What are the new models of prenatal care?

The new prenatal care models currently implemented in the country have essentially shifted from the past "disease-centered" assembly line prenatal care to "pregnant mother and family-centered" personalized care. Several models with high clinical recognition have already been implemented in maternal and child health hospitals in many provinces and cities.

In the past, pregnant mothers' prenatal check-ups were more like rushing to check in on an assembly line. Each time they registered, they might meet a different doctor. After they had just mentioned that their first baby had a history of postpartum hemorrhage, they would have to repeat it all over again when they change doctors next time. Many people complained that they were like a "walking checklist." Nowadays, the continuous midwifery care model promoted by many maternal and child hospitals has solved this problem. Sister Lin, a second-pregnant mother I met during the city's maternal and child matching project, had a traditional prenatal check-up process for her first child. Every time she saw the doctor, she had to go through the medical history again. Her blood sugar was high in the third trimester, and no one systematically explained how to adjust her diet. The tear during the final delivery was much more serious than expected. Few, when the second pregnancy was established, the hospital just launched a new model. From the establishment of the 12-week registration to the birth, the whole process was connected with a fixed three-person midwifery team. If I usually had a headache, brain fever, or abnormal fetal movement, I could ask via WeChat. I even taught my husband one-on-one in advance how to accompany the childbirth and how to practice the Lamaze breathing method. In the end, the tearing degree of the natural birth was more than one degree lighter than that of the first child, and the recovery was very fast. Of course, this model is not completely uncontroversial. At present, only leading maternal and child health hospitals in first- and second-tier cities can roll it out. After all, each pregnant mother must be assigned a fixed midwifery team, which requires too high a staffing requirement. Many midwives in grassroots hospitals are already busy and cannot spare manpower for long-term docking. ； A few pregnant mothers also reported that they were too familiar with the midwives and were embarrassed to talk about private issues such as depression and sexual intercourse needs during pregnancy. Instead, they lost the sense of security brought by the distance of unfamiliar medical care.

Many small and medium-sized hospitals cannot implement such a high-cost model, so they focus on online channels and use the Internet + home-based prenatal care. There is no need to go to the hospital for any minor problems. Online first, you can find a dedicated nursing staff for evaluation. You need to go to the hospital to make an appointment. You can also make appointments with nurses to measure fetal heart rate, blood sugar, and perineal care. This can really save a lot of unnecessary trips. A while ago, I met a pregnant mother who lived in a suburban county. Her feet were so swollen that she couldn't even put on shoes during her 32nd week of pregnancy. She had to go back and forth to the hospital for more than two hours. After making an appointment for home care, the nurse came to her home to measure her blood pressure and urine protein, which ruled out the risk of preeclampsia. She also taught her step by step how to use elastic stockings and how to raise her legs while sleeping to relieve edema, which saved her a lot of trouble. This model is also very controversial. After all, online assessment cannot be palpated. In the past two years, a pregnant mother complained online about a dull pain in her lower abdomen. The customer service mistakenly thought it was normal uterine contractions and did not prompt for timely consultation. In the end, it was found to be an extreme case of ruptured ectopic pregnancy. Now the industry is also constantly tightening the boundaries of online services. It has clarified that more than a dozen indications such as vaginal bleeding, severe abdominal pain, and disappearance of fetal movement must be seen offline immediately, and such consultations are not allowed online.

Some hospitals also use small-scale group management. Pregnant mothers with a gestational age difference of no more than 2 weeks are gathered into a small group of less than 15 people. They do everything from prenatal check-up knowledge, nutritional guidance during pregnancy, to maternal yoga, mindfulness psychological intervention, and even birth companionship training and postpartum care training for expectant fathers. I met a post-95s pregnant mother who had a history of miscarriage. She cried every day when she first set up her profile, fearing that something would happen again this time. After joining the group, I found that there were three other mothers who had the same experience. Everyone shared their experiences with each other, and a full-time psychiatrist provided regular group counseling. The mood during the entire pregnancy was much more stable, and the final vaginal delivery was particularly smooth. Of course, some people complain that this kind of group can easily become a "rumor distribution center". There are always mothers who hear rumors about "eating goose eggs to eliminate fetal toxins" and "high-risk Tang screening does not need to be performed", which in turn aggravates anxiety. Nowadays, regular hospital groups will have at least one full-time medical staff stationed there to refute false information as soon as they see false information. They will also regularly organize the most frequently asked questions into popular science content.

In fact, in the final analysis, these new models have no absolute advantages or disadvantages. They are essentially designed to adapt to the needs of different pregnant mothers. For those who live far away, it is more convenient to choose home care, and for those who are prone to anxiety, group or continuous care is more suitable. There will definitely be more new models in the future. The core is to make pregnant mothers more comfortable and secure throughout their pregnancy.