Impact of prenatal care on postpartum child care

Background: Although prenatal care has come a long way to be regarded as a standard routine care in pregnancy since its formal organization in the early 20th century, with several modifications to its content, it is just of recent that considerable attention was drawn to questions about its effectiveness. This awareness has led to several evaluations of the impact of prenatal care. Initially, these assessments concentrated on the effect of prenatal care on the more traditional outcomes (birth weight, maternal mortality and morbidity, infant mortality and morbidity). While subsequent studies have included other outcomes (e.g. breastfeeding, childhood immunization, etc), there have been calls to continuously expand the outcomes assessed in the evaluation of the effectiveness of prenatal care, especially its impact on the postpartum period. This present study was prompted by these present requests. The study therefore aimed at examining the impact of prenatal care on the postpartum practices of mothers, with special regards to care of the newborn. Aim of study: The aim of this study was to investigate the impact of prenatal care on postpartum child care and to identify the sources of information about prenatal available to mothers. Materials and Methods: After the implementation of a prenatal care intervention in 1999 in 20 townships in a rural Chinese setting (10 in the intervention group and 10 in control group), a sample of 1479 women who had given birth within a space of one year were randomly included in a KAP cross-sectional survey, which was carried out in 2001, 2002, and 2003. This survey gathered information on issues related to pregnancy, child birth, and the postpartum. From this dataset, I utilized the Adequacy of Prenatal Care Utilization (APNCU)index to classify the mothers into the different levels of prenatal care utilization proposed by the index. Analyses were carried out to examine the impact of time of initiation to prenatal care and its adequate utilization on mothers’ postpartum child care. Outcome measures included: breastfeeding, introduction of complementary foods, child sleeping place, infant sleeping position, childhood immunization, and maternal work after delivery. Parity and maternal age were treated as potential confounder in studying the relationship between prenatal care and the outcome measures. Results: After adjusting for parity and maternal age, the results show that prenatal care played varying impacts on the outcomes assessed: breastfeeding, cereal/porridge, and meat were significantly, positively impacted, while milk formula was negatively impacted. Child sleeping place, child sleeping position, and maternal work after delivery were not impacted by prenatal care. In addition, the health care system was the most important source of prenatal care information available to mothers. Discussions and Conclusion: On the whole, while both early start of prenatal care and its adequate utilization could largely predict uptake of recommendations on breastfeeding and introduction of complementary foods, they have no effect on mothers’ patterns of introduction of milk formula, pattern of care of child sleep and time of start of maternal work after delivery. Although most outcomes examined in this study have not been previously included in prenatal care evaluations, the results in most cases differ from studies that have taken similar assessment. Therefore, as a result of these mix-findings in prenatal care evaluations by consistent use of cross-sectional surveys, a longitudinal study will be more appropriately recommended, since a randomized controlled trial (i.e. denying group of women use of prenatal care services) will be unethical. It also follows that including all known confounding and explanatory variables in analyses will help minimize the issue of selection. Key Words: prenatal care, breastfeeding, postpartum child care, complementary/infant feeding, childhood immunization, maternal employmen