User:Scrabblehyper/sandbox

Overview
Across the nation, the number of women who are pregnant and incarcerated has been increasing. These women cannot choose their physician or even get into a car to go to the hospital where they will deliver to attend childbirth education classes. This wiki will introduce a new model of prenatal care in groups.

Prenatal Care
Prenatal care is a relatively new in health care. In the United States, Mrs.William Lowell Putnam, instituted a new program for the Boston Infant Social Service Department, that was offered to women who were enrolled in the home delivery service at the Lying-In Hospital in 1901. The program was so successful that an outpatient prenatal clinic was started there in 1911. The Maternity Center of America in New York City in 1907, provided care to women after the seventh month of pregnancy. By 1920, the program had expanded and provided home visits by nurses every two weeks to the seventh month and every week after until birth. Nurses educated women about hygiene, nutrition, exercise and infant care, and measured the blood pressure, examined the urine and listened to the fetal heart tones. A major push for prenatal care by physicians followed, and by 1929, physicians argued that they should manage prenatal care. Using the medical model, prenatal care began focusing on diagnosis and treatment of complications of pregnancy. And, as technology advanced, procedures or tests designed for high-risk pregnancies were incorporated into routine prenatal care without evidence to support their use, resulting in increased medical costs without improved perinatal outcomes. The current medical model of prenatal care recommends 14 visits, whether the mother is considered high risk or not.

Centering Pregnancy
Centering Pregnancy is a model of group prenatal care. Envisioned by nurse midwife Sharon Rising as a result of her experiences in a Minnesota prenatal clinic. Overwhelmed by educating multiple women on the same topics as she went from room to room, she thought about how easy it might be to educate a group of women who had similar concerns. This grew into a project that Rising wrote about in 1982 Over the next two decades the idea developed into a program that is a model for effort and cost effective prenatal care. In the early 1990's Rising began teaching others about her novel approach to prenatal care. Multiple site now exist where women experiencing uncomplicated pregnancies receive prenatal care in groups. One such group exists in Louisville, KY at a correctional facility.

Introduction to the Problem
A colleague who has a psych-mental health background was working with women behind bars and their daughters, in a program called Girl Scouts Behind Bars. She met with the mothers and their daughters and met with the mothers alone to deal with the issues surrounding being separated from their children. She asked me if I would come to a group, because "several of the women are pregnant, and they are asking questions I cannot answer", so I said yes. I arrived at the facility and accompanied her to the area where she met with the women. Several women was actually a group of 15 or more. For the next two hours I fielded questions about pregnancy, labor and delivery, and other topics they had questions about. I left with a chain around my heart because I learned from the women that there was no source of childbirth education for them at the facility.

Solution to the Problem
Earlier in the year I had attended an education program about Centering Pregnancy, a program that is the brainchild of another nurse midwife, Sharon Schindler Rising. The program is designed to empower women to choose health promoting behaviors. Research indicates that the group model of prenatal care increases pregnant women's satisfaction with their care. The model of care has been adopted by both nurse-midwife and physician practices. A variety of university medical centers have adopted the Centering model of prenatal care.

In the fall, 2003, after procuring a grant from the March of Dimes, I implemented a modified Centering Pregnancy program at the correctional facility. Student nurses accompanied me in this endeavor, and this site has become a stable clinical site for a community health setting for senior students over the past ten years. The Centering Pregnancy program was modified in a variety of ways to meet this special group of women's needs. I am not their primary care provider, they are cared for by a physician who visits once a week. There are also a number of differences that exist between the educational needs of pregnant women who are not incarcerated versus women who are. For example, incarcerated women relinquish their baby to their family or another caregiver on the day they are discharged from the hospital. For this reason, it is not necessary to discuss infant care. However, because incarcerated women are separated from their newborn it may place them at greater risk for postpartum depression.

Conclusion
Yesterday I visited the correctional facility for my last group. I am relinquishing this clinical to another capable, caring faculty member who assures me the care will continue. Needless to say, after going there three time a year for the past 10 years to provide the groups, it was a BITTER-sweet day in my life (more bitter than sweet :'(. I have learned so much from these women and have been blessed to work with them. It is a life experience I will treasure the rest of my life.

How to use WIKI if I were still teaching this course
This course requires a great deal of coordination because the students complete a project that is designed to meet the needs of the group with whom they are working. In the past, students have submitted pieces of the project and that makes it difficult to keep some sense of flow of the project. The year before last the students devised a postpartum instruction book for this special group of women, last year the students developed a pamphlet on postpartum depression. If the initial work for the project took place in a sandbox with all the students collaborating, I believe the project would develop more smoothly and then could be pasted into the format for the final project. This allows everyone to have access to the document as it develops.

This could also be done for the nursing research course. Students could begin the development of their evidence based project in the sandbox and I could go in and review the content and give feedback, much like I do with papers in the Dropbox. Just a bit of musing about how WIKI could be used.