MCH Nurse Home Visitation: One solution to access to 1st trimester prenatal care in a rural Virginia setting

Background/issues: Obstetrical care in rural Virginia is limited. To better care for impoverished women, one rural health district wished to understand barriers to prenatal care and local delivery.

Description: Vital statistics were analyzed for delivery location and prenatal care by month, care source, and payment method. Providers, PHNs, and patients were interviewed to understand barriers to prenatal care and local delivery.

Lessons learned: Private source of care and private insurance method of payment were both significantly related to the timing of first prenatal visit. In this rural setting, financial requirements, referral patterns, and lack of case management result in late entry to prenatal care for the most vulnerable rural mothers: those without private providers or private insurance.

Implications/recommendations: 21% of district mothers do not initiate prenatal care in the 1^st trimester, a significant number in terms of Healthy People 2020 and Rural Healthy People goals to improve rural maternity. Several policy solutions could improve access, including early pregnancy identification; “marketing” maternity services to women in poverty; adequate resources for indigent care clinics; funding PHN case management positions and expansion of nurse home visiting to accommodate the predicted volume of at-risk mothers. Women in poverty are the target population for both nurse home visiting programs and the Health Department. If the preceding recommendations have the effect of enlarging the Health Department client base, expansion of nurse home visiting and maternity case management services may be necessary and desirable outcomes for women and for public health.