Women's experiences of group antenatal care in Australia-the CenteringPregnancy Pilot Study

Objective: to describe the experiences of women who were participants in the Australian CenteringPregnancy Pilot Study. CenteringPregnancy is an innovative model of care where antenatal care is provided in a group environment. The aim of the pilot study was to determine whether it would be feasible to implement this model of care in Australia. Design: a descriptive study was conducted. Data included clinical information from hospital records, and antenatal and postnatal questionnaires. Setting: two metropolitan hospitals in Sydney, Australia. Participants: 35 women were recruited to the study and 33 ultimately received all their antenatal care (eight sessions) through five[CH1] CenteringPregnancy groups. Findings: difficulties with recruitment within a short study timeline resulted in only 35 (20%) of 171 women who were offered group antenatal care choosing to participate. Most women chose this form of antenatal care in order to build friendships and support networks. Attendance rates were high and women appreciated the opportunity and time to build supportive relationships through sharing knowledge, ideas and experiences with other women and with midwives facilitating the groups. The opportunity for partners to attend was identified as important. Clinical outcomes for women were in keeping with those for women receiving standard care; however, the numbers were small. Conclusion: the high satisfaction of the women suggests that CenteringPregnancy is an appropriate model of care for many women in Australian settings, particularly if recruitment strategies are addressed and women's partners can participate. Implications for practice: CenteringPregnancy group antenatal care assists women with the development of social support networks and is an acceptable way in which to provide antenatal care in an Australian setting. Recruitment strategies should include ensuring that practitioners are confident in explaining the advantages of group antenatal care to women in early pregnancy. Further research needs to be conducted to implement this model of care more widely. © 2009 Elsevier Ltd

The St. George Homebirth Program: An evaluation of the first 100 booked women

Background: The St. George Homebirth Program was the first publicly funded homebirth model of care set up in New South Wales. This program provides access to selected women at low obstetric risk the option of having their babies at home. There are only four other publicly funded homebirth programs operating in Australia. Aims: To report the outcomes of the first 100 women booked at the St. George Homebirth Program. Methods: A prospective descriptive study was undertaken. Data were collected on the first 100 women who gave birth between November 2005 and March 2009. Two databases were accessed and missing data were followed up by review of the relevant charts. Results: Of the first 100 booked women, 63 achieved a homebirth, 30 were transferred to hospital or independent midwifery care in the antenatal period and seven were transferred intrapartum. Two women were transferred to hospital in the early postnatal period, one for a postpartum haemorrhage and one for hypotension. One baby suffered mild respiratory distress, was treated in the emergency department and was discharged home within four hours. Conclusion: The St. George Hospital homebirth program has provided reassuring outcomes for the first 100 women it has cared for over the past four years. Wider availability of this service could be achieved provided there is the appropriate close collaboration between providers and effective processes for consultation, referral and transfer. The outcomes of women and babies in publicly funded homebirth programs deserve further study, and the development of a national prospective database of all planned homebirths would contribute to this knowledge. © 2009 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Group versus conventional antenatal care for women

© 2015 The Cochrane Collaboration. Background: Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. Objectives: 1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies. 2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies. Selection criteria: All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible. Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy. Main results: We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) and perinatal mortality (RR 0.63, 95% CI 0.32 to 1.25; three trials; N = 1943). Satisfaction was rated as high among women who were allocated to group antenatal care, but this outcome was measured in only one trial. In this trial, mean satisfaction with care in the group given antenatal care was almost five times greater than that reported by those allocated to standard care (mean difference 4.90, 95% CI 3.10 to 6.70; one study; N = 993). No differences in neonatal intensive care admission, initiation of breastfeeding or spontaneous vaginal birth were observed between groups. Several outcomes related to stress and depression were reported in one trial. No differences between groups were observed for any of these outcomes. No data were available on the effects of group antenatal care on care provider satisfaction. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess evidence for seven prespecified outcomes; results ranged from low quality (perinatal mortality) to moderate quality (preterm birth, low birthweight, neonatal intensive care unit admission, breastfeeding initiation) to high quality (satisfaction with antenatal care, spontaneous vaginal birth). Authors' conclusions: Available evidence suggests that group antenatal care is positively viewed by women and is associated with no adverse outcomes for them or for their babies. No differences in the rate of preterm birth were reported when women received group antenatal care. This review is limited because of the small numbers of studies and women, and because one study contributed 42% of the women. Most of the analyses are based on a single study. Additional research is required to determine whether group antenatal care is associated with significant benefit in terms of preterm birth or birthweight

Getting more than they realized they needed: a qualitative study of women's experience of group prenatal care

<p>Abstract</p> <p>Background</p> <p>Pregnant women in Canada have traditionally received prenatal care individually from their physicians, with some women attending prenatal education classes. Group prenatal care is a departure from these practices providing a forum for women to experience medical care and child birth education simultaneously and in a group setting. Although other qualitative studies have described the experience of group prenatal care, this is the first which sought to understand the central meaning or core of the experience. The purpose of this study was to understand the central meaning of the experience of group prenatal care for women who participated in CenteringPregnancy through a maternity clinic in Calgary, Canada.</p> <p>Methods</p> <p>The study used a phenomenological approach. Twelve women participated postpartum in a one-on-one interview and/or a group validation session between June 2009 and July 2010.</p> <p>Results</p> <p>Six themes emerged: (1) "getting more in one place at one time"; (2) "feeling supported"; (3) "learning and gaining meaningful information"; (4) "not feeling alone in the experience"; (5) "connecting"; and (6) "actively participating and taking on ownership of care". These themes contributed to the core phenomenon of women "getting more than they realized they needed". The active sharing among those in the group allowed women to have both their known and subconscious needs met.</p> <p>Conclusions</p> <p>Women's experience of group prenatal care reflected strong elements of social support in that women had different types of needs met and felt supported. The findings also broadened the understanding of some aspects of social support beyond current theories. In a contemporary North American society, the results of this study indicate that women gain from group prenatal care in terms of empowerment, efficiency, social support and education in ways not routinely available through individual care. This model of care could play a key role in addressing women's needs and improving health outcomes.</p

Midwives' experiences of becoming CenteringPregnancy facilitators: A pilot study in Sydney, Australia

Background: A pilot study was undertaken between 2006 and 2008 to explore the feasibility of implementing the CenteringPregnancy model of group antenatal care in Australia. The study was undertaken at two hospital antenatal clinics and two community healthcare centres in southern Sydney

What are the factors that improve how midwives interact with women in the antenatal appointment?

Introduction: Midwifery Continuity of Care (MCOC) demonstrates improved outcomes, which are linked to positive midwife-woman relationships that develop during the antenatal period. Aim: This study examined midwife-woman interactions in antenatal appointments in MCOC and Standard Midwifery Care (SMC) in order to discover what works well in the antenatal appointment and improve the care women receive. Methods: This feminist ethnographic study took place between 2012 and 2015 after ethical approval was received. Antenatal appointments were videoed, focus groups took place with midwives and managers and interviews with midwives and women. Data were analysed thematically and descriptively. Results: 18 midwife-woman pairs were video-recorded and observed during a 36 week appointment, at two hospital sites and in women’s homes. Worry was a significant part of the antenatal appointment and was affected by time, environment and midwife investment. Worry was transformed to shared hope when these factors were optimal. Investment was seen in the midwife-woman interaction when they shared communications with ‘storytelling’ and ‘discussing’ rather than a one-sided action of the midwife ‘telling’ the woman, which moderated and was moderated by time and environment. Midwives and women shared stories to share their knowledge, reciprocate and reassure, enabling connection. Conclusion: Shared storytelling in the antenatal appointment was facilitated by MCOC and some individual midwives and was important to women, as it engendered compassion, enhanced healthcare messages, moderated worry and created hope. Implications: How midwives interact with women in antenatal appointments matters. Antenatal care is improved when it occurs in women’s homes and non-clinical environments. Repeated and ongoing time with the same midwife (MCOC) facilitates storytelling and enables the worry of childbirth to be transformed to shared hope

In a hard spot: Providing group prenatal care in two urban clinics

AbstractObjectivesCenteringPregnancy (Centering) group prenatal care has been demonstrated to improve perinatal outcomes and provide a positive experience of care for women, but it can be difficult to implement and sustain in some clinical settings. The purpose of this study was to examine the challenges encountered when Centering group prenatal care was provided, and the responses of Centering group leaders to these challenges.Designthis was a longitudinal, qualitative study using interpretive description. Data collection included participant-observation and interviews with group leaders and women receiving group prenatal care.Settingtwo urban clinics providing care to low income women in the northeastern United States.Participantsinterview participants were 23 pregnant women (primarily African-American and Hispanic) receiving group prenatal care; other participants were 24 significant others and support staff participating in groups, and two nurse-midwife group leaders.Findingsthe clinics did not always provide full resources for implementing Centering as designed, creating numerous challenges for the group leaders, who were committed to providing group prenatal care. In an attempt to sustain the model in the face of these limitations, the group leaders made a number of compromises and modifications to the Centering model.Key conclusionsthe limited clinic resources and resulting modifications of the model had a number of downstream effects, some of which affected relationships within groups, participation, and group cohesion.Implicationsmodifications of the Centering model should be undertaken with caution. Strategies are needed to enhance the success and sustainability of Centering in varied clinical settings so that the benefits of the model, which have been demonstrated under more controlled circumstances, can be conferred to women receiving routine care during pregnancy