Today’s health care leaders are seeking alternate ways of delivering care that enhance efficiency and cost-effectiveness, improve quality and increase patient satisfaction.
Group care is one such approach and is being used for patients with chronic conditions such as diabetes and heart disease as well as healthy children and pregnant women.
A study from the Yale School of Public Health, published last fall in the American Journal of Public Health, showed that group prenatal care can substantially improve results for mothers and their babies and could also, according to the study’s lead author, reduce health disparities and lower health care costs.
Group prenatal care was developed in the 1990s in Connecticut. Called CenteringPregnancy®, the concept has been adopted and adapted by obstetrical practices around the country, including Cooley Dickinson Hospital in Northampton. It replaces individual care throughout the second and part of the third trimester.
In general, group care follows the same recommended appointment schedule as standard prenatal care — every four weeks until the 28th through 30th week of pregnancy, then every two weeks until the 36th week of pregnancy, then weekly until the baby is born.
With group care, pregnant women see their regular midwives or obstetricians for individual appointments for the first 18 weeks of pregnancy, then join the group. Toward the end of pregnancy, women continue in the group but also return to individual visits.
Group prenatal care is covered by insurance in the same manner as individual care.
Group sessions complement — rather than replace — childbirth education classes. Participants can use the group setting to further explore what they are learning in childbirth education and to compare notes with others.
In fact, getting to know other expectant parents is one of the main benefits of group prenatal care. The approach is structured to bring together eight to 10 women who are due at roughly the same time; partners are welcome and are encouraged to attend sessions, too.
Being in a group with other women who are at the same stage of pregnancy helps participants open up and learn from each other, developing strong friendships. The community created through the group setting — sharing important months before a baby is born — is often a lasting one. Some groups from past years still get together for an annual birthday party around the time all their children were born.
At the beginning of every two-hour session, each participant takes and records her own blood pressure and weight, then spends a few minutes with the certified nurse midwife. This hands-on assessment and check-in also enables the midwife to share lab results or explain upcoming imaging or lab work.
When everyone has completed the health assessment, which normally takes approximately five minutes per person, the group comes together. While the group facilitator and the midwife often have some information to share — issues pertinent to the baby’s gestational age, for example — much of the discussion revolves around what the participants want to talk about. This can be anything from asking for clarification of what happens during labor to expressing anxieties around breastfeeding to talking about emotional stresses and physical discomforts.
The idea of group prenatal care is appealing to many women. Those who are very proactive about their own and their family’s health care in general may find the format helpful, as participants have ample time during the sessions to ask questions, and the midwife is present for the whole two hours. Women who choose midwives as their prenatal care providers often opt for the group care approach for the same reason — more time for education. Women who are looking for an additional support network can find it in the group format. Finally, some women just find groups more interesting and more fun.
Many pregnant women believe group prenatal care represents the best of both worlds — meeting their physical, intellectual and emotional needs while also allowing for thorough prenatal care. It offers a sympathetic community, focused time with partners and peers, professional and real-life resources — gained through listening and sharing — and the prospect of developing long-term relationships with those who have shared the very special experience of pregnancy, childbirth and parenting.
Katherine Bohne is Education Coordinator for Women’s Health, Cooley Dickinson Hospital, Northampton. TheWomen’s Health column is written by health care professionals affiliated with Cooley Dickinson Hospital. It appears here monthly.