Experiences with Prenatal Care Among Women in a Philadelphia Homeless Shelter

  • Montida Fleming Sidney Kimmel Medical College at Thomas Jefferson University
  • Caitlin Callaghan Sidney Kimmel Medical School at Thomas Jeffferson University
  • Alexandra Strauss Sidney Kimmel Medical College at Thomas Jefferson University
  • Rickie Brawer Sidney Kimmel Medical College at Thomas Jefferson University
  • James Plumb Sidney Kimmel Medical College at Thomas Jefferson University

Abstract

Abstract
Prenatal care for the underserved is a national concern, especially amongst homeless women likely to experience barriers to care during pregnancy such as transportation and insurance issues, lack of a support system, and lack of education on the importance of prenatal care. Inadequate prenatal care confers increased risk for gestational complications and unfavorable postnatal outcomes, including prematurity and low birth weight. Yet while many studies delineate the prevalence and health consequences of inconsistent prenatal care in the homeless and underserved, few explore the women’s experiences or identify perceived needs within this population.

The researchers explored both positive and negative experiences with prenatal care and pregnancy among Philadelphia’s pregnant homeless women with the intention of designing effective interventions to increase the consistency and improve the quality of care despite perceived barriers. Study participants were recruited from Philadelphia’s primary intake shelter for women and children, and were individually interviewed about their pregnancies and prenatal care experiences. Interviews were digitally recorded, transcribed, and reviewed for thematic elements. Nine women were interviewed in total.

Self-identified barriers to consistent prenatal care included issues with insurance, lack of transportation to appointments, and negative experiences with prenatal care during previous pregnancies. While some women who had received prenatal care reported rewarding relationships with their prenatal care providers, many expressed a need for education in regards to exercise, diet, and stress-reducing practices for expecting and breastfeeding mothers. Women also demonstrated interest in support groups, parenting classes, and therapy sessions as venues to share their stories with, and learn from, others. These insights inspired several initiatives at JeffHOPE, Jefferson’s medical student-run free clinic at Eliza Shirley, including designing educational materials and classes, and providing family therapy sessions.

Author Biographies

Montida Fleming, Sidney Kimmel Medical College at Thomas Jefferson University

Third Year  Medical Student

 Department of Family Medicine

Center for Urban Health

Caitlin Callaghan, Sidney Kimmel Medical School at Thomas Jeffferson University

Third Year  Medical Student

Department of Family Medicine

Center for Urban Health

Alexandra Strauss, Sidney Kimmel Medical College at Thomas Jefferson University

Third Year  Medical Student

 Department of Family Medicine

Center for Urban Health

Rickie Brawer, Sidney Kimmel Medical College at Thomas Jefferson University

 PhD, MPH

Center for Ubran Health

Family and Community Mediicne

James Plumb, Sidney Kimmel Medical College at Thomas Jefferson University

MD

Center for Ubran Health

Family and Community Mediicne

References

References

National Coalition for the Homeless. How Many People Experience Homelessness? 2007. Available at: http://www.nationalhomeless.org/publications/facts/How_Many.pdf. Accessed August 10, 2014.

Bloom, K.C., Bednarzyk, M.S., Devitt, D. L., Renault, R. A., Teaman, V., & Van Loock, D. M. Barriers to Prenatal Care for Homeless Pregnant Women. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2004: 33(4): 428-435.

Little, M., Shah, R., Vermeulen, M. J., Gorman, A., Dzendoletas, D., & Ray, J. G. Adverse perinatal outcomes associated with homelessness and substance use in pregnancy. Canadian Medical Association Journal. 2005:173(6): 615-618.

Phillippi, J. C. Women’s Perceptions of Access to Prenatal Care in the United States: A Literature Review. Journal of Midwifery & Women’s Health. 2009: 54(3): 219-225.

Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., et al. Group Prenatal Care and Perinatal Outcomes. Obstetrics & Gynecology. 2007: 110(2, part 1): 330-339.

Homeless Prenatal Program. Prenatal and Parenting Support. 2014. Available at: http://www.homelessprenatal.org/services/parenting. Accessed August 10, 2014.

Published
2017-07-15
Section
Research