Prenatal and Intrapartum Care in Pregnancy Importance


This is a research paper that tries to give insight with regard to utilization of prenatal care (PNC) using PNC adequacy indices. These indices are Kessner and Kotelchuck which were developed to quantify outcomes associated full-term births. This paper has focused on the applicability of these indices in preterm births while trying to evaluate the outcome of preterm birth associated with inadequate PNC.


The target population was women through whom, preterm births had occurred. Unfortunately, the method by which the researcher has obtained his sample size is not reliable. According to the article by Bloch, Dawley & Suplee, the researcher has used the sample size as given in a nested case-control study during the landmark study of Neonatal Brain Hemorrhage. This way errors associated with this previously used sample size have been brought down to this research study. However, it is apparent that purposive sampling has been used since it has only focused on viable respondents to provide the researcher with the relevant ifnormation. The study is interested in women who had endured preterm deliveries and were obtained from an ongoing cohort study in central New Jersey. The sample population consisted of 367 women, who were mothers to preterm infants (Bloch, Dawley & Suplee, 2009).

The researcher was keen enough to put some of the ethical considerations in mind. One ethical consideration is that the researcher has used nurses to collect data through records and interviews. This is a very important aspect of research so as to enhance privacy which is achieved when the nurses carry out the face-to-face interviews with the mothers. Anonymity is also prevalent in that information of specific women has not been disclosed. This is in accordance with confidentiality since information pertaining to the identification of the respondents has not been made available to everyone. This is very important as one of the ethical considerations of research is to make sure that privacy and confidentiality is observed (Burns & Grove, 2009).

The study is valid because it has applied evidence based practice. According to the study, hospital records have been supported by face to face interviews. This research uses valid and reliable data from a cohort study that is still in progress and aimed at evaluating outcomes among 1105 infants with low birth weight. These infants had been born in central New Jersey between the years 1984 and 1987. However, internal inconsistency prevailed where the sample size used, 367, was not in concordance with the proposed sample size, 484. Errors in this research are as result of irregularities associated with number of visits (Bloch, Dawley & Suplee, 2009).

Tables were prepared for analysis purpose and the premature gestation was considered to be less than 37weeks of pregnancy. Kappa statistic was utilized to determine concordance of indices for measuring the scores of prenatal adequacy in mothers who had preterm infants. Comparing every mother’s adequacy score in variation with the PNC index used was conducted through the use of McNemar chi-square (Bloch, Dawley & Suplee, 2009).

The Kessner Index revealed that 42.8% of the mothers had had sufficient prenatal care, 42.5 % had received prenatal care at intermediate intervals and 14.7% were regarded to have received inadequate prenatal care. The Kotelchuck Index revealed the following results: 27% had obtained adequate plus kind of prenatal care, 33% had received adequate prenatal care, 18% received intermediate prenatal care and 22% received inadequate prenatal care (Bloch, Dawley & Suplee, 2009).

A distinct difference was evident during classification of prenatal inadequacy as indicated by a p value less than 0.001. This is justified by the fact that women considered to have received inadequate prenatal care were 15.5 times more likely to prevail while using the Kotelchuck Index unlike while using the Kessner index.

There is uncertainty on how appointments are given by the nurses or other health practitioners. This research shows that there are irregularities in the number of prenatal visits by the mothers. Therefore nurses should give more insight on the definition of a prenatal care visit so that some visits are not locked. In addition, the results show a substantial rate for women who lack prenatal care. This information is very important to the burses so that they can have extensive outreach programmes to train the community on the importance of prenatal care.

According to the guidelines that support credible data collection methods and instruments, the researcher’s methods and instruments of data collection are valid and reliable. This can be explained by the researcher’s use of hospital records which are based on actual information derived from the patients who in this case is a respondent in the research study. The data and information gathered from this research is of very high quality. This is due to the fact that a nurse was used to collect data on behalf of the researcher. The nurse is better placed to carry out the interviews with the mothers. This is because the mothers trust and have confidence in the nurses since they are the ones who attend to their needs while at the hospital (Burns & Grove, 2009).

Information obtained from this study is very important for use in different sectors. This information is very important to policy makers so that they are able to plan ahead on how to distribute resources. However, due to lack of a clear and distinct index for determining prenatal care utilization, there are arising issues. The two indices used have showed significant differences in the inadequacy rate of prenatal care in mothers. This difference has a great effect on the allocation of health resources as it becomes difficult to project the health service to the population.


Irrespective of the index used, it is apparent that there is a significant number, of women who do not seek prenatal care. On the other hand, a clear index or method needs to be used so as to determine the utilization of prenatal care. This will ensure that there is uniformity of results.


Bloch, J. R., Dawley, K. & Suplee, P. D. (2009). Application of the Kessner and Kotelchuck Prenatal Care Adequacy Indices in a Preterm Birth Population. Journal of Public Health Nursing, 26, 449-459.

Burns, G. & Grove, S. K. (2009). The Practice of Nursing Research, appraisal, synthesis, and generation of evidence. (6th ed.). Arlington: University of Texas.