve health outcomes is to increase access to prenatal education. Although prenatal education programs have become more frequently used, systematic descriptions of community collaborative models are lacking.

Methods: A prenatal education curriculum was developed in with national partners in 1998, in English and Spanish versions. The standard program has since been used in 13 states and Puerto Rico serving more than 13,000 pregnant women. The program included six sessions facilitated by trained health educators. In 2010, the use of community collaboratives was added to the program and combined prenatal education and clinical prenatal care. The collaborative program was launched through partnerships with the state health department, county health departments, federally qualified health centers, private obstetric practices and hospitals in four counties with high birth disparities. The goal was to implement and evaluate the program while improving knowledge and health behaviors that promote healthy pregnancies among women at highest risk for poor birth outcomes. Program evaluation tools were developed in partnership with two universities and refined for improved outcome measurement. 

Results: Pre- and post-test survey (N=400) analysis demonstrated statistically significant change in identification of  signs/symptoms of preterm labor (49% to 85%), normal postpartum symptoms (50% to 73%), safe sleep practices (81% to 98%), smoking during pregnancy harm (68% to 89%), early prenatal care (51% to 66%) and baby brain development (81% to 95%).

Eighty four percent of participants rated their experience as excellent; 98% said that they learned new information. Preliminary birth outcome data (n=30) showed improvements including fewer preterm births (10% versus 11% in Kansas) and fewer low-birth weight babies (3% versus 7%).  One site increased breastfeeding initiation rates by 10% and lowered infant mortality from 10/1,000 live births to 8.3.

The study was able to implement and evaluate the community collaborative prenatal education program in diverse settings. The improvement in participants' knowledge and behaviors indicated this model is an effective strategy to promote prenatal and postpartum health and it improved birth outcomes. The collaborative program helped ensure improved outcomes for mothers and promoted collective action within communities to provide prenatal services to mothers with the highest need.

Conclusion: Implementing the community collaborative prenatal education model is a strategy to improve maternal and infant health outcomes.