Home care shows no effect on preterm deliveries
But don’t count prenatal visits out
While private duty home care providers try to promote the benefits of prenatal home care, a study shows that home visits don’t affect preterm delivery or low birth weight.
Researchers of the study1, published in the Aug. 27 issue of the Journal of the American Medical Association, also found that home visitation had no effect on children’s immunization rates, mental development, or behavioral problems; or mothers’ education and employment.
Other benefits from visits
The study, however, did find that women receiving home visitation had fewer health care encounters for childhood injuries, fewer subsequent pregnancies, and fewer cases of pregnancy-related hypertension. (For more information on how home visitation affects postpartum health, see p. 130.)
One provider says the study’s findings do ot reflect her experience in the field or as a clinical manager. "I find the results surprising," says Tammy White, RN, BSN, branch director, Olsten Health Services in Hickory Hills, IL. Although the study seems to be saying that the visits were not beneficial, she says, "any type of early intervention, whether it be in the home or in the clinic, is going to be beneficial for the patient."
The study evaluated 1,139 mothers in the Memphis area. The participants were at less than 29 weeks’ gestation and had no previous live births. They also had at least two sociodemographic risk characteristics, such as being unmarried, having less than 12 years of education, or being unemployed.
Nurses made an average of seven home visits during pregnancy and an average of 26 visits from birth to the children’s second birthdays.
Researchers should not automatically assume from the study that home visitation does not have substantial benefits, White adds. The demographics of people participating in the study play a key role, she says, and changing them might change the results, too.
Researchers from the study agree. "Although one might consider dropping the prenatal phase of the program from the intervention in light of its failures to produce substantial prenatal and newborn effects in one current trial, this would be injudicious," they write in JAMA. "We have only limited insight into the extent to which the salutary postnatal effects are dependent on the prenatal initiation of the service. This issue deserves careful examination as the program is studied with new populations and in new contexts."
Reference
1. Kitzman H, Olds DL, Henderson Jr., CR, et al. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. JAMA 1997; 278:644-652.
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