Checkout the new list of preconception health indicators.1 If that terminology is new to you, indicators are the different numbers we use to keep track of how our health system is doing and to identify areas or groups of people whose health system isn’t performing as well as the rest of the country. You are probably familiar with some maternal and perinatal health indicators like the rate of primary cesarean and the rate of premature birth.
Having a standard list of preconception health indicators is a great step to bridging the gap between “well woman care” and “maternal care”. It reminded me of this statement from a faculty member during my midwifery training,
“When you are working with non-parous reproductive age women, assume every visit is a preconception visit.”
I don’t remember which faculty member made the comment. I don’t remember what we were discussing in class. But I do remember this was a concept-changing idea for me.
At the time I was enrolled in a dual program working on my MPH and my MSN for midwifery and family practice. I understood from the public health side that the health of the woman when she entered pregnancy was a driving force of our maternity outcomes. But clinically, a preconception visit was a distinct appointment a woman would make where she asked questions and worked to improve her health to prepare for pregnancy. The problem was, and is, in the United States more than half of pregnancies are unplanned. Women don’t prepare for an unanticipated pregnancy.
The faculty’s point was simple, by asking one question, “What are your future plans regarding pregnancy?”, you opened the door to help the woman plan and prepare to enter pregnancy healthy whether she wanted to be pregnant in the next few months or in ten years. Most women don’t think about how their health affects pregnancy until they either plan to start “trying” or become pregnant. Clinicians can help women connect the health decisions they make today to their future pregnancy plans. And public health surveillance of preconception health indicators can help us, as a country, connect the care we provide to women when they are not pregnant to future pregnancy outcomes.