PRENATALHEALTHEDUCATIONNEEDSOFMEDICALLYINDIGENT ANDUNDERINSUREDPREGNANTWOMEN

KaitlynMarieDresser,BSN SubmittedtotheSchoolofNursinginpartialfulfillmentofthe requirementsfortheNursingHonorsProgram

FacultyMentor:M.KathleenBrewerPhD,ARNP,BC UniversityofKansasSchoolofNursing

PrenatalHealthEducationNeeds

ABSTRACT
Educationisanimportantandintegralpartofprenatalhealthandplaysanimportantpart inreducingprenatalhealthdisparitiesamongvulnerablepopulations.Inanefforttoimprove healthoutcomesformothersandtheirinfants,nursesneedtodesignrelevantprenatalhealth educationprogramswhencaringformedicallyindigentandunderinsuredpregnantwomen. The purpose of this pilot study was to determine the prenatal educational needs of mediallyindigent and underinsured pregnant women to design appropriate health promotion programs. Women were asked to respond to questions related to their diet, exercise, use of medications,numberofpregnancies,theirreproductivehealth,anduseoftobaccoandalcohol.The information gained from this pilot study provides the framework necessary to develop relevant educationalprogramsandtoincreaseawarenessofhealthylifestylebehaviorsandtherebychange unhealthyprenatalbehaviorsforthispopulationofvulnerablewomen. The design of the study was a descriptive, crosssectional survey. All pregnant women receivingprenatalcareattheJayDocFreeHealthClinicwereinvitedtocompleteaPrenatalHealth Survey designed by the March of Dimes. The women were given the option of completing the survey in English or Spanish. Descriptive statistics were used to summarize the study results. A total of 15 pregnant women ranging in age from 17 years to 34 years (mean age 26 years) completedthesurvey.Themajorityofthewomen(n=12)completedthequestionnaireinSpanish. Themostsignificantresultsofthestudywere:(1)87%ofthewomen(n=13)reportedtheydidnot receive routine dental care and (2) 40% of the women (n = 6) reported they did not regularly exercise.

PrenatalHealthEducationNeeds Theresultsofthisstudyhaveimplicationsfornursescaringformedicallyindigentand underinsuredpregnantwomen.Whencaringforthispopulationofvulnerablewomen,itis importanttoassesstheirneedofdentalcare.Ifitisdeterminedthewomenareinneedofsuchcare, nursesneedtobeabletoprovideappropriateeducationabouttheimportanceofdentalhealthand dentalcareresources.

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INTRODUCTION
Communityhealthcentereducationalprogramsandservicesaredesignedtoprotect, promote,andpreservethehealthofallpopulations(Corrarino&Moos,2004).Communityhealth centersandclinicshavelongservedasplaceswheremembersofvulnerablepopulationsreceive healthcareandhealtheducation(Shi&Stevens,2007).Aparticularlyvulnerablepopulationthat frequentlyreceivescareinthecommunityismedicallyindigentandunderinsuredpregnant women.Prenatalhealtheducationshouldbeanintegralpartofprenatalcareasameansto improvetheperinataloutcomesforwomenandtheirinfants.Additionally,prenatalhealth educationisanimportantstrategyforreducingprenatalhealthdisparitiesforwomenwhoare membersofavulnerablepopulation(Vonderheid,Montgomery&Norr,2007).Toimprovethe efficacyofprenataleducationandcare,itisimportanttogaintheperspectiveofthepregnant womeninordertomeettheirprenataleducationalneeds(Nichols&Harris,2007). Educationisakeyaspectofnursingcareprovidedduringtheprenatalperiod.Appropriate educationmayresultinpositiveoutcomesforthemotherandherinfant.Theeducationalneedsof mothersvaryamongdifferentpopulationsreceivingcare.Itisimperativethatnursesprovidethe mostrelevant,uptodate,andculturallyappropriateandsensitiveeducationtothepopulation beingserved.Oneparticularpopulationthatseeksprenatalcareisthemedicallyindigentand underinsured.Theinformationprovidedbypatientsabouttheirprenatalhealtheducationneeds mayserveasaframeworktodesignaseriesofeducationalmessagesaimedtoincreaseawareness ofhealthylifestylebehaviorsanddecreaseunhealthybehaviorsformedicallyindigentandunder insuredpregnantwomen. Comparedwithmembersofthemajoritypopulation,pregnantwomenlivinginpovertyare facedwithmanysocialinequitiesthatplacethematriskforadversehealthoutcomes.Often,

PrenatalHealthEducationNeeds womenwhoaremembersofminoritygroupsandimpoverishedexperiencebarriersthatprevent themfromobtainingappropriateprenatalcareandeducation.(Enriquez,Farnan,Simpson, Grantello&Miles,2007).Additionally,womenoflowersocioeconomicstatustraditionallyhave beenconsideredathighriskforadversepregnancyoutcomes(Munro,1993)andgivingbirthto lowbirthweightinfants(Maloni,ChingYu&Cary,1996).Thus,improvingpregnancyoutcomesfor medicallyindigentandmedicallyunderinsuredwomenremainsamajorgoalofhealthproviders andpolicymakers(Gardner,Oliver,McNeal&Goldenberg,1996). PurposeoftheStudy Thepurposeofthispilotstudywastodeterminetheprenataleducationalneedsof medicallyindigentandunderinsuredpregnantwomenreceivingprenatalcareatacommunity healthfacility.Knowledgeofthelifestylebehaviorsofmedicallyindigentandunderinsured pregnantwomenwillprovidetheframeworkfordevelopingthemostappropriateeducational offeringstothiscohortofwomentherebyimprovingtheirmaternaloutcomes(York,Williams& Munro,1993).Wegainedinformationaboutthehealthbehaviorsofacohortofmedicallyindigent andunderservedpregnantwomenthatwillallowustodevelopappropriateeducationalprograms tomeettheirprenataleducationneeds. Apaucityofinformationexistsinthescientificliteraturethataddressestheeducational needsofvulnerablegroupsofpregnantwomenregardinghealthylifestylesbehaviors.The educationalneedsofmedicallyindigentandunderinsuredpregnantwomenhaveonlyminimally beenaddressedandremainamajorconcern.Inordertoachievehealthyoutcomesforboththe mothersandtheirinfants,educationalprogramsneedtobedesignedandofferedthatmost appropriatelymeettheirneeds.Aswithanyareaofpatientcare,itistheresponsibilityofthenurse toproviderelevanteducationaboutthehealthneedsoftheirpatients.Therefore,theprimaryfocus

PrenatalHealthEducationNeeds ofthisstudywastodeterminetheeducationalneedsofthisgroupofwomeninordertodesignthe mostrelevantandculturallyappropriateprogramstoachievehealthyoutcomesforthemothers andtheirinfants.Informationfromthisstudywilladdtothebodyofscientificandwillprovide nurseswiththemostuptodateinformationaboutthehealtheducationneedsofthisvulnerable population. Inclusioncriteriaforparticipatinginthestudywere(1)AbletoconverseinEnglishor Spanish,(2)AbletoreadinEnglishorSpanish,(3)Willingtogiveinformedconsent,and(4)First prenatalvisittoJayDocFreeClinic.Atnotimebefore,during,orafterthestudyprocesswerethe womenaskedabouttheirlegalorimmigrationstatus.Also,allstudyinstrumentswerecompleted anonymously.TheresearchersweregivenawaiverofwrittenconsentbytheIRBoftheirparent institution,thereforenonamesoridentifyinginformationwascollected.Completionofthesurvey servedasconsenttoparticipateinthestudy. ResearchQuestion Thispilotstudywasdesignedtoinvestigatethehealthbehaviorsofpregnantwomen receivingcareatacommunityhealthcenter.Assuch,theresearchquestionthattheinvestigators soughttoanswerwasWhataretheprenatalhealtheducationneedsofmedicallyindigentand underinsuredpregnantwomen? LiteratureReview Communitycenterhealthpromotioneducationalprogramsandservicesaredesignedto protect,promote,andpreservethehealthofthepopulation(Corrarino&Moos,2004).Community healthcentersandclinicshavelongservedasplaceswheremembersofvulnerablepopulations receivehealthcareandhealtheducation(Shi&Stevens,2007).Prenatalhealtheducationshould

PrenatalHealthEducationNeeds beanintegralpartofprenatalcareasameanstoimprovetheperinataloutcomesforthesewomen andtheirinfants(Vonderheid,Norr&Handler,2007).Additionally,prenatalhealtheducationisan importantstrategyforreducingprenatalhealthdisparitiesforwomenwhoaremembersofa vulnerablepopulation(Vonderheid,Montgomery&Norr,2003).Toachievehealthyoutcomes, pregnantwomenmustbeofferedrelevanthealtheducationandhealthpromotioninformation throughouttheirpregnancy(Risica&Phipps,2006theefficacyofAccordingtoFowles(2007), presentingeducationalofferingsatlocalcommunityhealthclinicsisauniqueapproachtoprovide healtheducationandpromotionwhencaringformembersofvulnerablepopulations.Prenatalcare shouldfocusonthelongtermwellbeingofwomenandtheirfamiliesandincludecomprehensive riskassessment,healthpromotiontoenhancehealthfulbehaviors,andinterventionstoprevent medicalandpsychosocialrisk(Vonderheid,Norr&Handler,2007).Thepositiveinfluenceof prenatalhealthpromotioncontentwasstrongestforwomenatcomparativelyhigherriskof adverseoutcomes,suchasadolescent,primiparas,andwomenhavinglowerincomestatus (Vonderheid,Norr&Handler,2007).Astudywithethniclowincomewomenreceivingprenatal carefoundthatreceivingprenatalhealthpromotionadvicewasassociatedwithhigherquality interpersonalcareandsatisfaction,animportantoutcomeandindicatorofthequalityofcare (Vonderheid,Norr&Handler,2007). Minoritywomenwillincreasinglyconstituteasignificantcomponentofthetarget populationinmaternitycare,andalargeproportionofthesewomenwillbeoflowincome,or indigent,andsubjecttothepooroutcomesofpregnancythatpovertyusuallyengenders(Esperat, Feng,Zhang&Owen,2007).Patienteducationisanessentialcomponentofprenatalcare(Risica& Phipps,2006).Prenatalcareserviceshavebeenshowntoaffectbirthoutcomeswhentheyimprove continuity,increasethedeliveryofotherservices,andmodifyhighriskmaternalbehaviors(Tiedje, 2004).Variablesidentifiedthatareassociatedwithpositivepregnancyexperiencesinclude

PrenatalHealthEducationNeeds demographicvariables,maritalsatisfaction,maternalfetalrelationship,prenatalchildbirth education,socialsupport,selfesteem,andselfconcept(Nichols,Roux&Harris,2007).Awayto worktowardeliminatinghealthdisparitiesistodevelophealthpromotioninterventionstailoredto underservedpopulations(Timmerman,2007).Forunderservedwomen,personalexperiences suchaspoverty,racism,immigration,inadequatehousing,familyturmoil,violence,andlackof accesstohealthcaremaycontributetostress,lowselfesteem,anddepression(Timmerman,2007). Underservedwomenwhoarechronicallystressedandwhomaysufferfromlowselfesteemor depressionmayfeelpowerlesstochangetheirbehavior(Timmerman,2007).

METHODS
Design Thedesignofthispilotstudyisadescriptive,crosssectionalsurveytoidentifylifestyle healthbehaviorsofpregnantwomenreceivingprenatalcare.Thedataobtainedfromthesurvey providesinformationregardingtheprevalence,distribution,andinformationaboutpeoples actions,knowledge,intentions,opinions,andattitudes.Thesurveyallowsfortheefficientcollection ofalargeamountofdatafromanumberofpeoplerelativelyquicklyandprovidesforanonymityof responses. TheMarchofDimes,theU.S.CentersforDiseaseControlandPrevention(CDC),and34 partnerorganizationsdevelopedascreeningquestionnaireaimedatidentifyingthelifestyle behaviorsofpregnantwomen.Thisinstrumentiswidelyusedbyhealthcareproviderscaringfor pregnantwomen.Determininglifestylebeliefsofthewomenwillprovidetheinformationnecessary todeveloprelevanteducationalprogramstomeettheprenatalhealtheducationneedsofmedically indigentandunderinsuredpregnantwomenreceivingprenatalcareatJayDocFreeClinic.

PrenatalHealthEducationNeeds DataCollection Thewomensdecisiontoparticipateinthestudywasstrictlyvoluntaryandtheyweretold thatiftheychosenottoparticipateinthestudy,theirdecisionwouldnotimpacttheprenatalcare thattheyreceivedataMidwesternfreehealthclinic.Thecompletionofthesurveyinstrument lastedabout15minutes.Thewomenweregiventheoptionofcompletingthestudyinstrumentsin eitherSpanishorEnglish Womenpresentingattheclinicfortheirfirstprenatalvisitwereapproachedbyamember oftheresearchteamandgivenaletterexplainingthestudyindetail(AppendixA).Thewomen whoagreedtoparticipateinthestudyweregivenaprivateroominwhichtocompletethestudy instrument.UsingthePrenatalHealthScreeningQuestionnaire,wesurveyedpregnantwomen receivingprenatalcareataMidwesternfreeclinic.Inadditiontothequestionsaskedonthe PrenatalHealthScreeningQuestionnaire,theresearcherscollecteddataabouttheage, race/ethnicity,numberofpregnancies,andnumberofchildrenofeachoftheparticipants.In addition,eachwomanreceivedanenvelopeinwhichtoreturntheircompletedsurveytothe researchers.Atnotimebefore,during,orafterthecompletionofthestudyinstrumentwerethey askedforpersonalidentificationorabouttheirimmigrationstatus. Analysis Descriptivestatisticswereusedtosummarizethesurveyresultsthatallowedusto organize,interpret,andcommunicatethenumericalinformation.Thismethodofdataanalysisalso allowedustosynthesizeanddescribethedatainthemostrelevantterms.Basedontheresponses oftheindividualsurveyitemsonthequestionnaire,wewereabletoteaseoutthoselifestyle behaviorsandpracticesthatwarrantedhealtheducationandhealthpromotionprograms.

PrenatalHealthEducationNeeds

.FINDINGSANDDISCUSSION
Atotalof15pregnantwomenranginginagefrom17yearsto34years,withameanage26 years,completedthesurvey.TwelveofthewomencompletedthequestionnaireinSpanishandthe remainingthreecompletedinEnglish.Eightoftheparticipantsselfidentifiedasbeing Hispanic/Latina,twoofthewomenselfidentifiedasCaucasianandfivedidnotrespondtothe question.Overall,thewomenindicatedtheywerepleasedwiththeirhealthstatusandhealth habits.Thirteenofthewomenstatedtheyatethreemealseachday,didnotfollowanyparticular dietorateundercookedmeat.Ofthesample,nineofthewomen(60%)reportedtakingfolicacid dailyandonlythreeofthewomenwereexposedtosecondhandsmoke.Themajorityofthewomen reportedbeingingoodreproductivehealth.Noneofthewomenhadahistoryofinfertility, problemswiththeirmenstrualcycleandonly3womenstatedtheyhadreceivedtreatmentfora sexuallytransmitteddisease.Ofsignificancewastheinformationreceivedfromthewomen regardingtheirdentalandoralcarehistories.Thirteenofthewomenreportedtheydidnotreceive routinedentalcareandsixreportedtheydidnotregularlyexercise.(SeeTable1andAppendixC). LimitationsoftheStudyImplicationsforImplicationsforNursing Whilethesamplesizeforthispilotstudywassmall,theresearcherswereabletocatcha glimpseoftheprenataleducationalneedsofmedicallyindigentandmedicallyunderinsured womenreceivingprenatalcareatacommunityhealthcenter.Whencaringforthispopulationof vulnerablewomen,itisimportanttoassesstheirneedofdentalcare.Oralhealtheducationshould beacomponentofholisticprenatalscreeningandcare.Whenitisdeterminedthewomenarein needofdentalcare,nursesneedtobeabletoprovideappropriateeducationabouttheimportance ofdentalhealthandequippedtoprovidethenecessarydentalresources.

PrenatalHealthEducationNeeds Recommendationsforfurtherresearchincludeidentifyingthebarriersexperiencedbythis groupofwomentoreceivingroutineoral/dentalcare.Alsoitwouldbebeneficialtoidentifyany culturalbeliefsorpracticesthatimpedethisgroupofwomenfromseekingroutineoral/dentalcare. Anotherstudycouldidentifythebeliefsabouttheimportanceofroutineexercise.

CONCLUSION
Improvingpregnancyoutcomesforminoritiesremainsamajorgoalofhealthprovidersand policymakersandnurses(Gardner,Cliver,McNeal&Goldenberg,1996).Thisstudywasundertaken toidentifytheprenatalhealtheducationneedsofacohortofmedicallyindigentandunderserved womenreceivingprenatalcareatacommunityhealthcenter.Theresultsofthisstudywillbeused todevelopculturallyappropriateandsensitiveeducationalofferingsregardingtheimportanceof regulardentalandoralhealthcare,especiallyforwomenduringtheirprenatalandsubsequent lactationtimes.Inaddition,duetothesmallsamplesize,thisstudywarrantsreplicationat additionalcommunityhealthcenters.

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REFERENCES
Carrarino,J.E.&Moos,M.K.(2004).Localhealthdepartments:Anunderrecognizedsourcefor womenathighriskforpretermbirth.AmericanJournalofMaternalChildNursing,29(6), 366372. Enriquez,M.,Farnan,R.,Simpson,K.,&Grantello,S.,&Miles,M.(2007).Pregnancy,poverty,and HIV.JournalofNursePractitioners,3(10).68793.Esperat,C.,Feng,D.,Zhang,Y.,&Owen,D. (2007).Healthbehaviorsoflowincomepregnantminoritywomen.WesternJournalof NursingResearch,29(3),284300. Fowles,E.R.(2007).Advancingthehealthofunderservedwomen.Family&CommunityHealth, January/March,553563. Fowles,E.R.(2007).Collaborativemethodologiesforadvancingthehealthofunderservedwomen. Family&CommunityHealth,30(1S),S53S63. Gardner,M.,Cliver,S.,McNeal,S.&Goldenberg,R.(1996).Ethnicityandsourcesofprenatalcare: Findingsfromanationalsurvey.Birth,23(2),8487. Maloni,J.,ChingYu,C.,&Cary,P.(1996).Transformingprenatalcare:Reflectionsonpastand presentwithimplicationsforthefuture.JournalofObstetric,Gynecologic,&Neonatal Nursing,25(1),1723. Nichols,M.,Roux,G.,&Harris,N.(2007).Primigravidandmultigravidwomen:Prenatal perspectives.JournalofPerinatalEducation,16(2),2132. Risica,P.M.&Phipps,M.G.(2006).Educationalpreferencesinaprenatalclinicpopulation. InternationalJournalofChildbirthEducation,21(4),47. Shi,L.&Stevens,G.D.(2002).Theroleofcommunityhealthcentersindeliveringprimarycareto theunderservedexperiencesoftheuninsuredandMedicaidinsured.TheJournalof AmbulatoryCareManagers,30(2),159170. Tiedje,L.B.(2004).Teachingismorethantelling:Educationaboutprematurityinaprenatalclinic waitingroom.TheAmericanJournalofMaternalChildNursing,29(6),373379. Timmerman,G.M.(2007).Addressingbarrierstohealthpromotioninunderservedwomen. Family&CommunityHealth,30(1S),S34S42. Vonderheid,S.C.,Norr,K.F.,&Handler,A.S.(2007).Prenatalhealthpromotioncontentandhealth behaviors.WesternJournalofNursingResearch,29(3),258276. York,R.,Williams,P.,&Hazard,B.(1993).Reducedriskoflowweightbirthsamongindigent womenreceivingcarefromnursemidwives.PublicHealthNursing,10(4),241244.

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APPENDIXA
DearParticipant: Asapregnantwoman,youareinvitedtoparticipateinaresearchstudyabouthealth

careprogramsforpregnantwomen.FacultyandstudentsattheKansasUniversitySchoolof Nursingwanttolearnhowbesttocareforpregnantwomen.Wewouldliketoaskyousome questionsaboutyourcurrenthealthandlifestylehabits.Bygaininginformationaboutyourcurrent healthandlifestylehabitswewillbeabletodevelopprogramstomeetyourhealtheducational needs. Weareaskingyoutocompleteananonymoussurvey:wewillnotaskyouyourname.Itwill takeapproximatelytenminutestocomplete.Wewouldlikeyoutocompletetheattachedsurvey andthenplaceitinthedesignatedbox.Evenifyoushoulddecidenottoanswerourquestions,you willstillreceivecareattheFamilyHealthServicesclinic. Ifyouhaveanyquestions,youmaycontactmeatkbrewer@kumc.eduorKaitlynDresser atkdresser@kumc.eduThankyousomuchforyourtime.Also,thankyouforconsidering participationinourstudy. Sincerely, Dr.M.KathleenBrewer AssociateProfessor KaitlynDresser,SN

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APPENDIXB PRENATAL QUESTIONNAIRE

Age:

Race/Ethnicity:_________________________________

ReproducedwithpermissionfromtheNationalMarchofDimesOrganization,August,2007.

PrenatalHealthEducationNeeds Pleasecircletheanswerthatindicatesyourresponsetothequestion. 1. Doyoueatthreemealsaday? 2. Doyoufollowaspecialdiet(vegetarian,diabetic,other)? 3. Doyoueatraworundercookedfood(meat,other)? 4. Doyoutakefolicacid? 5. Doyouhavecurrent/pastproblemswitheatingdisorders? 6. Areyouexposedtosecondhandsmoke? 7. Doyouseeadentistregularly? 8. Doyouusesaunasorhottubs? 9. Areyouusingbirthcontrolpills? 10. Doyougetinjectablecontraceptiveorshotsforbirthcontrol? 11. Doyouhaveanyproblemswithyourmenstrualcycle? 12. Haveyoubeentreatedforinfertility? 13. Haveyouhadsurgeryonyouruterus,cervix,ovariesortubes? 14. DidyourmothertakethehormoneDESduringpregnancy? 15. HaveyoueverhadHPV,genitalwartsorchlamydia? ReproducedwithpermissionfromtheNationalMarchofDimesOrganization,August,2007.

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

No No No No No No No No No No No No No No No

PrenatalHealthEducationNeeds Pleaseanswerthefollowingquestions. 1. Whatdoyouconsiderahealthyweightforyou?

2. Whichofthefollowingdoyoudrinkcoffee,tea,cola,milk,water,soda/pop,other?

3. Doyoutakeprenatalvitamins?

4. Doyouusedietarysupplements(i.e.blackcohosh,pennyroyal,other)?

5. Doyouexercise?Whattypeofexercisedoyoudo?Howfrequentlydoyouexercise?

6. Doyousmokecigarettesoruseothertobaccoproducts?Howmanycigarettes/packsaday?

7. Areyouemployedoutsideofthehome?Ifyes,whattypeofworkdoyoudo?

8. Doyouworkorlivenearpossiblehazards(chemicals,xrayorotherradiation,lead)?Ifyes, pleaselist.

9. Areyoutakingprescriptionmedications?Ifyes,pleaselist.

10. Areyoutakingnonprescribeddrugs?Ifyes,pleaselist.

11. Howmanytimeshaveyoubeenpregnant? ReproducedwithpermissionfromtheNationalMarchofDimesOrganization,August,2007.

PrenatalHealthEducationNeeds 12. Howmanychildrendoyouhave?

ReproducedwithpermissionfromtheNationalMarchofDimesOrganization,August,2007.

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TABLE1
Question Yes No Not Answered 1.Doyoueatthreemealsaday? 2.Doyoufollowaspecialdiet(vegetarian, diabetic,other)? 3.Doyoueatraworundercookedfood(meat, other)? 4.Doyoutakefolicacid? 5.Doyouhavecurrent/pastproblemswitheating disorders? 6.Areyouexposedtosecondhandsmoke? 7.Doyouseeadentistregularly? 8.Doyouusesaunasorhottubs? 9.Areyouusingbirthcontrolpills? 10.Doyougetinjectablecontraceptiveorshots forbirthcontrol? 11.Doyouhaveanyproblemswithyoumenstrual cycle? 12.Haveyoubeentreatedforinfertility? 13.Haveyouhadsurgeryonyouruterus,cervix, ovariesortubes? 14.DidyoumothertakethehormoneDESduring pregnancy? 15.HaveyoueverhadHPV,genitalwartsor chlamydia?

87% 0 13% 60% 7% 20% 13% 0 7% 0 0 0 7% 7% 13%

13% 93% 87% 40% 93% 80% 87% 100% 93% 93% 100% 100% 93% 87% 80%

0 7% 0 0 0 0 0 0 0 7% 0 0 0 7% 7%

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APPENDIXC
1. Whatdoyouconsiderahealthyweightforyou? 2. Didntanswer:67% 130ish:7% 140:13% 145:7% 165:7%

Whichofthefollowingdoyoudrink:coffee,tea,cola,milk,water,soda/pop,other? Milk:87% Water:27% Tea:27% Coffee:14% Cola/Soda/Pop:47% Juice:20%

3.

Doyoutakeprenatalvitamins? Yes:80% No:20%

4.

Doyouusedietarysupplements(i.e.blackcohosh,pennyroyal,other)? Yes:13% No:87%

5.

Doyouexercise?Whattypeofexercisedoyoudo?Howfrequentlydoyouexercise? Yes:47% No:40% Didntanswer:13% Walking:47%

6.

Doyousmokecigarettesoruseothertobaccoproducts?Howmanycigarettes/packsaday? Yes:0 No:93% Didntanswer:7%

7.

Areyouemployedoutsideofthehome?Ifyes,whattypeofworkdoyoudo? Yes:20% No:73% Didntanswer:7%

8.

Doyouworkorlivenearpossiblehazards(chemicals,xrayorotherradiation,lead)?

Yes:0

PrenatalHealthEducationNeeds 9. No:93% Didntanswer:7%

Areyoutakingprescriptionmedications?Ifyes,pleaselist. Yes:7%(AmoxicillinandPhenergran) No:87% Didntanswer:7%

10.

Areyoutakingnonprescribeddrugs?Ifyes,pleaselist. Yes:13%(MusinexandTylenol) No:80% Didntanswer:7%

11.

Howmanytimeshaveyoubeenpregnant? Once:27% Twice:27% Thrice:20% Fourtimes:20% Didntanswer:7%

12.

Howmanychildrendoyouhave? Zero:27% One:33% Two:13% Three:20% Didntanswer:7%