How Group Prenatal Care can Improve Maternal Healthcare

Group prenatal care is common in many of the countries where we provide grants. In the U.S., it’s a fairly new model of care that’s becoming increasingly popular.

In fact, in many parts of the world, including the U.S., when too few healthcare providers are available to meet every pregnant woman’s needs, it’s the only healthcare option that makes sense. Now, a new study says it might deliver bigger benefits than traditional one-to-one patient-provider prenatal care.

The study, published in December 2015 in The American Journal of Public Health found that group prenatal care could substantially improve health outcomes for both mothers and babies. Researchers in the Yale School of Public Health studied 1000 women in 14 healthcare settings in New York. Some women attended group prenatal care and others received traditional individualized care. Those who received group care had reduced risks for preterm delivery and low birth weight babies and their babies spent less time in NICUs. The mothers were also less likely to become pregnant again too soon after giving birth.

Group prenatal care brings small groups of women and their partners together at the same stage of pregnancy. They receive complete prenatal care, (typically by a midwife), which includes screening for risk factors and complications, comprehensive prenatal and childbirth education and personal support. It also includes individual private time with a healthcare provider. Each visit centers on facilitated group discussions on topics that are pertinent to their stage of pregnancy.

An average group prenatal visit might last one to two hours. Traditional prenatal visits might last less than 10 minutes. In many groups women are encouraged to take ownership of their care by dipping their own urine and recording their own weight and blood pressure. Groups meet for seven to ten sessions throughout pregnancy and the postpartum period and month-by-month, week-by-week, they form relationships that sustain and support them; sometimes, well into their parenting years.

Ellen Tilden, CNM, PhD is part of the nurse midwifery faculty practice at the Center for Women’s Health at Oregon Health and Science University in Portland and the recipient of an NIH women’s health award to research group prenatal care. She says the benefits of group care extend to mothers, babies and providers.

“My interest in group care started because I wanted to have more time with my patients and more depth in our relationships. Clinic schedules with individual care are really challenging. It’s frustrating when a woman wants to have a deeper conversation about some aspect of her pregnancy and I have to keep my eye on the clock. If I spend the time my patient needs, then my next patient is kept waiting. Group prenatal care increases the quality and quantity of time my patient and I spend together. It also addresses a problem I see a lot in traditional one-on-one care — isolation. So many women are isolated from family or friends and a community who can share and support their pregnancy. Group care creates a community of women and men who are all going through the same profound life changes at the same time. The connections made in these groups can be very strong and long lasting. I got a text from one group member recently inviting me to their baby’s 3rd birthday. Everyone from the group was going to be there.”

Tilden says the benefits of this program show up in the maternity ward.

“My labor and delivery colleagues report that group care patients seem more confident and prepared for labor. They tend to be admitted to the hospital more frequently in active labor. That translates to births that require fewer interventions, including fewer cesarean deliveries. And mothers often report that they feel better supported and equipped to cope with whatever comes their way during labor and birth whether they want an unmedicated birth or not.”

Prospective group care patients might worry that the group dynamic could stifle conversations about sensitive subjects; Tilden says that more often, the group inspires deeper, richer conversations.

“Group care creates a space for women and partners to share information and challenges with other people who really get it and at times, it’s far more effective than anything I can do in one-on-one care. For example, it’s hard as a provider to have discussions with patients about weight gain and diet, especially since shame about body size and shape is a major cultural issue women have to deal with. But the group setting offers opportunities for real education and communication.”

Tilden shared the story of one mother who was pregnant with her second child and how the group benefitted her.

“The woman told the group that she’d never lost all the weight she gained with her first baby and shared how hurt she was by her mother-in-law who criticized her body and food choices. Everybody in that group stepped forward and shared their own experiences of being criticized and their own worries about eating well for their child. Then, they started brainstorming ways to improve nutrition and formed a walking group so they could get some exercise together. It was inspiring. I couldn’t have done that on my own. The women and the group did that for themselves.”

Group prenatal care is available in medical centers all over the United States. Contact your hospital or county health facility or log on to the Centering Healthcare Institute’s website for programs near you.

Resources:

Yale University. (2015, December 21). Mothers-to-be, babies benefit from group prenatal care, study finds. ScienceDaily. Retrieved February 4, 2016 from www.sciencedaily.com/releases/2015/12/151221193406.htm

Topics: Maternal Health 101s