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 "Prenatal care: Initial assessment" 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.
- Catling CJ, Medley N, Foureur M, et al. Group versus conventional antenatal care for women. Cochrane Database Syst Rev 2015; :CD007622.
- Hildingsson I, Rådestad I. Swedish women's satisfaction with medical and emotional aspects of antenatal care. J Adv Nurs 2005; 52:239.
- Novick G, Reid AE, Lewis J, et al. Group prenatal care: model fidelity and outcomes. Am J Obstet Gynecol 2013; 209:112.e1.
- Rising SS, Jolivet R. Circles of community: the CenteringPregnancy group prenatal care model. In: Birth models that work, Davis-Floyd R, Barclay L, Daviss BA, Tritten J (Eds), University of California Press, Berkeley and London 2009. p.365.
- Rising SS, Senterfitt C. Repairing health care: building relationships through groups. Creat Nurs 2009; 15:178.
- Novick G, Sadler LS, Knafl KA, et al. The intersection of everyday life and group prenatal care for women in two urban clinics. J Health Care Poor Underserved 2012; 23:589.
- Gaudion A, Menka Y. 'No decision about me without me': centering pregnancy. Pract Midwife 2010; 13:15.
- Rising SS. Centering pregnancy. An interdisciplinary model of empowerment. J Nurse Midwifery 1998; 43:46.
- Teate A, Leap N, Rising SS, Homer CS. Women's experiences of group antenatal care in Australia--the CenteringPregnancy Pilot Study. Midwifery 2011; 27:138.
- Klima C, Norr K, Vonderheid S, Handler A. Introduction of CenteringPregnancy in a public health clinic. J Midwifery Womens Health 2009; 54:27.
- Jafari F, Eftekhar H, Fotouhi A, et al. Comparison of maternal and neonatal outcomes of group versus individual prenatal care: a new experience in Iran. Health Care Women Int 2010; 31:571.
- Patil CL, Abrams ET, Klima C, et al. CenteringPregnancy-Africa: a pilot of group antenatal care to address Millennium Development Goals. Midwifery 2013; 29:1190.
- Brock E, Charlton KE, Yeatman H. Identification and evaluation of models of antenatal care in Australia--a review of the evidence. Aust N Z J Obstet Gynaecol 2014; 54:300.
- Little SH, Motohara S, Miyazaki K, et al. Prenatal group visit program for a population with limited English proficiency. J Am Board Fam Med 2013; 26:728.
- Trotman G, Chhatre G, Darolia R, et al. The Effect of Centering Pregnancy versus Traditional Prenatal Care Models on Improved Adolescent Health Behaviors in the Perinatal Period. J Pediatr Adolesc Gynecol 2015; 28:395.
- Weber Yorga KD, Sheeder JL. Which Pregnant Adolescents Would be Interested in Group-Based Care, and Why? J Pediatr Adolesc Gynecol 2015; 28:508.
- Kershaw TS, Magriples U, Westdahl C, et al. Pregnancy as a window of opportunity for HIV prevention: effects of an HIV intervention delivered within prenatal care. Am J Public Health 2009; 99:2079.
- Rising SS, Kennedy HP, Klima CS. Redesigning prenatal care through CenteringPregnancy. J Midwifery Womens Health 2004; 49:398.
- Preconception and Antepartum Care. In: Guidelines for Perinatal Care, 7, Riley LE, Stark AR (Eds), American Academy of Pediatrics and American College of Obstetricians and Gynecologists, 2012. p.105.
- National Institute for Health and Clinical Excellence. www.nice.org.uk/guidance/cg62 (Accessed on August 31, 2015).
- Society of Obstetricians and Gynaecologists of Canada. Clinical Practice Guidelines. http://sogc.org/clinical-practice-guidelines/ (Accessed on August 31, 2015).
- World Health Organization: Provision of effective antenatal care. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/effective_antenatal_care.pdf (Accessed on August 31, 2015).
- The Royal Australian and New Zealand College of Obstetricians and Gynaecologists: Standard of maternity care in Australia and New Zealand. https://www.ranzcog.edu.au/college-statements-guidelines.html (Accessed on August 31, 2015).
- Caring for our future: the content of prenatal care. US Public Health Service, Dept of Health & Human Services, Washington, DC 1989.
- Richardson C. Crossing the quality chasm: A new health system for the 21st century. National Academy Press; Institute of Medicine, Washington, DC 2001.
- Shakespear K, Waite PJ, Gast J. A comparison of health behaviors of women in centering pregnancy and traditional prenatal care. Matern Child Health J 2010; 14:202.
- Robertson B, Aycock DM, Darnell LA. Comparison of centering pregnancy to traditional care in Hispanic mothers. Matern Child Health J 2009; 13:407.
- Wedin K, Molin J, Crang Svalenius EL. Group antenatal care: new pedagogic method for antenatal care--a pilot study. Midwifery 2010; 26:389.
- Andersson E, Christensson K, Hildingsson I. Mothers' satisfaction with group antenatal care versus individual antenatal care--a clinical trial. Sex Reprod Healthc 2013; 4:113.
- Carter EB, Temming LA, Akin J, et al. Group Prenatal Care Compared With Traditional Prenatal Care: A Systematic Review and Meta-analysis. Obstet Gynecol 2016; 128:551.
- Grady MA, Bloom KC. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. J Midwifery Womens Health 2004; 49:412.
- Kennedy HP, Farrell T, Paden R, et al. "I wasn't alone"--a study of group prenatal care in the military. J Midwifery Womens Health 2009; 54:176.
- Tanner-Smith EE, Steinka-Fry KT, Gesell SB. Comparative effectiveness of group and individual prenatal care on gestational weight gain. Matern Child Health J 2014; 18:1711.
- Magriples U, Boynton MH, Kershaw TS, et al. The impact of group prenatal care on pregnancy and postpartum weight trajectories. Am J Obstet Gynecol 2015; 213:688.e1.
- Kominiarek MA, Crockett A, Covington-Kolb S, et al. Association of Group Prenatal Care With Gestational Weight Gain. Obstet Gynecol 2017; 129:663.
- Hale N, Picklesimer AH, Billings DL, Covington-Kolb S. The impact of Centering Pregnancy Group Prenatal Care on postpartum family planning. Am J Obstet Gynecol 2014; 210:50.e1.
- Ickovics JR, Reed E, Magriples U, et al. Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial. Psychol Health 2011; 26:235.
- Heberlein EC, Picklesimer AH, Billings DL, et al. The comparative effects of group prenatal care on psychosocial outcomes. Arch Womens Ment Health 2016; 19:259.
- Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstet Gynecol 2007; 110:330.
- Tanner-Smith EE, Steinka-Fry KT, Lipsey MW. Effects of CenteringPregnancy group prenatal care on breastfeeding outcomes. J Midwifery Womens Health 2013; 58:389.
- Mazzoni SE, Hill PK, Webster KW, et al. Group prenatal care for women with gestational diabetes (.). J Matern Fetal Neonatal Med 2016; 29:2852.
- Massey Z, Rising SS, Ickovics J. CenteringPregnancy group prenatal care: Promoting relationship-centered care. J Obstet Gynecol Neonatal Nurs 2006; 35:286.
- Kennedy HP, Farrell T, Paden R, et al. A randomized clinical trial of group prenatal care in two military settings. Mil Med 2011; 176:1169.
- Tilden EL, Hersh SR, Emeis CL, et al. Group prenatal care: review of outcomes and recommendations for model implementation. Obstet Gynecol Surv 2014; 69:46.
- Rowley RA, Phillips LE, O'Dell L, et al. Group Prenatal Care: A Financial Perspective. Matern Child Health J 2016; 20:1.
- DeFrancesco M, Rising SS. A new way to be “patient-centered” and help your practice. The Female Patient 2010; 35:46.
- McNeil DA, Vekved M, Dolan SM, et al. A qualitative study of the experience of CenteringPregnancy group prenatal care for physicians. BMC Pregnancy Childbirth 2013; 13 Suppl 1:S6.
- Klima CS. Centering pregnancy: a model for pregnant adolescents. J Midwifery Womens Health 2003; 48:220.
- McNeil DA, Vekved M, Dolan SM, et al. Getting more than they realized they needed: a qualitative study of women's experience of group prenatal care. BMC Pregnancy Childbirth 2012; 12:17.
- Mooney SE, Russell MA, Prairie B, et al. Group prenatal care: an analysis of cost. J Health Care Finance 2008; 34:31.
- Sheeder J, Weber Yorga K, Kabir-Greher K. A review of prenatal group care literature: the need for a structured theoretical framework and systematic evaluation. Matern Child Health J 2012; 16:177.
- Bloomfield J, Rising SS. CenteringParenting: an innovative dyad model for group mother-infant care. J Midwifery Womens Health 2013; 58:683.
- Picklesimer A, Heberlein E, Covington-Kolb S. Group prenatal care: has its time come? Clin Obstet Gynecol 2015; 58:380.