Prenatal Care

A woman's childbirth care choices have a profound effect on her pregnancy and childbirth experience. Today, some pregnant women have three different options to choose from: obstetrical care and a hospital birth, a midwife-assisted birth in a hospital, and a midwife-assisted birth at an out-of-hospital birthing center. By using a combination of qualitative and quantitative methods, this volume examines how and why 200 women made their choices, how satisfied they were with the care they received, and the impact of their choices on the availability of options in the future. Although most women in the U.S. still choose an obstetrician and a hospital setting, the number of women who choose to be assisted by a Certified Nurse Midwife is growing with the result that this profession is acquiring new strength and jurisdiction over childbirth care.

Reed and his colleagues consider the health status of African-Americans and the medical care available to them. In their study, they clearly link the economic condition of black Americans to the care they receive. Indeed, the disadvantaged position in which most African-Americans are locked correlates to their level of illness and medical care deprivation. Drawing attention to the high percentage of adverse birth outcomes, increasing cancer rates, homicide trends and the special problem of Sickle Cell Anemia, the authors call for social and economic policy changes that will result in an adequate level of care. This important research brings new attention to not only the often noted issues of AIDS and substance abuse but to the "invisible epidemic," lead poisoning. The book is a call to national conscience.

Preface Medical Risks and Medical Beliefs Assessing the Medical Literature Important Issues for Older Women: Down's Syndrome, Infertility and More The Circumstances Surrounding Later-Life Pregnancy Past and Present Pregnancy for Older Women Appendixes: Studies of Advanced Maternal Age and Eight Pregnancy Outcomes, United States, 1917-January 1983; Percentage of Studies Falling into Each Rating Category According to Pregnancy Outcomes Studied and Findings Concerning the Effects of Advanced Maternal Age; Selected Medical Views Concerning Pregnancy at Advanced Maternal Age; Incidence of Down's Syndrome by Mother's Age: Four Samples; Selected Etiological Studies of Down's Syndrome References Index

This timely volume presents a rich picture of the lives of parents with young children in the U.S. Using the first national survey on parents with young children, a diverse group of scholars present new information about what parents do, the economic and social challenges they face, and the resources they use to improve their children's health and development. The analyses and insights provided by this book will be invaluable for policy makers as well as others involved in public health, social work, law, medicine, psychology, sociology, and child development.

Testing for genetic abnormalities has transformed pregnancy and motherhood, and the recent discoveries by the Human Genome Project affect us all. In this updated version of their important book with its new Afterword, the authors have incorporated the most recent prenatal testing information. Using their own research, the authors analyze the psycho-social and ethical implications of genetic testing. Among the issues discussed in the new Afterword are the spread of prenatal testing, the changing meanings of pregnancy, and the perils and promises of the Human Genome Project.

This report is one of five volumes providing detailed information on the QA Tools, RAND's comprehensive, clinically based system for assessing quality of care for children and adults. The QA Tools indicators encompass screening, diagnosis, treatment, and follow-up in 46 clinical areas and cover a variety of modes of providing care, including history, physical examination, laboratory study, medication, and other interventions and contacts. Development of each indicator was based on the ratings of a panel of experts in the relevant fields and on a focused review of the scientific literature, which is clearly documented for each clinical condition. This volume focuses on indicators for care of women. Each chapter summarizes the results of the literature review for a particular condition, provides RAND staff's recommended indicators, and lists the cited studies.

No single area of medicine promises more acrimonious and intense debate in the coming decades than the implications of new medical technologies on the maternal-fetal relationships. This is the only book to combine comprehensive coverage of the legal and social issues raised as a result of both emerging technologies for fetal intervention and increasing knowledge of fetal development. It examines such issues as the effects of maternal behavior on the fetus's health, hazards in the workplace, teenage pregnancy, and the use of therapeutic and diagnostic techniques. The volume also summarizes the legal/political context of policies regarding the mother's responsibility for the welfare of the fetus and describes the current status of these issues in public law.