Seizing the 9-month moment: Addressing behavioral risks in prenatal patients

Objective: Our qualitative study explored prenatal care providers’ methods for identifying and counseling pregnant women to reduce or stop smoking, alcohol use, illicit drug use, and the risk of domestic violence.Methods: We conducted six focus groups (five with OB/Gyn physicians, one with nurse practitioners and certified nurse midwives), total N = 49, using open-ended questions. Investigators analyzed transcripts to identify and describe themes.Results: Three major themes emerged: (1) specific risk-prevention tactics or strategies exist that are useful during pregnancy; (2) some providers address patients’ isolation or depression; and (3) providers can adopt a policy of “just chipping away” at risks. Specific tactics included normalizing risk prevention, using specific assessment techniques and counseling strategies, employing a patient-centered style of smoking reduction, and involving the family.Conclusions: Providers generally agreed that addressing behavioral risks in pregnant patients is challenging. Patient-centered techniques and awareness of patients’ social contexts help patients disclose and discuss risks.Practice implications: Brief but routine assessment and risk reduction messages require little time of the provider, but can make a big difference to the patient, who may make changes later.