Objective
The purpose of this study was to evaluate the office-based component of delayed entry into prenatal care.
Study Design
Phone numbers for all obstetrics offices in a single state were obtained from a commercial list. A research assistant who posed as a newly pregnant, fully insured woman asked each clinic when she should come in for her first prenatal visit.
Results
Information was provided by 239 of the 279 (86%) offices. The recommended appointment times ranged from immediately (4 weeks of gestation) to 10.6 weeks, which averaged 6.37 weeks. Twenty-five percent of clinics recommended a first appointment at ≥8 weeks. Scheduling calls were not a source of prenatal advice: <5% of clinics asked about smoking, alcohol, or medical condition; 88% of clinics did not mention vitamins.
Conclusion
Office-based delays in scheduling the first prenatal visit occur in a substantial proportion of clinics, even for fully insured women. There is a need for a standard source of advice in early pregnancy.
Delayed entry into prenatal care has been associated with adverse outcomes for both mother and baby. Of women who have delayed prenatal care or no prenatal care, more than one-half would have preferred to begin their care earlier. The top reasons for the delay include not recognizing the pregnancy, financial reasons, and inability to get an appointment. With regard to the latter reason, no study has examined appointment availability systematically.
For Editors’ Commentary, see Table of Contents
See related editorial, page 192
See Journal Club, page 288
A woman’s first prenatal visit typically includes a variety of health care messages. Advice includes use of folic acid, abstinence from alcohol, and avoidance of teratogenic medications. These measures have their maximal effectiveness if adopted early in pregnancy when the spinal cord and organs are still forming. Delays in receiving prenatal care reduce the potential effectiveness of these messages.
Some pregnant women may already have all pertinent health information before the first prenatal visit because of discussions with peers, advice during previous pregnancies, or information available in the lay media. However, studies have shown that such knowledge is not universal among pregnant women. Information may also be provided over the phone at the time the prenatal visit is scheduled, but it is not known if this is done commonly.
The goal of the current study was to assess the office-based component of delay in obtaining prenatal care. A secondary goal was to assess the advice that is given to a pregnant woman when she schedules the appointment, especially if the appointment was delayed for office-based reasons.
Materials and Methods
A list of phone numbers for all obstetrics offices in a single state was obtained through a commercial directory service ( physiciandatabases.com ). To maintain anonymity, counties with only 1 listed obstetrics office phone number were excluded. There were 279 valid phone numbers provided for obstetrics offices that delivered prenatal care. Of these, 21 offices could not be reached after repeated attempts; 6 offices did not have appointment scheduling available; 2 offices were not accepting new patients; 8 offices were included under another phone number (duplicates); 1 office did not accept self-referrals; 1 office did not accept the insurance product, and 1 office was closed permanently. Thus, 239 of the 279 obstetrics offices (86%) were included in the telephone survey.
A research assistant posed as a woman whose regular period was 2 days late and who had a positive urine pregnancy test. She asked when she should come to the office for her first prenatal visit. She did not volunteer additional information but responded to questions if asked. If asked, she stated that she had Blue Cross insurance and that she was married, 29 years old, had never been pregnant, and had no health problems. The date of her last period was stated as exactly 4 weeks before the call. The research assistant did not actually make an appointment; she portrayed herself as seeking information about when an appointment should be made. Phone calls took approximately 1 minute each.
All data were recorded anonymously without phone numbers or office names, although the county in which the office was located was recorded. Thus, it was not possible to relate the results back to an individual office. The study was determined to be exempt by the institutional review board. Gestational age was calculated from the last menstrual period. Comparisons for continuous data were done with the unpaired t test and linear regression. The χ 2 test was used for categoric data.
Results
Appointment times that were recommended by the clinics ranged from immediately (4 weeks of gestation) to 10.6 weeks of gestation, with an average of 6.37 weeks. Fifty-one percent of clinics recommended an appointment at <6 weeks of gestation; 66% of the clinics recommended an appointment at <7 weeks of gestation, and 75% of the clinics recommended an appointment at <8 weeks of gestation ( Figure ). For clinics that recommended a visit time after 6 weeks (n = 118), the caller asked if she could be seen earlier. Only 1 of the clinics offered an earlier appointment.
