Running head: PRENATAL CARE BY FIRST-TIME MOTHERS 1

Prenatal Care by First-Time Mothers

Lydia Anderson

Brigham Young University Idaho

Nursing 433C Section 01

Linda Orchard

June 23, 2017

PRENATAL CARE BY FIRST-TIME MOTHERS 2

Prenatal Care by First-Time Mothers

Part 1: Defining The Population

The Health Issue

Maternal, infant, and childhood health are some objectives Healthy People 2020 (2017)

strive to improve. It is stated that a [mothers] well-being determines the health of the next

generation (Healthy People, 2017a). Primary care physicians provide the means for first-time

mothers to maintain their well-being and establish a foundation for their future infants health.

According to the CDC (2015), Madison County ranks poorly in access to primary care providers,

which indicates a poor health status for this community. This lack of primary care providers

includes a lack of accessible OB/GYN practitioners. This presents an obstacle for accomplishing

the Health People 2020 objectives previously mentioned. Along with the shortage of primary

care providers, the Eastern Idaho Public Health Department (2010) does not provide prenatal

care services. Maternal care during pregnancy is an issue among the Madison County

community. In this community with limited access to health care providers, primary

preventative care during pregnancy needs to be a focus among first-time mothers of Madison

County.

The Population

Women whose firstborn child is under the age of 12 months or are pregnant for the first

time will be the assessed population. These women must be between the ages of 19 and 30 years

and either attend Brigham Young University Idaho (BYU-Idaho) or have a spouse who attends

this school. Key informants useful to this assessment are mothers or pregnant women in the

community of Rexburg, Idaho. There are not many boundaries that separate this population from
PRENATAL CARE BY FIRST-TIME MOTHERS 3

another one, but those who will be assessed must live in Madison County. Their socioeconomic

status, culture, and ethnicity may vary.

The Purpose

Assessing this particular population will generate data about the type and amount of

information reaching these first-time mothers and what more can be done to ensure adequate

prenatal care. This data could potentially support the need for improved education for the future

mothers of this community. The County Health Rankings and Roadmaps (2017) claimed 5% of

the Madison County population to be of low birthweight. Although this is under the listed 6% of

the United States population, reducing this number would greatly impact this communitys

future health. With the success of improving prenatal care among mothers, the health of infants

will also be improved as primary preventative care is being performed on these mothers.

Resources

To gather existing data about prenatal care in this community, the Community Health

Status Indicators from the CDC (2015), County Health Rankings and Roadmaps (2017),

Community Health Needs Assessment (n.d.), and Healthy People 2020 (2017a) will be used.

The webpages of the various womens clinics located in Rexburg will be also be consulted to

learn what is offered to the community. Along with these webpages, key informants will be

interviewed to generate new data, which include the aforementioned women.

Part 2: Assessment

Demographics

The Community Health Needs Assessment (CHNA, n.d.) was accessed to gather local,

state, and national data about population demographics for the years 2011-2015, as shown in the

following tables.
PRENATAL CARE BY FIRST-TIME MOTHERS 4

Population by Gender
Percent
Report Area Male Female Male Percent Female
Madison County, ID 19,077 18,839 50.31% 49.69%
Idaho 810,464 806,083 50.14% 49.86%
United States 155,734,280 160,780,741 49.20% 50.80%

Population by Age Group

Age 18-24 Age 25-34 Age 18-24 Age 25-34
Report Area Population Population Percent Percent
Madison County ID 12,040 6,006 31.75% 15.84%
Idaho 156,153 212,383 9.66% 13.14%
United States 31,368,674 42881649 9.91% 13.55%

Not all age groups are included, but those pertaining the population of interest are listed.

Ages 18-24 years is the most populated age group in Madison County with the 25-34-year age

group as the third most populated in Madison County.

The following tables show on-campus student enrollment at BYU-Idaho during the

Spring Semesters of 2015 and 2017 according to their Academic Office (BYU-Idaho, 2017).
BYU-Idaho April 2015-July 2015 Enrollment
Total On-
campus
Campus Attendence Age 18-24 Age 25-30 Married Female Enrollment
Count 11,281 2,092 3,478 6,956 13,742
Percent 82% 15% 25% 51%

BYU-Idaho April 2017-July 2017 Enrollment

Total On-
campus
Campus Attendence Age 18-24 Age 25-30 Married Female Enrollment
Count 15,632 2,753 5,016 9,659 18,844
Percent 83% 15% 27% 51%
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According to BYU-Idaho (2017), the majority of students enrolled on-campus are

females between the ages 18 and 30 years. Almost 30 percent of students are married, increasing

the possibility of pregnant women in this community.

Population in Poverty
Report Area Total Population Population in Poverty Percent Population in Poverty
Madison County, ID 37,112 13,232 35.65%
Idaho 1,584,410 245,177 15.47%
United States 308,619,550 47,749,043 15.47%

The previous table shows the percentage of the local, state, and national population living

in poverty between the years 2011 and 2015 according to the Community Needs Health

Assessment (CNHS, n.d.). The following figure shows the distribution of Madison Countys

population in poverty during the aforementioned years.

The following table and map show the population of people in Madison County who live

at or below 200% of the Federal Poverty Line (FLP), also gathered from the Community Needs

Health Assessment (CNHA, n.d.).

Population with Percent Population with
Income at or Below Income at or Below 200%
Report Area Total Population 200% FPL FPL
Madison County, ID 37,112 22,686 61.13%
Idaho 1,584,410 616,210 38.89%
United States 308,619,550 105,726,604 34.26%
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Government Agency Information

Healthy People 2020 (2017b) has set a target goal for infants younger than 12 months to

have a death rate less than 6.0 per 1,000 live births by the year 2020. In 2014, the rate of infant

deaths of whom the mothers were between the ages of 20-24 years was 6.8 per 1,000 and 5.5 per

1,000 was the rate among 25-29-year-old mothers (Healthy People, 2017b). Data also showed a

correlation between very low birthweight, less than 1,500 grams, and infant deaths (Healthy

People, 2017b). In Madison County, the infant mortality rate was 4 per 1,000 live births between

2007 and 2013, which is under the target for the year 2020 (County Health Rankings &

Roadmaps, 2017). According to this same source, the percentage of live births with a

birthweight less than 2,500 grams was 5% between 2008 and 2014. This is below the low

birthweight target goal of 7.8% (Healthy People, 2017b).

PRENATAL CARE BY FIRST-TIME MOTHERS 7

Clinical Care Data

The following tables show data from the Community Health Needs Assessment (CHNA,

n.d) about prenatal care and primary care provider access in Madison County, Idaho, and the

United States.
Lack of Prenatal Care
Mothers
Starting Mothers with Percentage
Prenantal Late or No Mothers with
Area of Care in First Prenatal Prenatal Care Late or No
Interest Total Births Timester Care Not Reported Prenatal Care
Madison
County, ID No data No data No data No data Suppressed
Idaho 97,103 68,371 27,291 1,441 28.10%
United
States 16,693,978 7,349,554 2,880,098 6,464,326 17.30%
Access to Primary Care Physicians
Primary Care Physicians,
Total Population, Primary Care Rate per 100,000
Report Area 2014 Physicians, 2014 Population
Madison County,
ID 38,038 24 63.09
Idaho 1,634,464 1,153 70.5
United States 318,857,056 297,871 87.8
PRENATAL CARE BY FIRST-TIME MOTHERS 8

Further data from 2016 has been collected by the United Health Foundation (2017) which

shows a rate of 93.7 providers per 100,000 people in Idaho while the national rate is 145.3

physicians per 100,000 citizens.

An assessment of six womens clinics was accomplished through analyzing each of their

websites. They include Madison Womens Clinic, Rexburg Medical Clinic, Complete Family

Care, Teton Medical Group, Grand Peaks Medical, and Seasons Medical. Both Madison

Womens Clinic and Seasons Medical provided information on their website about what mothers

would expect from each doctors visit and how often they would need to make appointments.

The other four clinics only listed that prenatal care was available, but would require either a visit

or a phone call to elicit further information.

PRENATAL CARE BY FIRST-TIME MOTHERS 9

Windshield Survey

An observation through the city of Rexburg, Idaho was completed to assess the density

and location of clinics available to pregnant women.

Map of Rexburg with the red dots representing the six clinics
PRENATAL CARE BY FIRST-TIME MOTHERS 10

Seasons Medical

Teton Medical Group

PRENATAL CARE BY FIRST-TIME MOTHERS 11

Rexburg Medical Clinic

Madison Womens Clinic

PRENATAL CARE BY FIRST-TIME MOTHERS 12

Complete Family Care

Grand Peaks Medical

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Billboards for Seasons Medical and Madison Womens Clinic

Interviews
Three women who fit the criteria volunteered to participate and answer questions during

an interview. The following questions were asked:

1. How old are you?

2. How many weeks pregnant are you or how old is your baby?

3. Are you or your spouse a student at BYU-I?

4. When did you seek prenatal care?

5. What type of prenatal care did you receive?

6. How did you know what care to get?

7. Where was the physicians office you attended?

PRENATAL CARE BY FIRST-TIME MOTHERS 14

8. How did you find out about your doctor?

9. Explain your thoughts about healthcare accessibility.

10. What were your feelings when you found out you were pregnant?

Woman As responses:

1. 27 years

2. Infant is 8 months.

3. Yes, my husband is a student.

4. Around 12 weeks pregnant.

5. I saw a midwife.

6. I did my own research along with resources my provider gave me.

7. Its called Rosemark and its attached to Mountain View Hospital in Idaho Falls.

8. I had friends refer places. I was going to stay in Rexburg, but the hospital wouldnt let

me tour the facility. I felt more comfortable with Mountain View Hospital, especially

with this being my first child. They did their best to refer me, when needed, to specialists

in Rexburg.

9. I felt healthcare during pregnancy was easily accessible. I was still on my parents

private insurance so that covered most of the costs.

10. I wasnt expecting to get pregnant so quickly, so I guess I was a little nervous.

Woman Bs responses:

1. 24 years

2. 18 weeks pregnant

3. Yes, both of us are students.

PRENATAL CARE BY FIRST-TIME MOTHERS 15

4. The office told me to come in when I was 9 weeks pregnant. I went to a midwife when I

thought I was 8 weeks pregnant, but I was really 12 weeks pregnant.

5. So far, I have had a doppler ultrasound and one other ultrasound done. I take prenatal

vitamins along with folic acid.

6. I talked with my family and did my own research online.

7. Seasons Medical in Rexburg

8. I went by local referrals. I chose a midwife to try out the experience of a natural birth.

9. I think it has been easy to access healthcare and Seasons Medical staff know what they

are doing. My parents private insurance covers most of the medical costs, but I also

have pregnancy Medicaid to cover the rest. Filling out paperwork for that took less than

a day to finish.

10. My initial thought was that we ruined our lives. The thought of becoming pregnant was

exciting, but when it actually happened I was so stressed. Finding out what I needed to

do from my first doctors appointment decreased my anxiety.

Woman Cs responses:

1. 23 years

2. Infant is 2 months.

3. Yes, we both are students.

4. At the beginning of my pregnancy. My husband and I had been trying to get pregnant for

a year so I had already been going to Madison Womens clinic for that.

5. I had ultrasounds done and took prenatal vitamins. I saw a midwife, an OB/GYN, and a

Nurse Practitioner.

6. I researched online during the year prior to getting pregnant.

PRENATAL CARE BY FIRST-TIME MOTHERS 16

7. Madison Womens Clinic in Rexburg.

8. Madison Womens was the only one I had heard of and seen advertisements for.

9. I think healthcare was fairly easy to access during my pregnancy. I was on the schools

insurance and added the pregnancy Medicaid on top of that to fully cover the costs.

10. Since I had been trying for a long time, I was excited and not anxious about being

pregnant. My mom was a good support person to talk to.

Part 3: Data Interpretation

Student Growth and Population

It is clear that the student population of BYU-Idaho has grown since the spring of 2015

by about 37% of an increase. The percentage of married students, females, and ages 18 to 30 has

stayed relatively the same, meaning that an increase in their numbers must have occurred.

The graph from the United Health Foundation (2017) proves Idaho to have a rate of

physicians per 100,000 under the national rate, making access to primary care providers, as well

as OB/GYNs difficult. Madison Countys rate of physicians per 100,000 people is even lower

than the states number. With a growing population, this problem will only get worse and

contribute to poor health outcomes of the community. No data were found for just Madison

County, but Idahos percentage of late or no prenatal care is higher than the national rate, which

is a possible result of the limited primary care provider access across the state.

Fortunately, the current infant mortality rate and low-birthweight rate are below the

national average, but without an increase in physician access in Madison County, the community

is at risk for increasing these rates.

It is shown by the Community Health Needs Assessment (CHNA, n.d.) that the age group

of interest, 18 to 30 years, is the largest age group that makes up Madison Countys total
PRENATAL CARE BY FIRST-TIME MOTHERS 17

population. It is this age range that is common for first-time moms to exist, making OB/GYNs

highly important for this county.

Poverty

Madison Countys poverty rate is higher than both the state and the nation at 35.65% of

the population living at or under the poverty line. A map provides a visual of where these people

in poverty reside within the county. Rexburg is in the area where more than 20% of the 35.65%

in poverty live. Data about people who live at or below 200% of the FPL were also gathered and

showed the majority of this population to reside the city of Rexburg. This brings a challenge to

the population of interest to obtain healthcare, let alone prenatal care. Medicaid or Medicaid

Pregnancy Programs are available, but some people may not be aware of their eligibility or some

may be just above the qualifying income to receive these benefits.

Womens Centers

Searching online and around town provided a prospective from what women see when

seeking prenatal care in Rexburg, Idaho. The various websites of Seasons Medical Center,

Madison Womens Clinic, Grand Peaks Medical, Complete Family Care, Rexburg Medical

Clinic, and Teton Medical Group are possible resources found by first-time moms researching

available physician offices. All sites listed the option of prenatal care being provided at each

office, but only Seasons Medical and Madison Womens Clinic explained thoroughly what

would be expected at each visit and when to first come in for prenatal care.

As data was gathered from driving around town, it was shown that, again, only Seasons

Medical and Madison Womens Clinic were the only offices to clearly state their option of

womens health care, both on their building signs as well as on billboards. Seasons Medical is

located close to Main Street, making it easily seen with an aesthetic appearance. Both Madison
PRENATAL CARE BY FIRST-TIME MOTHERS 18

Womens Clinic and Complete Family Care are next to each other, hidden in a neighborhood,

but Madison Womens Clinic has an advertising billboard so women can know of its existence

easier. Grand Peaks Medical is combined with a dental office, so this may cause confusion about

those seeking prenatal care. Rexburg Medical clinic has a sign for a Foot and Ankle Center on

their building, so people may assume that is the only care they provide, when they actually have

OB/GYNs. Teton Medical Group does not appear as a womens center by looking at the outside,

but they do have a street sign labeled as a Family Practice, but this is difficult to see without

searching because it is blocked by bushes.

Each of these offices are located around Madison Memorial Hospital as well as near the

university. This is beneficial for the population of interest to have access close to where they

live.

Key Informants

The first woman interviewed to generate data chose to not see a physician in Rexburg,

but rather travel to Idaho Falls because she did not like the care available in Rexburg. She

wanted to feel comfortable with the care she received, especially with this being her first child.

This may put the woman at risk for not receiving adequate care if appointments were missed due

to travel troubles. The other two stayed in Rexburg with one attending Madison Womens Clinic

and the other going to Seasons Medical. Both women said they chose these offices based on

recommendations and these were the only places they had heard of. These women support what

was seen through internet searches and the windshield survey.

Woman C, who attended Madison Womens Clinic had been trying to get pregnant for a

while, so she already had a consistent provider before she needed prenatal care. In contrast to

Woman C receiving prenatal care at the beginning of her pregnancy, the other two women did
PRENATAL CARE BY FIRST-TIME MOTHERS 19

not see a provider until they were 12 weeks pregnant. Although 12 weeks is considered as the

first trimester, one of the women was told to come in at 9 weeks gestation. Waiting to seek

prenatal care puts the mom and fetus more at risk for complications.

All informants mentioned they did their own research on the internet and by asking

friends and family what to do and who to see. The internet may not always be a reliable source,

or, like mentioned before, may have limited information available for the reader.

The three interviewees had a source of insurance, whether it was the schools or parents,

but only two said they used Pregnancy Medicaid to cover expenses their other insurance did not

cover. This federal insurance is available to encourage women to seek prenatal care when they

cannot afford payment from their own income.

Despite the challenges presented to this population, they have a strength of being

educated or living with a spouse who is receiving an education. Being educated, regardless of

the area of study, provides individuals with the chance to strengthen their reading level. This

will improve their health literacy because of their ability to read higher levels of material.

Part 4: Population Health Plan

Improvement Areas

As shown from gathered and generated data, OB/GYNs and other primary care providers

are scarce in the city of Rexburg. Increasing the number of providers may be too complicated

for a nurse to implement, but improving awareness of the existing physicians may help counter

the limited access.

Recommendations

With the lack of providers, it would be great for more physicians to come to Rexburg and

either open a practice or join an existing one, but other options exist. As mentioned in Part 3,
PRENATAL CARE BY FIRST-TIME MOTHERS 20

some of the clinics in Rexburg do not easily appear to offer womens or prenatal care. It is

recommended that these offices add to or change their advertisements on their website as well as

on their buildings and signs. This may help women in the community become aware of the six

locations to receive prenatal care rather than the two that are advertised on billboards and on

their websites.

Informational booths or classes could be held on BYU-Idaho campus and run by

community health nurses. Materials could be provided about appropriate times to seek prenatal

care and the facilities in Rexburg that offer these services. Emails could be sent out to every

student, male and female, notifying them of this information. Males need to be included in case

their wife is not a student.

Evaluation of Effectiveness

The Centers of Disease Control and Prevention (2016) has joined with state departments

in a research project called PRAMS (Pregnancy Risk Assessment Monitoring System) to

determine reasons for healthy and unhealthy infants. Women who have recently given birth to a

live baby are randomly selected to complete a mailed survey asking questions regarding their

baby and pregnancy (CDC, 2016). Unfortunately, three states, those being Idaho, Ohio, and

California, are not currently participate in this program (CDC, 2017). If Idaho were to start

participating, data could be collected to evaluate various aspects of a womans pregnancy,

especially details about when and what prenatal care was accessed. This would allow state

agencies to evaluate the effectiveness of changes and improvements made for this population.

Reflection

After completing this project, I have realized the importance to some mothers of finding

the best OB/GYN for them and the struggle to achieve this goal. I plan on being a labor and
PRENATAL CARE BY FIRST-TIME MOTHERS 21

delivery nurse who works closely with these primary care providers within the community in

which I reside. As I apply the knowledge gained from this experience, I can help others by being

a source of information about the various womens clinics in town.

Performing a community assessment has taught me the importance of knowing what

problems exist among the population. Being aware of what is out in the community will allow

me to implement possible plans to improve lives of at-risk individuals, such as first-time

mothers.

I believe as nurses who work closely with the various providers in the community, we

may not realize the lack of available information to members of that same community. Nurses

have access to provider information, including their names and office of practice. In gathering

information about the womens clinics in Rexburg, I was only successful after viewing a list

found on the labor and delivery unit at the hospital. This changed my thought process from

assuming clients can easily find needed information to realizing I need to share this knowledge

with the public.

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References

BYU-Idaho. (2017). Official enrollment statistics for BYU-Idaho degree-seeking students.

Retrieved from http://www2.byui.edu/IR/stats/index.htm

CDC. (2016). About PRAMS. Retrieved from https://www.cdc.gov/prams/aboutprams.htm

CDC. (2017). Participating PRAMS states, territory and tribe. Retrieved from

https://www.cdc.gov/prams/states.htm

Community Health Needs Assessment. (n.d.). Health indicators report. Retrieved from

https://assessment.communitycommons.org/CHNA/report?page=3&reporttype=libraryC

HNA

Community Health Status Indicators. (2015). Madison County, ID. Retrieved from

https://wwwn.cdc.gov/CommunityHealth/profile/currentprofile/ID/Madison/

County Health Rankings and Roadmaps. (2017). Madison (MA). Retrieved from

http://www.countyhealthrankings.org/app/idaho/2017/rankings/madison/county/outcomes

/overall/snapshot

Eastern Idaho Public Health. (2010). Pregnancy services. Retrieved from

https://phd7.idaho.gov/FACHS/Pregnancy/pregnancyservices.html

Healthy People. (2017a). Maternal, infant, and child health. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-

health

Healthy People. (2017b). Maternal, infant, and child health. Retrieved from

https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Maternal-

Infant-and-Child-Health/data#May-2017
PRENATAL CARE BY FIRST-TIME MOTHERS 23

United Health Foundation. (2017). Primary care physicians. Retrieved from

http://www.americashealthrankings.org/explore/2016-annual-

report/measure/PCP/state/ID