Group prenatal care
- Sharon Schindler Rising, MSN, CNM, FACNM
Sharon Schindler Rising, MSN, CNM, FACNM
- President Emeritus
- Centering Healthcare Institute
The goals of prenatal and postpartum care are to provide education and preparation for childbirth and the postpartum period; screen for risk factors and complications of pregnancy; and promote well-being for the pregnant woman, the fetus/infant, and the family. Rising healthcare costs and limited provider availability have intensified the search for evidence-based, cost-effective prenatal care that maximizes the outcomes of the mother and child. While traditional prenatal and postpartum care has consisted of one-on-one visits, there are no data suggesting that this care model is optimal. Group prenatal care, in which a small cohort of women with similar due dates participate in a structured prenatal care program facilitated by a clinician, is an alternative model of care that has been associated with benefits for both the patient and the provider.
This review will focus on the structure, outcomes, and patient selection for group prenatal care. Specific components of prenatal care are presented separately. (See "Initial prenatal assessment and first-trimester prenatal care" and "Prenatal care (second and third trimesters)".)
Antenatal care has traditionally consisted of one-on-one visits with a clinical provider(s) that occurred at specific time intervals throughout the pregnancy . While this model allows for individualized attention and risk assessment, it has also been associated with long wait times, fragmented and inconsistent care, and decreased patient satisfaction .
Group prenatal care is built on the premise that some types of health care are more effectively and efficiently provided in groups that are facilitated rather than taught. To this end, the group prenatal care model traditionally brings together 8 to 12 low-risk pregnant women, who are matched by gestational age, for prenatal care and facilitated discussion and learning sessions. After each woman has had an initial, individual prenatal visit, this cohort moves through pregnancy care and milestones together as they meet over 8 to 10 visits, each visit lasting approximately 90 to 120 minutes . The facilitators and clinicians are generally the same throughout the sessions. Group sessions can be extended into the postpartum period as well. Of note, group prenatal care is not the same as enhanced prenatal care. In enhanced individual prenatal care, a woman receives more visits or more information using didactic approaches.
The first part of the session typically includes the standard maternal and fetal assessments. The group prenatal care model encourages women to be involved in their own care; in some programs, the women measure and record their blood pressure and weight, and calculate their gestational age. Data collection can be done with the assistance or supervision of a nurse or medical assistant. Routine physical assessments, such as fundal height and fetal heart rate, are often done in a semi-private area of the group space by one of the clinicians. This semi-private portion of the visit also allows the provider and patient to assess if there are concerns that should be addressed outside of the group context.
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