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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Re: The process of prenatal care
The process of prenatal care
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Ian M Bennett, Philadelphia, USA Assistant Professor, University of Pennsylvania
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Thanks for the positive reaction. I was surprised that there was not a relationship between care utilization and literacy. In care for chronic illnesses there is such a relationship and adults with low literacy participate in care much less. I had been thinking of prenatal care as analagous to care for diabetes, asthma, etc but our study has made me rethink that model. One of the important findings is that most of these women, low or higher literacy, had less prenatal care than is generally recomended. Of course our current model of care doesn't seem to provide much benefit for reducing preterm birth (the WHO recommends three prenatal visits), so many of those visits are probably unnecessary from the point of view of preterm birth anyway. I agree with you though that it is very nice, and perhaps important, to develop a relationship with women through prenatal care and build trust as well. Some of the other tantalizing suggestions from our focus groups included an apparent difference in the reasons that women with low literacy don't go to prenatal care as compared to women with higher literacy. We are following up on the finding but I think that trust is a bigger issue for women with low literacy. More to come. Ian Bennett Competing interests: None declared |
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Randall L Longenecker, Bellefontaine, Ohio, USA Family Physician, Rural Program Director
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This is a fascinating study and an excellent example of the potential for trans-disciplinary research and integrated research methods (mixing both quantitative and qualitative methods to more appropriately explore complex phenomena)! More than that, it is congruent with my personal experience. I am not at all surprised that literacy is not related to the initiation or quantity of prenatal visits. Perhaps the positive outcomes that have been associated in the past with participation in prenatal care are more a proxy for the quality of the relationship between doctor and patient than a direct result of our prenatal message. Perhaps inconsistent results across studies are more a function of the caregiver than the recipient of care. An ardent advocate for process as much as content in obstetrical care, I like to describe good prenatal care as an effective conversation, a time to build trust among participants in the ritual of childbirth. After all, it is the woman herself who provides her child with prenatal care; we are more than anything her guide, her coach, and an honored guest. This article certainly seems to support what our colleagues in midwifery have long asserted, that learning to be “with women” before as well as during and following birth is a valuable skill and an invaluable stance. The authors also demonstrate excellent parallel process – “breakin’ it down” for readers, many of whom may not be literate or familiar with qualitative methods. Competing interests: None declared |
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