Insights into the Efficacy of Pre- and Postnatal Group Care

Do your expectant clients ever ask you whether other pregnant women are sensitive to strong smells? Do they wonder about the different ways to hold a baby while nursing? Do postpartum women with whom you interact, wonder if their babies are hitting the right milestones? Group care in both prenatal and postpartum periods of the childbearing years has been shown to improve birth, breastfeeding and parenting outcomes, parent satisfaction, and parent empowerment.

Sharon Schindler Rising first took women out of the exam rooms and into a group setting for education, support, and prenatal care in 1994.  Her vision was to bring women together with the goal of empowering them, and giving them autonomy and responsibility for their care.  Centering Pregnancyퟀ (CP) , CenteringParenting, and CenteringDiabetes can now be found in more than 300 U.S. locations and in several foreign countries as well.

The University of North Carolina's Department of Family Medicine started providing CenteringPregnancy group care in 2002 and about half of our 170 prenatal patients annually choose group care, as an extension of their () individual care, versus individual care, alone.  UNC Family Medicine provides an average of 250 group visits per year.Group care was successful for both diabetics (starting in 2001) and prenatal parents and was followed in 2006 with group care for well child visits.  The program is called WellBabies and follows the routine preventive schedule developed by the American Academy of Pediatrics.  Like group prenatal care, the intention is to educate, to empower, and to provide care for parents and their babies .  Both groups meet in the same friendly room where the initial prenatal visit takes place.   There are differences in numbers and types of visits that appears below:

Group Prenatal Care Group WellBabies Care
Length of visits 90 minutes 120 minutes
Timing of visits Groups meet around the 15th-17th week of their pregnancies.  After the initial prenatal visit and an individual visit with their resident physician, they are scheduled for group care at the standard times for prenatal visits. WellBabies starts at the baby's 2- month well child visit.  Babies may have been born within 1-3 weeks of each other. A total of 5 visits occur at 2,4,6,9, and 12 months.
Care providers Faculty physician, resident physician, and perinatal nurse coordinator Faculty physician or pediatric nurse practitioner along with resident physician.
Structure Check-in.  Self-monitoring and charting of date, gestational age, weight, blood pressure, and fetal movement.  Parents write concerns on the board. Check-in and assessments. Parents with facilitator assistance document child's length, weight, head circumference, complete the well-child form and write concerns on the board. Facilitator leads group discussion and explains growth charts as parents review their child's chart.  Children are placed on colorful mats and the discussion focuses on parent concerns, development and anticipatory guidance.   Parents complete the Parents' Evaluation of Developmental Statusퟀ (PEDS) Questionnaire and/or the Ages and Stages Questionnairesퟀ (ASQ) for babies over 6 months with Medicaid or with developmental concerns.  Immunizations are given as needed.
Education Parents' concerns, facilitators' discussion points and anticipatory guidance.  Topics are taken first from needs to know group and then from nice to know group. Community resources and personal experiences give depth to the discussion. Parents' concerns, growth and development, infant cues, sleep/wake states, communication, feeding, sleeping and other activities of daily living, normal infant behaviors, and anticipatory guidance.
Health Assessment Self-monitoring and charting. Physician assessments and communication with parent. Infant monitoring and charting. Physician interprets findings and shares with parents.
Supportive Care Group members become learners and teachers.  Sharing of experiences and knowledge empowers them in both ways. Parents see the normal differences in behavior and temperament among the children and share lessons learned while adapting to the ever-changing baby.
Recruiting Begins with initial prenatal visit. Many who have been in prenatal group together like to remain together for WellBabies.  Others are recruited by phone.

Not many assessments of group versus individual care have been done. However, evidence shows that after experiencing group care, parents valued support from other women, developmental comparisons, learning from others' experiences, increased parental involvement in well-child visits, and more time with care providers.  In the Fall 2011 issue of the Journal of Perinatal Education a study of "Midwives - Perceptions Of Implementing the Centering Pregnancy Model of Prenatal Care" recommends, that individual providers and professional organizations embrace the CP model of group prenatal care and that more midwifery, nursing, and medical schools integrate CP into their obstetrical/maternity curricula. (Baldwin and Phillips, 2011).

Group care embodies the definition of patient-centered care by the Institute of Healthcare Improvement and the Institute of Medicine's (2001) report, "Crossing the Quality Chasm".  Shared decision making and respecting patients and their families as partners in health-care are assets of patient-centered care found in group care and are endorsed by the National Committee on Quality Assurance, Institute of Medicine, Institute for Healthcare Improvement, as well as other professional healthcare organizations.  References_B Hotelling_blog post.

Posted by:  Barbara Hotelling, MSN, WHNP-BC, LCCE, CD(DONA) Barbara has been an active birth doula and Lamaze educator for over 25 years. She maintains her certifications with DONA International and Lamaze International, is on the Lamaze Faculty and is an approved DONA Doula Trainer. In addition to teaching Lamaze seminars for training childbirth educators and doula trainings, she has taught Labor Support for Nurses, Labor Support and the Teen Specialist programs of Lamaze throughout the United States , Canada, and in Korea. Barbara has served as President of DONA International, Chair of the Coalition for Improving Maternity Services (CIMS) and President of Lamaze International. Presently she serves on the Certification Council of Lamaze International and the Leadership Team of CIMS.

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