Prenatal Care in Israel: A Doctor – Nurse Dual Model

Background: Studies have shown significantly lower risk of complications during labor following prenatal care, allowing early detection, promoting normal pregnancy and birth. In May 2013 Maccabi Health Services launched “prenatal personal care” a dual gynecologist and nurse follow up model. Our goals were to Preserve and promote physical and mental condition of pregnant women and conduct early identification of high risk situations and intervention. Methods: The model is based on periodic visits provided by 150 designated nurses and 200 gynecologists working in collaboration. The follow up consists of 4-6 visits through pregnancy period. Additional visits provided according to woman’s health state. The intervention includes information on recommended tests, abnormal conditions, preliminary screening for depression during pregnancy (Edinburgh questionnaire) and counseling. Various communication services such as Facebook, email, phone, app and personal meetings are available. The model maintains interfaces with other health care providers such as dieticians, pelvic floor physical therapists, social workers and others. A designated computerized record was developed allowing generate and transparent follow up. Results: Prenatal care was given to 22% of pregnant women. 58% of them were vaccinated for pertussis compared to 22% in standard care. Depression screening found 0.4% positive answers to tendency for suicide, 11.5% were suspected for depression. In addition, 85.6% performed GCT test versus 74.3% with standard care. Conclusion: The model contributes to higher health outcomes and higher satisfaction among doctors, nurses and pregnant women. The service will be expanded to telehealth prenatal care allowing broader availability and accessibility for service nationwide. 1Women’s health coordinator, Maccabi Healthcare Services, Israel 2Director of Gynecology, Maccabi Healthcare Services, Israel 3Director of women’s Health Center, Maccabi Healthcare Services, Israel 4Director of public health department, Maccabi Healthcare Services, Israel 5Director of the Nursing Department, Maccabi Healthcare Services, Israel 6Head of North District, Maccabi Healthcare Services, Israel *Corresponding author Odelia Keshev, Women’s health coordinator, Maccabi health care organization, Israel, E-mail: [email protected] Submitted: 31 Oct 2016; Accepted: 04 Dec 2016; Published: 08 Dec 2016 Background Pregnancy is characterized by physiological and psychological changes. Prenatal care allows early detection of health problems that may occur during this period thereby increasing the chances of normal pregnancy and birth of a healthy newborn. Prenatal care is a key preventive health service used in developed countries around the world. By providing expectant mothers with regular health evaluations and information about the course of the pregnancy, labor, birth, and parenthood, prenatal care aims to reduce the risk of unfavorable pregnancy and birth outcome [1]. Studies have shown that the risk of complications during labor and birth outcomes were significantly lower among women who were followed by prenatal care coordination compared to those who were under medical supervision only [2]. In the U.S., the American College of Obstetricians and Gynecologists (ACOG) recommends a uniform prenatal visit schedule comprised of approximately 14 visits: every four weeks up to 28-32 weeks of gestation, then every two weeks up to 36 weeks, and finally weekly until birth [3].