Applying a Maternal Standards of Care Audit Tool and Quality Improvement Process to Improve Healthcare for Pregnant Women in Prison.

Women are the fastest growing prison population, but little is known about the quality of maternal care for pregnant women in prison. In partnership with the Indiana Department of Correction (IDOC) Transitional Healthcare Team (THT), we developed a maternal standard of care (MSOC) audit tool to identify existing strengths and weaknesses and recommend evidence-based strategies for improvement. After creating the MSOC audit tool, we used it to audit 52 charts and conducted interviews of IDOC staff regarding maternal health care processes. Identified strengths include prenatal care, screening/treatment for sexually transmitted diseases and substance use disorders, contraception use, and health education. Mental and nutritional health care are areas of weakness. Staff motivation and community partnerships facilitate positive change, but a "punitive" culture, lack of resources, and communication challenges are barriers to change. Developing accountability tools and processes to promote maternal standards of care holds the potential to increase the health and wellbeing of mothers and their babies and improve re-integration into society.