AP E D TR MENT OF HEALTH & HUMAN SERVICES • USA 

EARLY HEAD START NATIONAL RESOURCE 

Technical Assistance Paper No. 3 Giving Children the 
 Earliest Head Start:
 ...............................................
 Developing an Individualized Approach to 
 High-Quality Services for Pregnant Women
 Prepared by Early Head Start National Resource Center @ ZERO TO THREE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Administration on Children, Youth and Families Head Start Bureau 
Technical Assistance Paper No. 3 

Giving Children the Earliest Head Start: Developing an Individualized Approach 

to High-Quality Services for Pregnant Women 

This document was developed by the Early Head Start National Resource Center (EHS NRC) @ ZERO TO THREE in 

collaboration with the Head Start Bureau. The contents of this paper are not intended to be an interpretation of policy. 

The information in the Early Head Start program profiles are offered to assist programs in the effort to develop and 

implement high quality services for pregnant women and families with infants and toddlers. 

Early Head Start National Resource Center @ 

ZERO TO THREE 

734 15th St., NW, Suite 1000 

Washington, DC 20005-1013 

Phone: 202-638-1144 

Fax: 202-638-0851 

Web site: www.ehsnrc.org 

The EHS NRC is funded by contract #105-98-2055 

U. S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth, and Families 

Head Start Bureau 

© 2000 

ISBN 0-943657-44-X 

Printed in the United States of America 

First Printing, August 2000 
1 ...............................................
 

Technical Assistance Paper No. 3 

Giving Children the Earliest Head Start:
 

Developing an Individualized 


Approach to High-Quality Services 


for Pregnant Women
 ................................... ..................................


The prenatal period of growth and development is 

critical to optimal child development in the first 

three years of life and beyond. From conception 

to age three, human development occurs more rapidly then 

at any other time in life. Fetal development, like all stages 

of development, is progressive, involves critical periods, 

and benefits from supportive practices administered 

through a range of supports and services offered as early 

as possible. Inadequate prenatal care is associated with a 

host of health and developmental problems — low birth 

weight, premature delivery, birth defects, poor growth. 

Furthermore, these babies are at an increased risk of 

learning, social, and behavioral problems. Thus, Early 

Head Start (EHS) is poised to make a significant and longlasting impact on the future of America’s most vulnerable 

children. 

......................................

Elements of Quality: The Head 

Start Program Performance 

Standards 

The Head Start Program Performance Standards specify 

the supports and services that must be offered to 

expectant families enrolled in Head Start programs 

serving pregnant women. These services include 

comprehensive prenatal and postpartum health care, 

prenatal education, and breastfeeding education and 

accommodations. 

............................................
 

Laconia EHS, Laconia, NH 

The Performance Standards that govern services to 

pregnant women are located in the Family and 

Community Partnerships section (45 CFR 1304 Subpart 

C) of the Performance Standards1. The Performance 

Standards identify which services must be provided by the 

EHS grantee, and which services grantees must assist 

pregnant women in accessing through community 

referrals. 

1 The Performance Standards in 45 CFR 1304 Subpart D, Program Design and 

Management also apply to grantees serving pregnant women. The Performance 

Standards in 45 CFR 1304 Subpart B, Early Childhood Development and Health 

Services only apply to children and do not apply to pregnant women. The 

regulations governing the Home-based Program Option in 45 CFR 1306 refer 

to services for children and do not apply to services to pregnant women. 
2 Early Head Start National Resource Center 

...............................................
 

Comprehensive Prenatal and 

Postpartum Health Care 

Early Head Start grantee and delegate agencies must 

assist pregnant women to access comprehensive prenatal 

and postpartum care, through referrals, immediately 

after enrollment in the program. This care must include: 

(i) Early and continuing risk assessments, which include 

an assessment of nutritional status as well as nutrition 

counseling and food assistance, if necessary; 

(ii) Health promotion and treatment, including medical 

and dental examinations on a schedule deemed appropriate 

by the attending health care providers as early in the pregnancy as possible; and 

(iii) Mental health interventions and follow-up, including substance abuse prevention and treatment, as needed. 

45 CFR 1304.40(c)(1)(i)(ii)(iii) 

Collaboration with community partners is essential to 

the design and management of a high-quality EHS 

program serving pregnant women. Some examples of 

potential community partners include: health clinics, 

transportation services, counseling and other mental 

health programs, doula services, or translation services for 

non-english speaking families. 

Pregnant women must be connected to health care 

providers, and ultimately a “medical home.” A medical 

home is a place where an individual will receive routine 

health care, and ideally, establish an ongoing relationship 

with a familiar health care provider. A pregnant women 

will need a medical home to have her health monitored 

during pregnancy, to gather information on the status of 

her developing child, and where she will continue to receive 

medical care following the delivery of her baby. Oral health 

and a regular source of dental care are equally important 

during pregnancy. The baby will also need a medical home 

for well-baby checkups and immunizations. 

...........................................................................................................


Along with resources that allow EHS parents to access
 

comprehensive health care, they must also receive
 

information on good eating habits and proper diet. The
 

effects of a healthy diet translates into the creation of cells
 

which evolve into the developing child’s tissue, muscle, and
 

bone. All of the child’s organs and the brain begin to
 

develop in the earliest weeks of pregnancy. Optimal
 

health and nutrition allow parents, very early on, to
 

positively influence their child’s future. EHS programs are
 

required to make an assessment of nutritional status and,
 

if necessary, help families find resources to obtain
 

adequate food.
 

In addition to partnering with community health and
 

nutrition programs, EHS should join forces with agencies
 

that address families’ housing and social service needs.
 

Stressors such as unstable housing or violent communities
 

pose significant threats to any parent’s ability to care for
 

herself and her child. Parents may need help securing safe
 

and appropriate housing. Expectant parents and families
 

with very young children should be educated about the
 

risk of lead poisoning that is commonly found in low-


income communities. Examples of potential community
 

collaborations include: health care clinics for lead
 

screening, homeless shelters, local churches for food and
 

clothing donations, or family support centers for adult
 

education or job training.
 

Community mental health partners also support
 

services to expectant parents. Substance abuse prevention
 

or treatment, and other mental health concerns are
 

critically important to the healthy development of the
 

growing fetus and the parent’s ability to appropriately care
 

for their baby. Free or low-cost counseling and treatment
 

programs may be available through religious
 

organizations, county departments of Health and Human
 

Services, or local nonprofit agencies.
 

The Health Services Advisory Committee is a vital
 

resource for addressing the issues affecting local families.
 

EHS programs can tailor the composition of the group
 

to ensure that expertise and linkages to local resources are
 

represented. Members of the Health Services Advisory
 

............................................
 
3 

Committee can assist with developing health care 

guidelines, locating community resources, and 

establishing important linkages for services to pregnant 

women. 

Community partnerships are critical to providing the 

prenatal and postpartum health care that is required by 

the Head Start Program Performance Standards. Since most 

of these services are rendered outside of the EHS grantee, 

it is imperative that EHS programs develop effective 

systems for planning services, communicating pertinent 

information with all the involved parties, and recordkeeping and tracking to ensure that services were rendered 

and in a timely manner and to monitor the outcome of 

the referrals. 

Prenatal Education 

Grantee and delegate agencies must provide pregnant 

women and other family members, as appropriate, with 

prenatal education on fetal development (including 

risks from smoking and alcohol), labor and delivery, 

and post-partum recovery (including maternal depression). 45 CFR 1304.40(c)(2) 

The Performance Standards identify the major topics 

to be covered in prenatal education efforts. These include 

information about: 

• 	typical fetal development, including the risks of 

smoking and drinking alcohol; 

• 	what to expect during labor and delivery; and 

• postpartum recovery, including maternal depression. 

Prenatal education can take many forms: written 

materials, informal conversation, structured classes, 

videotapes, one-on-one instruction, or group meetings 

with other expectant parents. The role of EHS staff is to 

serve as an advocate and liaison between expectant 

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Technical Assistance Paper No. 3 

...............................................
 

parents and service providers2. EHS program activities may
 

range from providing transportation to community-


based prenatal classes, to providing referrals to substance
 

abuse treatment programs, or using written materials to
 

explain the stages of fetal development.
 

Written or audiovisual materials are popular and useful
 

tools for explaining many of the physical changes that
 

occur during pregnancy and child birth. It is a challenge
 

for EHS staff to sift through the vast array of materials,
 

identify the best resources, and carefully select what will
 

most effectively meet the individual and diverse needs of
 

participating families, as well as how the information
 

should be delivered. The needs and resources of
 

participating families, the individual expertise of EHS staff
 

members, community partners, and the Health Services
 

Advisory Committee are critical links in planning an
 

effective approach to prenatal education. (Please see
 

Appendix A for an example of a creative approach to
 

prenatal education.)
 

Children’s Home Society of Washington, Auborn, WA 

............................................
 

2 U. S. Department of Health and Human Services, Head Start Program Performance 

Standards and Guidance, pg. 131. 
4 Early Head Start National Resource Center 

...............................................
 

Breastfeeding Education and 

Accommodations 

Grantee and delegate agencies must provide information on the benefits of breastfeeding to all pregnant and 

nursing mothers. For those who choose to breast feed in 

center-based programs, arrangements must be provided 

as necessary. 45 CFR 1304.40 (c)(3) 

The medical evidence for the benefits of breast milk 

is so compelling that the American Academy of Pediatrics 

issued a statement in 1998 urging mothers to breastfeed 

for at least the first year of life. Pregnant or nursing mothers 

enrolled in EHS must receive information on the benefits 

of breastfeeding. It is also helpful to have other family 

members involved in these efforts so that the mother is 

fully supported and necessary accommodations can be 

made to ensure that breastfeeding is successful. Some 

parents may need the additional support of a lactation 

specialist, who is trained to address the problems that can 

arise in the breastfeeding process. 

Children’s Home Society of Washington, Auborn, WA 

...........................................................................................................


Heartland Programs, Salina, KA 

Early Head Start programs must also ensure that the 

facilities they use for center-based activities, including 

group socializations, are conducive to breastfeeding. 

This means that mothers have a place they can breastfeed 

comfortably, and the storage and handling of breast 

milk can be accomplished according to the recommended 

health and safety guidelines. 

Developing an Individualized 

Approach 

Programs that serve expectant parents are challenged 

to meet the varied and complex needs of mothers and 

fathers during such an important time in the life of the 

family. The needs of families vary based on family and 

cultural differences, personality and coping styles, health 

and medical status, stage of the pregnancy, and a host of 

other variables. There are many resources to help EHS staff 

successfully meet this challenge. The key is 

individualizing the approach to fully engage parents, fulfill 

the requirements of the Performance Standards, and give 

each baby the best possible start in life. 

............................................
 
5 

Prenatal Planning 

The Head Start Program Performance Standards do not 

require that programs use a specific curriculum for 

pregnant women. There is no single tool that will be 

appropriate for all families. The development of an 

approach to services for pregnant women is best defined 

in the broadest terms as the goals and process for 

learning. At its best, this approach provides a framework 

within which individual needs are met. The Performance 

Standards describe a process for developing a Family 

Partnership Agreement [45 CFR 1304.40 (a)(2)]that can 

provide a framework for developing services for pregnant 

women. This approach would include: 

• 	identifying the goals for participating 


families;
 

• 	creating the strategies through which they 


will achieve these goals;
 

• determining EHS staff and parent 


responsibilities; and
 

• 	developing a timeline to carry out the plan. 

This comprehensive approach allows EHS programs 

tremendous flexibility to be truly responsive to the 

individual needs of participating families, programs, 

and communities. 

Prepackaged Prenatal Materials 

There are prepackaged materials for pregnant women 

on the market. These resources can be valuable tools for 

EHS programs. Be creative and take from them what is 

appropriate for your program, and meets the needs of your 

particular community and the individual mother and 

family you are working with. 

...........................................................................................................
 

Technical Assistance Paper No. 3 

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Postnatal Transition Planning 

The postnatal period is a unique time for every family
 

as its’ newest member takes his or her place in the world.
 

Emotions run from one extreme to the other, and all
 

members of the family experience a certain amount of
 

upheaval and adjustment. During this time, EHS
 

programs are required to arrange for health staff to visit
 

the newborn (within two weeks after birth) to ensure the
 

well-being of the mother and child [45 CFR 1304(i)(6)].
 

This individual may be staff of the EHS program, or may
 

be with a public health or other collaborating community
 

agency. Selecting the appropriate staff requires sensitivity
 

to the individual family’s needs, and the mother’s existing
 

relationships with EHS staff and community health
 

providers. The two week visit does not exclude other
 

contacts, such as telephone calls, depending on the needs
 

of the family and available resources in the community.
 

West Medford EHS, Medford, OR 

............................................
 
6 Early Head Start National Resource Center 

...............................................
 

Tennessee Cares EHS, Paris, TN 

This first postnatal visit is an opportunity to assess the 

family’s interests and needs and to continue developing 

a manageable plan to transition the infant into the 

appropriate EHS program option. This transition plan 

would include the types of support the family may need, 

timelines for meeting these needs, and the roles that EHS 

staff will play to assist the family. For example, the most 

pressing need may be to support the mother’s desire to 

breastfeed by collaborating with a lactation specialist who 

can assist with any problems she is experiencing. 

Alternatively, a mother may be experiencing a degree of 

postpartum depression that requires mental health 

consultation. Perhaps she is feeling isolated and lonely and 

would find it helpful to talk to a home visitor each week. 

Or she may be feeling exhausted and overwhelmed and 

prefer to postpone home visits until her physical and 

emotional strength have returned. Each of these scenarios 

is an example of individualizing the EHS services in the 

postnatal period to effectively support parents in their most 

important new role. 

Another important aspect of this transition planning 

is the transition of the child into the appropriate EHS 

program option. Family circumstances and preferences 

will dictate the type of program services most appropriate 

for the infant. For example, home-based services may be 

a desirable option until the time that the parents return 

...........................................................................................................


to work and have the need for child care. At that time 

center-based or family child care partnerships may be the 

best arrangement. Issues of health and safety are 

paramount. For example, very young infants (less than 

6 weeks old) or premature infants should not be exposed 

to crowded environments and may be too young for group 

socializations. Mothers who need to return to work prior 

to 6 weeks postpartum must be supported in making the 

best child care decisions for their young infants. 

Anticipating future needs maximizes the EHS program’s 

ability to be responsive to family circumstances. Prior to 

the birth of the child, EHS staff, in collaboration with 

program administrators, need to consider programming 

issues such as: how space will be made available in 

center-based programs; how home visitor caseloads will 

be affected; and how the group socializations for infants 

will build upon the goals of the home-based services and 

meet the needs of parents with newborns. 

How Do You Create an 

Individualized Approach? 

1. Respond to the mandates of the Head Start Program 

Performance Standards 

The requirements of the Head Start Program 

Performance Standards, outlined above, provide the 

essential elements of what EHS programs must provide 

or help families access: comprehensive prenatal and 

postpartum health care, prenatal education, and 

breastfeeding education and accommodations. It is up to 

each program to determine how these will be 

accomplished. 

2. Consider the community and population being served 

by EHS 

What does the Community Assessment reveal about 

the potential needs of expectant parents in your 

community? For example, can pregnant women in a rural 

community access an Obstetrician/Gynecologist in the 

community or must she travel significant distances for 

............................................
 
Technical Assistance Paper No. 3 7 

medical care? How can EHS bridge the limited access to 

prenatal care? Alternatively, if the Community Assessment 

identified a high rate of teenage pregnancy, how will the 

EHS program meet the unique needs of pregnant teens? 

The short and long term goals of the EHS program are 

one part of the overall approach to developing effective 

services for expectant parents. 

The Health Services Advisory Committee, composed of 

both parents and volunteers from the community, is a key 

component in the development of a comprehensive 

approach to services for pregnant women enrolled in EHS. 

Ideally, health professionals from the field of obstetrics and 

gynecology are active participants. As discussed above, 

the members of this committee can provide important 

linkages to community resources, in addition to bringing 

their individual expertise in selected areas relevant to the 

needs of pregnant women. 

3. Determine the unique needs of participating families 

Every pregnant woman enrolled in EHS has a Family 

Partnership Agreement which is a rich source of 

information for individualizing program services. The 

Performance Standards describe a collaborative process of 

developing a plan that is driven by the parents’ 

identification of family strengths, needs, resources, and 

goals. Since each Family Partnership Agreement will be 

unique, so will the plan for achieving those goals. EHS 

staff play an important part in helping parents determine 

how their goals will be defined in measurable terms, 

timelines for achieving those goals, the process for how 

the goal will be achieved, and how it will be determined 

that a goal has been met. Answering these and similar 

questions will help determine if services should be 

provided through home visits and/or other service 

delivery options, how often these activities will occur, and 

so on. 

............................................


..
 .........................................................................................................

...............................................
 

EOC Early Head Start, St. Joseph, MO 

Tying It All Together 

Develop Management Systems 

Management systems and procedures only exist to 

support program services. It is easy to overlook this aspect 

of program planning in the drive to establish effective 

relationships with families. Yet these systems are the critical 

supports that allow the vision of EHS to come to life. 

The following five management systems are identified 

in section 45 CFR 1304.51 of the Performance Standards. 

Consider how services to pregnant women are integrated 

into each key area. It is important to remember that each 

of these systems are interrelated and influence each 

other. 

Program planning: Services to expectant parents, like 

all EHS programming, is tied to the Community 

Assessment. Written plans identify both long and short 

term objectives and goals that meet the identified needs 

in the Community Assessment. 

Communications: Effective communication systems 

ensure that pregnant women receive comprehensive 

services, and that community partners are well prepared 

to support EHS efforts. It is important to consider how 

information can be shared in a timely manner, and that 

appropriate confidentiality guidelines are established. 

Effective communication with the governing bodies 
8 Early Head Start National Resource Center 

............................................... 
 ...........................................................................................................
 .

ensures that members have adequate time to review and 

reflect on information and materials, participate in 

decision-making, and respond to grantee needs. 

Communication between staff members, and staff and 

family also require a thoughtful approach. Both formal 

and informal mechanisms provide the opportunity to share 

information that contributes to the quality of the services. 

A climate of open communication is built over time and 

requires mutual trust and respect. 

Record keeping: Many of the services for pregnant 

women are delivered in partnership with community 

agencies. Up-to-date and comprehensive records are 

necessary to ensure that these services are of high quality, 

delivered in a timely manner, and that any follow-up 

activities are carried out appropriately. Record keeping 

is also essential in documenting how services are meeting 

the Performance Standards and other federal or state 

regulations; following the progress of individual families; 

and to identify the emergence or resolution of specific 

issues across the entire program. 

Reporting: Formal, written reports of program 

progress for services to expectant parents provide 

governing bodies and staff with the information needed 

to continually assess and improve the quality of program 

services. 

Self-assessment and monitoring: High-quality services 

to expectant parents require on-going review and 

reflection to remain responsive to families needs. Seek both 

formal and informal feedback on how program services 

are having an impact. Use this information to build on 

program strengths and identify areas to improve. 

Consider Staff Development 

Needs 

Working with expectant parents requires specialized 

knowledge of a broad array of topics that cross many fields 

of study: fetal and infant development, reproductive 

health and child birth, lactation, mother and infant 

nutrition, substance abuse, family functioning, and 

mental health. Staff who are hired to work with pregnant 

women in EHS come from varied backgrounds and have 

different levels of knowledge, experience, or comfort 

addressing these topics. A wide variety of training and 

professional development experiences are necessary to meet 

staff development needs. Reading material, formal course 

work, conferences or workshops, “shadowing” more 

experienced staff, and role-playing are some of the 

experiences to consider. Delivering information in a variety 

of ways creates staff development experiences that build 

on each other over time. 

The role of reflective, or supportive supervision is 

central to effective staff development. Reflective 

supervision refers to a collaborative relationship between 

supervisor and staff members that provides regular 

opportunities to reflect on the work of providing highquality services to expectant families. This opportunity 

provides a safe environment in which staff can openly 

discuss challenges, celebrate achievements, brainstorm 

solutions, identify needs, and deepen their understanding 

of working effectively with families. 

Remain Flexible and Responsive 

Individuals, families, and communities change. In fact, 

the ability to change is the very quality that makes work 

with families and children so rewarding. There is no one 

recipe or formula that will guarantee success for all 

families. However, there are many resources and tools 

available to design a program that is truly responsive to 

the needs of expectant families enrolled in the EHS 

program. In fact, services to expectant parents are where 

the potential to have the greatest impact can be realized. 

By supporting children and their parents at the earliest stage 

of parenthood, our most vulnerable children are afforded 

the best start in life. 

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Technical Assistance Paper No. 3 9 ...............................................
 

Early Head Start Program Profiles
 ........................................................................................ ....


The program profiles in this section provide an 

overview of two EHS grantees’ particular 

approach to serving pregnant women in EHS. The 

Clermont County Head Start describes their process for 

developing a comprehensive approach to structure their 

prenatal education efforts. The Drake University EHS 

describes their unique partnerships in community 

collaboration and diverse staff development efforts. All 

EHS programs are empowered to develop services to meet 

the needs of their own communities, thus each program 

model is unique. 

Clermont County Head Start,
 

Child Focus Learning Center
 

Cincinnati, Ohio
 

Community Profile: Clermont County is a rural county 

located in southwestern Ohio. The population continues to be predominantly (about 98%) white with the 

remainder being African American, Asian/Pacific 

Islanders and Eskimo/American. 

The culture native to Clermont County is the white, 

Appalachian culture. Education and income levels do not 

seem to improve from one generation to the next. In Ohio, 

there is a severe poverty concentration in the Appalachian 

population. According to a report from the Cincinnati 

Health Care Foundation, the poverty rate in Clermont 

County is currently 8%. Unemployment rates are 

currently 0%. 

Welfare reform has left many families without 

healthcare coverage leading to more children who are not 

receiving needed health care. Medical providers are faced 

with more uninsured patients and decreased 

reimbursement creating the need to cut services, 

...............

implement new policies regarding fee arrangements and 

other cost-cutting strategies. Information revealed during 

a recent Healthy Baby Coalition meeting shows fewer 

women are accessing prenatal care in the first trimester, 

in some instances, not until the third trimester, and that 

fewer are keeping routine postpartum visits. 

Comprehensive Prenatal and Postpartum Care: 

Clermont County Early Head Start serves 84 children 

and their families ages birth to three as well as pregnant 

women. The program goals are to promote the physical, cognitive, social and emotional growth of infants and 

toddlers and prepare them for future growth and development; support parents – mothers, fathers, guardians 

– in their role as primary caregivers and educators of 

their children, and in meeting family goals and achieving self-sufficiency across a wide variety of domains; 

strengthen community supports for families with 

young children; and develop highly trained, caring and 

adequately compensated program staff. 

Upon enrollment into the EHS program, pregnant 

women are assisted with locating a medical provider, 

healthcare coverage, transportation and other needs as 

indicated. Clermont County EHS developed a prenatal 

plan to deliver comprehensive services in a home-visiting 

model. The importance of routine prenatal care is stressed 

throughout the plan. Mothers complete a nutritional 

assessment upon enrollment which is reviewed by the 

Nutrition Services Manager who makes direct contact with 

mothers regarding deficiencies or other concerns. This is 

shared with the home visitor or advocate working directly 

with that mother to provide follow-up. The material 

focuses largely on the importance of prenatal care as well 

as the need for mother to address health issues. For 

example, mothers are assisted with locating a dental 

provider, health and dental care coverage and 

transportation as indicated. Our agency has a strong 

............................................
 
10 Early Head Start National Resource Center 

...............................................
 

substance abuse prevention component headed by the 

Prevention Manager who is easily accessible for assistance 

as needed. The material includes information regarding 

fetal development, including risks and hazards during 

pregnancy due to substance abuse, labor, delivery and 

postpartum issues. The Health Services Manager conducts 

a joint home visit with the indicated staff person within 

two weeks of the child’s birth. 

Development and Format of the Pregnancy Curriculum: 

Our approach to serving pregnant women was developed 

by the Health and Nutrition Services Managers and 

approved by an Assistant Professor of Pediatrics at 

Children’s Hospital Medical Center. We utilize a multimedia approach in a structured format to provide prenatal education on array of topics, including fetal development, nutrition, breastfeeding, maternal changes, 

hazards during pregnancy, and postpartum issues. 

Several factors led to the development of this 

approach. Many important factors impact pregnancy 

outcomes including health and nutritional status, hazards 

during pregnancy such as smoking and alcohol 

consumption, compliance with routine prenatal 

appointments and others. Some of our goals are to 

reinforce the importance of keeping all prenatal visits and 

following health recommendations, and to provide 

specific clinical information regarding maternal changes, 

fetal development, nutrition during pregnancy and other 

health-related information. The staff who work with 

pregnant women have an early childhood and child 

development background, rather then training in clinical 

or health-related fields. The Pregnancy Curriculum 

provides a tool to deliver this specific clinical information 

in an integrated, discussion-based approach using 

teaching tools written and designed by clinical 

professionals. Regular home visits allow EHS staff to track 

medical appointments, provide opportunities for dialogue 

around how prenatal health visits went and follow 

through on any recommendations, and promote healthy 

habits in a case management approach. 

...........................................................................................................


The structured format consists of monthly planning 

guides to assure all topics are covered during the 

pregnancy. There is no specific order for this, however, for 

organizational purposes all topics are assigned to a 

specific month of the pregnancy. Each month is further 

broken down into various activities and experiences 

which are to be covered over the course of the month. 

In addition to the monthly guides, the materials 

include a section on postpartum information, and an array 

of materials about the perinatal period including videos, 

books, pamphlets and other teaching tools available 

through our lending library. A portable TV/VCR is 

available to show videos in the home as needed. We also 

purchased flip charts for educating families on specific 

perinatal topics. These materials include the With Child 

Flipchart, Postpartum Flipchart, and Breastfeeding 

Flipchart. These provide realistic visual aides to 

compliment the written materials and verbal information 

shared with the family. Other materials that we have 

included in our curriculum consist of the Help Me Grow 

publication from the Ohio Family and Children First 

Initiative obtained from the Ohio Department of Health. 

We also utilize the Great Beginnings Calendar published 

by the United Dairy Council. 

Our county is fortunate to have prenatal services 

provided through several agencies regarding 

breastfeeding, childbirth preparation and postpartum 

services. We include these agencies as resources in the 

Pregnancy Curriculum for referrals as needed. 

Pregnancy Curriculum Evaluation: Of the 20 pregnant 

women served by utilizing the Pregnancy Curriculum 

who gave birth in the 1998-99 program year: 

•	 100% of pregnant women accessed prenatal 

care in the first trimester; 

•	 92% kept all prenatal appointments; 

•	 61% made a positive lifestyle change such as 

decreased caffeine intake, decreased number of 

cigarettes smoked each day or quit smoking, and 

increased exercise; 

•	 100% kept all postpartum follow-up and first 

newborn doctor visits; 

............................................
 
11 

The evaluation process was done with a survey tool that 

rated each section of the material on a scale from one to 

five. Percentages were then computed from those 

responses. As reflected above, the results are very 

complimentary. EHS staff are also surveyed on an 

annual basis to determine their assessment of using 

these materials with families. Staff reported this approach 

to be very useful for parent education. 

Contact:
 

Karen Balon, L.P.N.
 

Health Coordinator
 

513-528-7224
 

Drake University 

Early Head Start 

Des Moines, Iowa 

Background Information: Drake University has been a 

grantee administering the Head Start program since 

1977. Drake University Head Start serves eligible threeto four-year-old children and their families in Boone, 

Jasper, Marion, Polk, Story, and Warren counties in central Iowa. In 1991, Drake University received funding to 

operate a Parent & Child Center in Polk County. The 

Drake University Parent & Child Center operated five 

years prior to converting to an Early Head Start program 

site as part of Wave II. Drake University Early Head Start 

is currently funded to serve 63 pregnant women, infants, 

toddlers and their families (53 with Federal funds and 

10 with State funds) in Polk County. 

Community Information: Polk County has the fourth 

highest infant mortality rate among counties in the 

United States3. Approximately 25% of medically uninsured Iowa women are between the ages of 15 and 44 

(Healthy Iowans 2000). There are high rates of smoking, low-birth weight babies, and low rates of breastfeeding initiation and duration. 

............................................
 

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Technical Assistance Paper No. 3 

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The Prevent Child Abuse Council of Iowa estimates 

that 30% of the Iowa population is at-risk due to poverty 

and other hardships. With approximately 6,000 births per 

year in Polk County, an estimated 1,800 families are 

identified as at-risk. In Polk County, there are only three 

programs, including Drake University Early Head Start, 

offering comprehensive services to families with a total 

enrollment of 225 families. There are, therefore, an 

estimated 1,575 families with children under three years 

of age with unmet needs for support services in Polk 

County. 

Des Moines has the highest number of 

methamphetamine abusers per capita of any city in the 

nation. To date, Des Moines has one of the highest arrest 

rates for possession and/or production of 

methamphetamine in the United States. Physicians in the 

Des Moines metro area have reported an increase in the 

number of infants born drug-affected. 

The Hispanic/Latino community in Des Moines 

continues to grow in geometric proportions. Hispanic 

Educational Resources reports that there are more than 

28,000 Hispanic families living in Des Moines comprising 

more than 12% of the population. Currently, 25% of the 

families enrolled in Drake University Early Head Start 

speak only Spanish. In all of Polk County, there is only one 

comprehensive support program for families with 

children under the age of one year with bilingual staff. In 

addition, Des Moines serves as a refugee hub. The need 

for translation and interpretation services in our 

community is overwhelming. 

At least two free health care clinics in the Des Moines 

area expect to close their doors within the next year due 

to lack of funding and volunteer health care providers. 

The infant mortality rate among African Americans 

in Polk County has increased from an average of 22 infant 

deaths to 23 infant deaths per 1,000 live births. 

3 Iowa Infant Mortality Prevention Center, Infant Mortality Prevention 

Consortium Quarterly Review Meeting on April 28, 1998. 
12 Early Head Start National Resource Center 

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 .

Comprehensive Prenatal and Postpartum Care: In an 

effort to impact as many pregnancies as possible due to 

the high infant mortality rates in our community, Drake 

University Early Head Start has a Perinatal Support 

Specialist (PSS). The PSS works with women during 

pregnancy and six months postpartum with follow-up 

visits at 9 and 12 months. If a woman already participating in Early Head Start becomes pregnant, the 

specialist working with her family will work with her in 

concert with the PSS (See staff development section for 

additional information). Some families choose to 

transition to another EHS specialist and continue with 

Early Head Start (as space is available) while other families transition to other programs. 

Our program offers a monthly support and education 

group for pregnant women and postpartum women with 

infants. In addition, our program offers a monthly support group for fathers and other significant male caregivers. 

We have developed our own tool for assessment 

combining a variety of resources. This assessment has an 

initial contact component as well as a component for each 

trimester. The assessment was developed using a strengthbased approach. In terms of the nutrition assessment, we 

have a collaborative agreement with WIC. We make sure 

each pregnant woman is receiving WIC services. WIC, in 

turn, provides us with a copy of each woman’s nutrition 

assessment. This practice ensures that WIC services are 

in place, the assessment is completed, a dietician reviews 

the assessment and follow-up services are provided for each 

woman. If a pregnant woman refuses to participate in 

WIC, we utilize a nutritional assessment we developed in 

concert with WIC, and maintain a contract with a 

dietician to review these assessments and make 

recommendations for follow-up. 

If a pregnant woman is not receiving prenatal care, we 

connect her to a medical home for prenatal care 

immediately. Prenatal care and dental care are critical 

aspects of our work with a pregnant woman. We have 

Prenatal Exam Records that physicians and midwives 

complete each trimester and the pregnant woman returns 

to her specialist. The pregnant woman and her specialist 

review the Prenatal Exam Record together prior to the 

appointment and the pregnant woman completes a 

section with any questions she has to review with her health 

care provider. Mental health interventions are employed 

as appropriate on an individualized basis. 

Community Partnerships: We have a number of 

partnerships in the community to support pregnant 

women. In terms of community resources, we individualize referrals and connections to other community 

resources depending on the needs of each pregnant 

woman and her family. Examples of our partnerships 

include, but are not limited to those listed in Table 1. 

...........................................
 
...

13 

Table 1 .....

Drake University EHS Community Partnerships* 

*All of the agencies/individuals listed above provide referrals to Early Head Start as appropriate. 

Agency Primary Collaboration 

Healthy Start Translation services 

Refugee Services Translation services and cultural training for staff 

Young Women’s Resource Center Car seats and support services for pregnant women 

OB/GYN physicians, midwives Consultation 

Perinatologist Consultation and free testing 

La Clinica Perinatal care, consultation, translation, and assistance 

with Department of Human Services paperwork for 

Latina women 

Creative Visions Support and assistance for African American teens 

House of Mercy Free lead screening and substance abuse treatment 

Lutheran and Catholic Services Counseling 

Doulas in Des Moines Free doula services 

Technical Assistance Paper No. 3 

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......... ..........................................................................................
 ............................................
 
.

14 Early Head Start National Resource Center 

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Access to prenatal care continues to be challenge in our 

community. Several free and/or sliding scale fee clinics 

are expected to close due to lack of funding and/or lack 

of volunteer health care providers. In addition, when a 

woman is identified late in pregnancy without prenatal 

care; it is not uncommon to have difficulty locating a health 

care provider that can schedule an appointment before her 

due date. As a result, Drake University Early Head Start 

has been working with other community partners to 

establish a free ob/gyn and pediatric clinic to serve 

women and children in Polk County. As a result, the Heart 

& Hands: Women & Children’s Health Center was 

established and co-located within the same facility as Drake 

University Early Head Start. Renovations on the clinic 

space are currently underway. 

The overall goal of Heart & Hands: Women & 

Children’s Health Center is to increase the accessibility and 

utilization of well-woman, prenatal, postnatal, newborn 

and well-child health care. This clinic will serve women 

and children from families with low incomes as well as 

homeless and at-risk women and children. This health 

center will focus on preventative and client-centered care. 

Heart & Hands Health Center staff will work 

collaboratively with other health care providers and 

outreach programs such as EHS, Healthy 

Families/HOPES and Healthy Start to promote continuity 

of care. In addition, there will be an emphasis on 

education to empower families to make informed choices 

and be proactive concerning their care and health. 

Ultimately, the aim of the Health Center is to promote 

wellness, improve the health of women and children, 

increase utilization of health care services by low-income 

women and their families and reduce infant mortality and 

morbidity. 

A certified nurse midwife and a pediatric nurse 

practitioner as primary care providers will staff the 

clinic. Nurse-midwives are certified to care for women 

from puberty until death as well as newborns through the 

age of one year. Pediatric nurse practitioners are able to 

care for children through adolescence. Contracted 

consulting relationships with physicians will facilitate the 

referral of clients requiring additional or specialized 

...... ...................................................................................................
 

care. In addition, the established relationship and rapport 

between Health Center staff and clients will ensure better 

client compliance in accessing specialized medical care 

from a physician. Care provided by advanced nurse 

practitioners is comprehensive and more cost effective than 

the same services provided through most medical clinics. 

In addition, studies show that clients have found advanced 

nurse practitioners to be more accessible both in terms 

of availability of appointment times and in the amount 

of time devoted to each visit. This is a distinct advantage 

in working with low-income families who frequently have 

accessibility problems as well as additional needs for health 

education. 

This project owes its feasibility to the unique 

partnering of community agencies and services, the 

availability of certified nurse-midwives and pediatric 

nurse practitioners and the interest, enthusiasm and 

commitment of many agencies and professionals. A very 

significant benefit to this project is a community-based 

site. This church also serves as the site for the EHS program 

so pregnant women and families with young children are 

already accustomed to participating in activities in this 

building. The services already in place through the EHS 

Program dovetail and enhance those which would be 

provided through the clinic. As a result, EHS and the 

Health Center staff will function as a multidisciplinary 

team. 

First and foremost, we work with pregnant women to 

be their own best advocate in obtaining and negotiating 

services. Feedback from a pregnant woman and her family 

provides important information regarding the 

appropriateness and timeliness of services she received (or 

did not receive). We also attend appointments and visit 

other agencies with pregnant women to ensure the 

appropriate provision of services and to provide support. 

We obtain consents to release information as appropriate 

to communicate with providers and community partners. 

Moreover, the EHS staff participate on many community 

committees, boards, work groups and forums to ensure 

the appropriate provision of services to pregnant women, 

children and their families in Polk County. 

............................................
 
15 

Prenatal Education: The approach to perinatal education is highly individualized. We do not follow a 

particular, formalized curriculum although we have 

access to a variety of curricula. The information provided and manner of presentation is highly dependent on the pregnant woman’s circumstances, needs 

and interests. Our assessment tool helps to identify 

strengths, needs and interests as well as support that 

can be provided by staff. Some of the factors considered include: 

•	 Needs and resources of the pregnant 

woman and her family 

•	 Expectations, knowledge of pregnancy, 

labor and delivery 

•	 Gestation 

•	 Age of the pregnant woman 

•	 Parity and the previous past experience(s) 

with pregnancy and birth. 

•	 Complications in current or previous 

pregnancy. 

•	 Primary language 

•	 Feeding choices (breast or bottle) 

•	 Prenatal care 

•	 Newborn care 

•	 Nutritional status 

•	 Substance use or abuse 

• Support systems 

•	 Resources 

We have a number of materials in Spanish as well as 

for work with pregnant teens. We are also continually 

reviewing and obtaining new and different curricula as well 

as additional materials as resources. 

Staff Development: First and foremost, the qualifications in job descriptions require degrees and experience. 

For example, the Perinatal Support Specialist qualifications are as follows: 

..........................................................................................................
 

.

Technical Assistance Paper No. 3 

..............................................
 

1.	 Education: B.A. or B.S. in infant & toddler 

development, family development, social 

work, psychology, human services or related 

field or B.A., B.S. or R.N. in pediatric or maternal 

health nursing or a related field preferred. 

2.	 Experience: Minimum of three years of 

experience working with pregnant women, 

infants, toddlers and/or their families. 

In addition, we have a multidisciplinary team within 

Drake University Early Head Start. Staff from different 

areas of expertise serve as a resource to one other. We have 

staff with education and/or experience in health, early 

childhood education, infant and toddler development, 

psychology, social work, cultural studies, and adult 

learning. In addition, there is a great deal of experience 

working with low-income and at-risk populations among 

staff members. 

Our professional development plans and continuing 

education are critical to ensure skilled and well-trained 

staff. This is especially true for the other specialists as they 

work with pregnant women and their families. Planning 

for professional development and further education is 

comprehensive addressing perinatal and newborn care as 

well as other issues impacting the expectant family. 

The following examples illustrate professional 

development opportunities in our agency: 

Certified Breastfeeding Educator Training: The Early 

Head Start Coordinator, the Perinatal Support Specialist, 

two Early Education Specialists, the Family Development 

Specialist and the Male Involvement Specialist have 

participated in training and are certified as breastfeeding educators. (Note: All specialists are home visitors.) 

All staff maintain this certification through ongoing 

professional development activities in regard to breastfeeding. This training better prepares staff to promote 

and support breastfeeding women and their families. 

............................................
 
16 Early Head Start National Resource Center 

...............................................
 

Certified Doula Training: The Early Head Start 

Coordinator, the Perinatal Support Specialist, two Early 

Education Specialists, the Family Development Specialist 

and the Program Assistant have participated in training 

and are in the process of completing the requirements 

for certification as a doula. This professional development opportunity provides important training 

regarding labor, delivery and postpartum period for staff 

to share with pregnant women and their families. In 

addition, EHS staff can serve as a professional labor assistant and provide support during labor and delivery. 

Certified Infant Massage Instructor Training: The Early 

Head Start Coordinator, the Perinatal Support Specialist, 

two Early Education Specialists, the Family Development 

Specialist and the Program Assistant have participated 

in training and have completed the requirements for 

certification as Infant Massage Instructors. The Male 

Involvement Specialist will be participating in this training in the next six months. Staff teach infant massage 

on an individualized basis during home visits. Infant 

massage classes are offered during the prenatal/postpartum classes and other parent child activities. 

Certified ChildBirth Educator Training: Currently, we 

are reviewing two different certification programs for 

staff training. 

Other Services for Expectant 

Families 

Slings: Expectant families participating in Drake 

University Early Head Start receive a sling and training 

on proper use upon the birth of their infant. Research 

shows that infants that are carried in a sling during the 

first six months of life, actually cry less from 6 to 12 

months of age. Again, this is a tool that increases contact between parent and infant and promotes bonding 

and attachment. 

...........................................................................................................


Breast Pump Loaner Program: Drake University Early 

Head Start has a breast pump loaner program for breastfeeding women to support breastfeeding. We provide 

the kits, training, on-going support and the loaner pump 

for the duration of breastfeeding. We have a variety of 

pumps available to best meet the needs of each breastfeeding woman. We make referrals to lactation consultants as appropriate. We have a high breastfeeding initiation and continuation rates in our program. 

Contact:
 

Kari Lebeda Townsend 515-282-9899
 

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Technical Assistance Paper No. 3 17 ...............................................
 

Selected Resources 


For Services to Pregnant Women
 ............ ..... ..........................................................................................


Biancuzzo, M. (1999). Breastfeeding the newborn: Clinical 

strategies for nurses. St. Louis, MO: Mosby, Inc. 

Burke, B. (1998). Preventing neural tube birth defects: A 

prevention model and resource guide. Atlanta, GA: CDC Folic 

Acid Promotion/NTD Prevention Clearinghouse. 

Florida State University Center for Prevention and Early 

Intervention Policy. (1999). Partners for a Healthy Baby Home 

Visiting Curriculum for Expectant Families. Tallahassee, FL: 

Author. 

Graham, M. Stablie, S. Powell, A., Pruett, Zervigon Hakes, 

A., & Butler, B. (1997). Serving pregnant women within Early 

Head Start: Lessons from the Panhandle Healthy Start and 

Early Head Start. Zero To Three, 18(2), 31-36. 

Institute of Medicine. Nutrition during pregnancy and 

lactation: An implementation guide. Washington DC: 

National Academy Press. 

Klaus, M., & Klaus, P. (1998) Your amazing newborn. New 

York, NY: Perseus Books. 

Lally, J.R., Quiett, D., Coelho, A., & Bailey, S. (1993). A case 

management and family support handbook. Sausalito, CA: 

WestEd. 

March of Dimes. (1994). Babies and you: A prenatal health 

promotion program. Wilkes-Barre, PA: March of Dimes 

Birth Defects Foundation. 

March of Dimes and the National Coalition of Hispanic 

Health and Human Services Organizations. (1995). 

Comenzando Bien: A prenatal education program for Hispanic 

women. White Plains, NY: March of Dimes Birth Defects 

Foundation. 

National Center for Education in Maternal and Child 

Health (1994). Reaching out: A directory of national 

organizations related to maternal and child health. Arlington, 

VA: Author. 

National Center for Education in Maternal and Child 

Health (1995). Building and sustaining systems of care for 

substance-using women and their infants: Lessons learned. 

Arlington, VA: Author. 

National Center for Education in Maternal and Child 

Health (1996). Prenatal Care: Bibliography of selections from 

NCEMCH reference collection and database of organization. 

Arlington, VA: Author. 

National Partnership for Women and Families. (1998). 

Guide to the Family and Medical Leave Act. Washington, DC: 

Author. 

Nickel, P.S., & Delany, H. (1985). Working with teen parents:
 

A survey of promising approaches. Chicago, IL: Family
 

Resource Coalition. 

U.S. Department of Health and Human Services. Caring for 

our future: The content of prenatal care. Washington, DC: 

Public Health Services. 

Zill, N., Zabin, L., & Armstrong, K. (1998). Family planning 

services for special populations. Menlo Park, CA: Kaiser Family 

Foundation. 

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Technical Assistance Paper No. 3 19 ...............................................
 

Appendix A 

My Pregnancy Memory Book:
 

A Week by Week Journal
 ...........................................................................................................


This resource was developed by Hand in Hand 

Early Head Start in Waterloo, Iowa. It is 

reproduced here as an example of one approach 

to introducing topics for prenatal education, and as a 

vehicle to address a variety of physical, social, and 

emotional issues that arise during pregnancy and 

childbirth. This is a condensed version of the format that 

is used with families. The actual journal provides space 

for writing and reflecting on the questions posed, a 

bibliography, handouts for each month of pregnancy, and 

answers to commonly asked questions. 

Week 1: This is the week of your last menstrual period. The 

first day of significant bleeding is considered the start date 

of pregnancy because it’s easier to remember than the date 

of conception. 

Week 2: In anticipation of a new life, the uterus forms a 

blood-rich lining of tissue called the endometrium. 

Week 3: This is the week of ovulation. If during this week 

the sperm and egg meet, a new life is started. 

Week 4: This is the week that the fetus will begin to develop. 

By the end of this week you will have missed a period, 

though slight staining is possible. 

Week 5: The embryo is now the size of an apple seed. This 

is the week that most women suspect they are pregnant; a 

home test can often confirm it. Schedule an appointment 

with a doctor. Who was the first person I told I was pregnant? 

Week 6: The embryo now looks more like a tadpole than 

a human. Baby’s heart, no bigger then a poppy seed, has 

started beating. If you haven’t already, you may begin to 

experience some nausea, vomiting, sore breasts, fatigue and 

frequent urination. What physical changes have I noticed 

in my body so far? 

Week 7: The embryo is the size of a raspberry. Dark spots 

are appearing where the eyes and nostrils will be. The arms 

and legs are beginning to form. What are my fears about 

parenthood? 

Week 8: The embryo has slightly webbed fingers and toes. 

Your expanding uterus is now the size of a peach. If I could 

give you any gift in the world, what would it be? 

Week 9: The baby is now about the size of a strawberry and 

is constantly moving, though you won’t feel it yet. What

changes am I making to prepare for you? 

Week 10: The baby’s genitals are now beginning to form, 

but it’s too soon for your doctor to tell the sex from an ultrasound. What are my hopes and dreams for you? 

Week 11: The baby is now swallowing and kicking. 

Fingernails and hair begin to fill in. You and your doctor 

can hear the heart beat with a special stethoscope. Your 

uterus is now the size of a grapefruit. What is something 

I want to teach you someday? 

Week 12: Your nausea may now begin to go away. The baby 

is fully formed from tooth buds to toenails. The odds of 

miscarriage drop considerably at this point. What things 

am I doing to communicate to you? 

Week 13: Your baby will squirm if your abdomen is prodded, though you can’t feel the movement. What were my 

thoughts when I first heard your heart beat? 

Week 14: Your baby is now the length of a crayon and has 

fingerprints. What exercises am I doing to keep you and 

me healthy? 

Week 15: Hair and eyebrows begin to grow. The baby’s skin 

is covered with ultrafine hair that usually disappears before 

birth. What is the best advice I have gotten so far and who 

was it from? 

Week 16: Your baby continues to grow. Most women need 

maternity clothes by now. What is my favorite outfit to 

wear and where did I get it? 

............................................
 
20 Early Head Start National Resource Center 

...............................................
 

Week 17: Your baby’s lungs are working and the heart is 

pumping blood through the body. Sometimes I wonder 

about......? 

Week 18: Within the next couple of weeks, you may begin 

to feel your baby move. Your baby is now able to suck its 

thumb. What unusual dreams have I had? 

Week 19: An ultrasound may be done around this time. 

During this sneak preview, you may see the baby kick, roll, 

or even such his thumb. If the baby is in the right position, it’s possible to tell if it’s a boy or girl. I’ve been thinking about names. Here are some ideas! 

Week 20: The top of your uterus now reaches your belly 

button. The baby is about six inches long and weighs about 

nine ounces. What family traditions do I want to pass on 

to you? 

Week 21: Your baby has grown a coat of a waxy, furry substance called vernix. Ask about childbirth classes if you 

haven’t already. Which holiday traditions will I pass on 

to you? 

Week 22: Sudden loud noises may set off a startle reflex in 

your baby, causing its heart rate to rise and arms and legs 

to kick. What movements have I felt and what do they 

remind me of? 

Week 23: At about one pound, your baby is proportioned 

like a newborn, though still scrawny. What foods am I craving? 

Week 24: Your baby’s hearing is fully developed. You may 

be given a test for gestational diabetes between now and 

28 weeks. I know it’s important to talk to you at this time. 

I like to tell you about.... 

Week 25: If you feel something in your midsection that 

resembles a dripping faucet, this is your baby having hiccups! To keep you healthy, these are some of the foods I 

am eating... 

Week 26: The baby weighs about one and a half pounds 

and is about nine inches long. I know you love music. What 

songs am I sharing with you? 

Week 27: Most women have gained 16-22 pounds by this 

point. Your baby weighs about 2 1/2 pounds and is about 

15 inches long. So far, I’ve gained______pounds. What 

am I doing to make myself more comfortable? 

Week 28: Your baby’s eyelids have opened and it will try 

to shield its eyes with its hands if a light is shone inside 

the uterus. What were my thoughts about your ultrasound 

pictures? 

...........................................................................................................


Week 29: Space starts to get tighter and the baby will do
 

less tumbling, but you will still feel plenty of stretching and
 

kicking. I have noticed your are most active when....
 

Week 30: The baby has eyelashes and any hair with which 

he or she will be born. When I think of you, I see..... 

Week 31: Now is the time to select a pediatrician for your
 

baby. You may want to check into pre-registering at the
 

hospital. These are the preparations I am making for your
 

arrival....
 

Week 32: Your baby now has fat developing for the first time
 

under the skin. What is my favorite baby gift I have bought
 

or received for you?
 

Week 33: You should be gaining about a pound a week now;
 

roughly half of that goes right to your baby. Your baby gains
 

50% of its birth weight during the next seven weeks, while
 

the skin grows plumper and pinker. How is this pregnancy
 

affecting my sleep?
 

Week 34: Most babies settle into the head-down position
 

now. This is also a good time to think about what you will
 

take with you to the hospital. What will I take with me
 

to the hospital?
 

Week 35: Your doctor will probably check you weekly until
 

you deliver. Be sure to write down your questions and take
 

them with you to your appointments. Here are some questions I have before you arrive...
 

Week 36: Your uterus is now a thousand times its original
 

size. The baby is beginning to position itself for birth. What
 

comments am I receiving about my pregnancy?
 

Week 37: By the end of this week your pregnancy has come
 

full term. Baby could be born any day. What fears do I
 

have about my delivery?
 

Week 38: Most of the baby’s waxy vernix and downy
 

hair have disappeared, although some babies may still
 

have some at birth. Who have I invited to be with me
 

during your delivery?
 

Week 39: The average full-term newborn is 20 inches
 

long and weighs about 7 ? pounds. Take it easy. If you
 

feel tired, rest. I want to be a good mom to you. Here
 

are some things I think it takes....
 

Week 40: Don’t worry if your baby isn’t born by your
 

due date. Only 5% are. Most doctors wait two weeks
 

before considering a pregnancy overdue. But it won’t be
 

long before the miracle that nature started so many
 

weeks ago is finally nestled in your arms. I knew it was
 

time for you to be born when...
 

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EARLY HEAD START NATIONAL RESOUR

Giving Children the Earliest Head Start: Developing an Individualized Approach to High-Quality Services for Pregnant Women Technical Assistance Paper No. 3 Prepared by Early Head Start National Resource Center @ ZERO TO THREE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Administration on Children, Youth and Families Head Start Bureau ...............................................

AP E D TR MENT OF HEALTH & HUMAN SERVICES • USA