A Hospital-Based, Healthy Pregnancy Promotion Program to Empower the Socially at Risk: The Healthy Beginnings Program


Paper Presentation

Purpose for the Program

The Healthy Beginnings Program provides education, support, counseling, and a link to community resources to socially high-risk pregnant women who will give birth at Saint Joseph Medical Center. The purpose is to encourage a healthy lifestyle for every mother, so she will give birth to a full-term, healthy newborn.

Eligibility includes the following: Medicaid patient; limited finances; uninsured; single or without social support; teen; domestic violence; and drug/alcohol use.

Proposed Change

A registered nurse meets privately with the patient (four 1-hour visits) and encourages her to write goals and attend childbirth and breastfeeding classes. Participants also are offered incentives, such as free books, maternity clothes, infant clothes, a breast pump, food vouchers, and a car seat. The following are topics covered in the program: Maternal/fetal growth and development, preterm labor, urinary tract infection prevention, nutrition, benefits of breastfeeding, seat belt use, smoking and secondhand smoke, healthy relationships, sudden infant death prevention, shaken baby syndrome awareness, and infant care and car seat usage.

Implementation, Outcomes, and Evaluation

The Healthy Beginnings Program was established in 1996 and has enrolled between 100 patients and 172 patients annually. The annual operating budget for the Healthy Beginnings Program is approximately $35,000 per year. The average cost per participant in 2012 was $203. Statistics, such as birth weight, birth length, number of neonatal intensive care days, gestational age, and hospital costs, are compiled and compared with those of infants whose mothers are not in the program, but who are similar demographically.

The comparative outcomes show that enrolled women tend to have infants that are slightly larger and slightly longer than nonparticipants who come from a similar client base. The most remarkable facts are the number of days spent in the neonatal intensive care unit and the gestational age. Year after year, program participants have healthier infants that are closer to term than nonparticipants. In 2009, 8.8% of program participants gave birth to infants at 37 weeks of gestation or less. Comparatively, out of the women who qualified for the program but did not partake 15.2% gave birth to infants at 37 weeks of gestation or less.

Implications for Nursing Practice

Caring for the socially high-risk pregnant patient and her infant is an ongoing nursing challenge because of the short hospitalization period at delivery. By establishing a rapport with families prenatally, the transition of a healthy mother and newborn from the hospital to the home is much easier and often times seamless, which saves both nursing time and energy.