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Background: Culturally sensitive intervention programs are needed to help Native American and Hispanic populations reduce alcohol, drug and tobacco use during pregnancy. Reduction of the adverse impact of psychosocial stress, increase of social support, and adequate preparation for labor and birth is also desirable.

Methods: Social marketing theory and public health strategies that included focus groups, in-depth interviews, and intercept interviews were used with Native American and Hispanic health educators and health care providers to develop a series of 7 group sessions. Two pilot groups of 150 women were conducted. Then a series of workshops were conducted for health educators with the aim of their importing the program to their home communities. A subgroup of these educators undertook further training and then collected data on the outcomes of 320 women who attended the intervention. These outcomes are compared to a matched, comparison group.

Results: The initial retention rate of women starting classes was 62%. Active encouragement by health care practitioners increased retention to 94%. Women in the Intervention group had significantly fewer Cesarean deliveries, oxytocin augmentations, and use of analgesia/anesthesia. Apgar scores were better and the number of special care nursery admissions was lower. The Intervention Group showed more drinking reduction among heavy drinkers. More women quit smoking. Being in the Intervention Group was associated with a greater likelihood of normal delivery (OR = 4.40). Membership in the Intervention Group protected against cesarean delivery (OR = 0.33). Being in the Intervention Group (OR = 0.22) decreased the risk for use of analgesia or anesthesia, oxytocin use during labor (OR = 0.23), the infant's having a low Apgar at one minute (OR = 0.15) and at 5 minutes (OR = 0.18).

Conclusions: A prenatal intervention program which includes endorsement and support by health care providers as well as intrapartum labor support can reduce the risks for cesarean birth and can improve infant outcome and incidence of normal delivery. The means by which this is accomplished is hypothesized to relate to reduction of substance use during pregnant, to the avoidance of analgesia and anesthesia during labor, and to nonspecific effects of women having a supportive, female companion during labor. Health education programs for pregnant women can be implemented in minority communities and can be made sufficiently attractive to women to foster attendance. Costs are within the budgets of most Indian Health Service units and are more than offset by savings during the perinatal period.


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