March 13, 2012 -- It’s a disturbing trend. Babies in America are being born too soon. As of 2006, the preterm rate for all live births in the US increased more than 30 percent, from 9.4 percent to 12.8 percent, according to the Centers for Disease Control and Prevention. While that trend has leveled out in more recent years, the U.S. preterm rate still rates poorer than that of many other countries, and remains below the levels here of just a few years ago.
Oregon tends to fare better than the rest of the nation, but there are still pockets where more work needs to be done to avoid slipping deeper into outcomes that are costly in terms of both health and finances.
“Preterm birth is a huge issue not only because of the potential for infant death and the risk to the mom, but there is also a huge cost in the care for and the lifetime health issues of the smaller babies,” says Michele Megregian, NMNP.
Since early November 2011, Megregian and Sally Hersh, CNM, MSN, nurse-midwives at the Oregon Health & Science University Center for Women’s Health, also have been seeing patients at Neighborhood Health Center–Beaverton, 17175 SW Tualatin Valley Highway, Suite B2, Aloha. Trained in all aspects of women’s primary care, nurse-midwives help address one of the contributing factors of preterm birth: inadequate prenatal care.
Disparity between access to primary care and OB-GYN and the demand for it in the surrounding community is the reason why the Neighborhood Health Center and its nurse-midwives are located where they are.
Additionally, both nurse-midwives at the clinic are bilingual in Spanish. In Oregon and across the country, the rate of first-trimester prenatal care is worse for Hispanic women than for any other group. According to the March of Dimes, that disparity is attributable in part to Hispanic women being three times as likely as non-Hispanic white women to be uninsured.
The Neighborhood Health Centers provide care regardless of insurance status, which helps address the prenatal care need for uninsured women. And getting prenatal care early can make the difference for a healthy pregnancy.
“Your first prenatal visit should be your pre-conception visit,” Megregian says. “We should be talking about lifestyle changes that you can make before you even get pregnant, so that you are at your optimal health when you become pregnant. But at the very least, we should see you before 10 weeks of pregnancy.”
Starting early not only helps with the medical and educational needs, it also helps establish a relationship that’s important throughout pregnancy and delivery.
“Prenatal care is a conversation with women about what’s happening in their life, and how she’s eating, how her weight is, what her stress level is, how her relationship is with her partner, how she’s working,” Megregian says. “You have to look as the person as a whole. You find solutions in partnership with the woman. You can’t do that really well if you don’t have a relationship with them.”
At the Beaverton clinic, which still has room to grow, nurse-midwives devote a full hour for a new patient’s first prenatal visit, and 30 minutes for return visits.
Megregian also likes to assure patients that although she is not a medical doctor, she can provide prenatal care safely for even mothers with high-risk pregnancies.
“Even if she is out of my scope of practice in terms of her medical complexity, through OHSU we have relationships with maternal-fetal medicine and OB-GYNs,” she says. “We can be the bridge in communication and access for people. And that’s an important role for people, especially for a community health center like this, when the larger institution can be intimidating.”
