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Benefits of a comprehensive, publicly funded prenatal care and obstetrics program.

OBJECTIVE
To demonstrate the effectiveness of a comprehensive, multispecialty, interdisciplinary team approach to prenatal and obstetric care for previously medically underserved patients.


STUDY DESIGN
A retrospective chart review analysis was performed on a total of 1,800 charts pertaining to 600 patients divided evenly between a publicly funded, comprehensive prenatal care program and that same institution's private faculty practice. For each of the 600 patients data were extracted from prenatal, intrapartum and postpartum records. Data were analyzed using Fisher's exact test, the chi2 test and the Mann-Whitney test. In addition, for certain parameters, the data from the publicly funded program were compared to national data.


RESULTS
In the publicly funded group, more patients initiated prenatal care at a later date (p < 0.0001), had a significantly higher rate of illegal substance use (p < 0.0007), utilized home care services more frequently (p < 0.0001) and averaged a somewhat longer hospital stay for mother and neonate (p < 0.0019, p < 0.0001, respectively). However, there was no significant difference between the 2 groups or between the publicly funded group and the national averages for most antepartum, intrapartum and postpartum complications or for maternal or fetal morbidity or mortality. The publicly funded group averaged a higher rate of breast-feeding.


CONCLUSION
Despite belonging to a higher risk population, there were no statistically significant differences in maternal or neonatal outcomes between the publicly funded group and the private faculty practice group or between the publicly funded group and national data. This suggests that a comprehensive, multispecialty, interdisciplinary team approach to prenatal and obstetric care is an effective program to provide to patients who have previously been medically underserved.