The special prenatal clinic: one approach to women and substance abuse.

We aimed to determine if the trend in substance use in this central core of a large inner-city area confirmed an increase in marijuana use among young women < 22 years of age as childbearing years were beginning or if marijuana use and harder drug use were greatest among women beyond the teens and the early second decade of life and to describe one prenatal care intervention. Statistical reports for the Special Prenatal Clinic, a Harlem clinic for women with a current or past history of substance use, were reviewed from 1985 (the clinic's inception) through March 1996 to determine the trends, patterns, and types of drug use. Findings chronicled the beginning and rise in crack cocaine use, especially after 1986, confirmed an increase in marijuana use by adolescents since 1992, and suggest that the risk for use of hard drugs increases with age, predominantly in the childbearing years. Intervention by the Special Prenatal Clinic aided case-finding, allowed for comprehensive care, offered women opportunities for behavior change, and increased their chances of keeping their babies after delivery.

A master's degree for entry-level ACNM-certified midwives. An option or necessity?

The health care industry is a massive system that is changing so rapidly that it is reinventing itself. With these changes, added demands have been placed on the knowledge base and practice of nurse-midwifery with emphasis on primary care, administration, and research as well as traditionally accepted nurse-midwifery practice. The American College of Nurse-Midwives (ACNM) has a history of being alert to consumer demands, sociopolitical forces, and the health care industry itself as stimuli for change after full dialogue with the membership and appropriate study. Because the ACNM Division of Accreditation will be requiring a baccalaureate degree upon entrance or completion of each midwifery education program by June 1999, dialogue should begin now about the benefits of requiring a masters degree as the entry-level credential.

Modifying a childbirth education curriculum for two specific populations. Inner-city adolescents and substance-using women.

An interdisciplinary care provider team conducted a nonexperimental, observational, descriptive study to determine a childbirth education curriculum that would meet the needs of pregnant adolescent and substance-using women who attend prenatal clinics at an urban, municipal hospital center. A childbirth education curriculum, originally taught to a clinic population in 1974, was used with the two special populations in 1993 for a 7-month period. Participants were encouraged to provide feedback about the curriculum for each class by offering suggestions for additions or deletions of content. Provider staff also evaluated the content for applicability today. At the end of the study period, the pregnant adolescent group had been most involved with the class exercises; members of the group provided feedback about content. They were consistently positive in evaluating the entire six-class curriculum and recommended some additional topics. The adolescents demonstrated sustained interest in breast-feeding. The substance-using women, on the other hand, expressed a preference for content that focused on labor and birth; they preferred to ask questions, individually and in the privacy of the examining room, and showed negligible interest in breast-feeding.