Bio: Anna Gaudion is an academic researcher from University of Cambridge. The author has contributed to research in topics: Health education & Health care. The author has an hindex of 4, co-authored 13 publications receiving 72 citations. Previous affiliations of Anna Gaudion include King's College & University of East London.
TL;DR: A feasibility study was conducted in South East London from 2008 to 2010, to assess if the CenteringPregnancy model could be introduced into NHS settings, if women would be prepared to join a group model of care and to explore the views of the women, their partners and midwives who participated.
Abstract: CenteringPregnancy® is a model of group antenatal care which was devised and developed in the United States. A feasibility study was conducted in South East London from 2008 to 2010, to assess if the model could be introduced into NHS settings, if women would be prepared to join a group model of care and to explore the views of the women, their partners and midwives who participated. This was the first time the model had been implemented in the UK. Six antenatal groups, attended by 60 women and their partners and facilitated by 12 midwives, were established for the feasibility study with a seventh group of 8 women and their partners established later to bring the learning together and inform an operational guidance document (Gaudion and Menka, 2011). Women whose pregnancies were classed as low or high risk could opt for group antenatal care at the study site after discussion with a midwife at their antenatal booking visit. Integral components of the CenteringPregnancy model are the evaluations of care whi...
TL;DR: The background to the development and implementation of the first feasibility study to be conducted in the UK is described and adaptations necessary to comply with national guidance and policy recommendations for NHS maternity care, and midwifery rules and regulations are described.
Abstract: CenteringPregnancy® is an innovative model of group antenatal care devised and developed in the United States. The model differs from traditional care in that women participate in a social, supportive group process, which develops their knowledge and confidence, and increases their personal and maternal self-efficacy. Following initial studies in the US, the CenteringPregnancy model has been adapted and implemented in a number of studies internationally, with a growing body of evidence of positive results in terms of clinical outcomes, satisfaction with antenatal care, perceived knowledge of issues around pregnancy, birth and parenthood. The background to the development and implementation of the first feasibility study to be conducted in the UK is described. This includes adaptations necessary to comply with national guidance and policy recommendations for NHS maternity care, and midwifery rules and regulations. There is a need for further larger studies to assess if similar positive outcomes could be re...
TL;DR: King’s College Hospital, London has been piloting an innovative way of providing antenatal care in which physical care, information sharing and an opportunity to meet other pregnant women is combined within a group setting.
Abstract: T he premise of working in partnership with women and their families is a core value and direction present in the regulation, policy direction and guidance that informs our professional lives. King’s College Hospital, London has been piloting an innovative way of providing antenatal care in which physical care, information sharing and an opportunity to meet other pregnant women is combined within a group setting. This way of working can facilitate and enhance partnership working, and in many ways puts the women and their families ‘in the driving seat’. This article will begin with a brief summary of the policy and direction, and a description of the essential elements of ‘centering pregnancy’. It will then describe what we learnt during our delightful experience of working in this way.
TL;DR: The contribution of maternity care to child health and the implications of legislation that excludes ‘failed’ asylum seekers from free NHS secondary health care and denies them housing and financial support are identified.
Abstract: This article analyses provision of health and social care for pregnant women and new families who have been unsuccessful in their asylum claims in the United Kingdom. It identifies the contribution of maternity care to child health, and examines the implications of the legislation that excludes ‘failed’ asylum seekers from free NHS secondary health care and denies them housing and financial support. Finally, the article examines the impact on pregnant women and their babies of being held in removal (detention) centers.
TL;DR: Available evidence suggests that group antenatal care is positively viewed by women and is associated with no adverse outcomes for them or for their babies, and additional research is required to determine whether group antennatal care is associatedWith significant benefit in terms of preterm birth or birthweight.
Abstract: Background Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. Objectives 1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies. 2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies. Selection criteria All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy. Main results We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) and perinatal mortality (RR 0.63, 95% CI 0.32 to 1.25; three trials; N = 1943). Satisfaction was rated marginally higher among women who were allocated to group antenatal care, but this 5 point difference is not clinically meaningful on the scale used (mean difference 4.90, 95% CI 3.10 to 6.70; one study; N = 993). No differences in neonatal intensive care admission, initiation of breastfeeding or spontaneous vaginal birth were observed between groups. Several outcomes related to stress and depression were reported in one trial. No differences between groups were observed for any of these outcomes. No data were available on the effects of group antenatal care on care provider satisfaction. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess evidence for seven prespecified outcomes; results ranged from low quality (perinatal mortality) to moderate quality (preterm birth, low birthweight, neonatal intensive care unit admission, breastfeeding initiation) to high quality (satisfaction with antenatal care, spontaneous vaginal birth). Authors' conclusions Available evidence suggests that group antenatal care is acceptable to women and is associated with no adverse outcomes for them or for their babies. No differences in the rate of preterm birth were reported when women received group antenatal care. This review is limited because of the small numbers of studies and women, and because one study contributed 42% of the women. Most of the analyses are based on a single study. Additional research is required to determine whether group antenatal care is associated with significant benefit in terms of preterm birth or birthweight.
TL;DR: Interventions warrant replication within randomised controlled trials (RCTs), and the most cost-effective interventions were estimated to be midwifery redesigned postnatal care, PCA-based and IPT-based intervention in the sensitivity analysis, although there was considerable uncertainty.
Abstract: Background Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. Objectives To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness. Data sources We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013. Review methods Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values. Results From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of –1.43 (95% credible interval –4.00 to 1.36)], person-centred approach (PCA)-based and cognitive–behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent–infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive–behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated) and IPT-based intervention in the sensitivity analysis (indicated), although there was considerable uncertainty. Expected value of partial perfect information (EVPPI) for efficacy data was in excess of £150M for each population. Given the EVPPI values, future trials assessing the relative efficacies of promising interventions appears to represent value for money. Limitations In the NMAs, some trials were omitted because they could not be connected to the main network of evidence or did not provide EPDS scores. This may have introduced reporting or selection bias. No adjustment was made for the lack of quality of some trials. Although we appraised a very large number of studies, much of the evidence was inconclusive. Conclusions Interventions warrant replication within randomised controlled trials (RCTs). Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future work recommendations Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future research conducting RCTs to establish which interventions are most clinically effective and cost-effective should be considered. Study registration This study is registered as PROSPERO CRD42012003273. Funding The National Institute for Health Research Health Technology Assessment programme.
TL;DR: Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care.
Abstract: Background: Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities. Objective: To provide up-to-date systematic evidence on migrant women’s experiences of pregnancy, childbirth and maternity care in their destination European country. Search strategy: CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017. Selection criteria: Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe. Data collection and analysis: Qualitative data were extracted and analysed using thematic synthesis. Results: The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: ‘Finding the way—the experience of navigating the system in a new place’, ‘We don't understand each other’, ‘The way you treat me matters’, and ‘My needs go beyond being pregnant’. Conclusions: Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs.
TL;DR: Birth Counts brings together statistical information about pregnancy and childbirth in the United Kingdom, drawing on information made available by the Government Statistical Service and the Office of Population Censuses and Surveys.
Abstract: Epidemiologists, sociologists, economists, health service administrators, the media, as well as the medical and nursing professions are, for different reasons, increasingly involving themselves in the statistics of reproduction and birth. Only the brave would contemplate writing a book on the subject-the risk of generating a large literary yawn is formidable. Nonetheless, Alison Macfarlane, a statistician, and Miranda Mugford, an economist, both from the National Perinatal Epidemiology Unit in Oxford, rise to the challenge and the result is a remarkable book that is anything but dull. Birth Counts brings together statistical information about pregnancy and childbirth in the United Kingdom, drawing on information made available by the Government Statistical Service and the Office of Population Censuses and Surveys. There are two volumes-the first comprises the main text, illustrated by some well chosen figures and tables. The scope of the book is most impressive. The reader is introduced lucidly to definitions and classifications of perinatal statistics. The need to present data in a comparable way is apparent and is highlighted by a chapter devoted to international comparisons. One of the purposes of the book is to avoid the duplication of effort which is inherent in a widespread interest in data collection. Our attention is drawn to the numerous sources of statistical information which is now routinely collected in the National Health Service. This information is expanded in a very helpful appendix, which also draws attention to some key official publications on health statistics. The authors write in a very stimulating style, using short historical reviews and liberally quoting from diverse sources of literature to illustrate a point or to sustain the reader's interest. Individual chapters deal with birth and death statistics and factors responsible for their variation; fertility and early fetal loss; parents and their social circumstances; the characteristics of babies including illnesses and later disabilities; maternal mortality and morbidity; and the care of mothers and babies including a most revealing account of the costs of having a baby. The companion volume comprises numerous statistical tables, arranged so that they can be referred to alongside the appropriate chapter in the main volume. The tables generally include data for 10 years up to 1980. There is a plethora of information here ranging from the commonplace to, for example, the total weight of contraceptive sheaths (including packing) imported into the UK each year from 1975-82. For those who find themselves stuck for party conversation, it was 43 200 kg in 1982! Of course, there is the prospect of new or revised systems of data collection for the future; one of the appendices deals with such developments as the Child Health Computor System, the Neonatal Discharge Record, and the implications of the report of the Steering Group on Health Services Information. Birth Counts is an important and innovative book and I can confidently recommend it as an essential personal buy for anyone who is involved in the collection or interpretation of birth statistics. The companion volume of tables is perhaps a luxury for personal use; it is about twice the price of the main volume but it should certainly have a prominent place in reference libraries. M L CHISWICK
TL;DR: Cost savings were achieved with better outcomes due to the participation in CenteringPregnancy among low-risk Medicaid beneficiaries and after considering the state investment, there was an estimated return on investment of nearly $2.3 million.
Abstract: Objectives This study was undertaken to determine the cost savings of prevention of adverse birth outcomes for Medicaid women participating in the CenteringPregnancy group prenatal care program at a pilot program in South Carolina. Methods A retrospective five-year cohort study of Medicaid women was assessed for differences in birth outcomes among women involved in CenteringPregnancy group prenatal care (n = 1262) and those receiving individual prenatal care (n = 5066). The study outcomes examined were premature birth and the related outcomes of low birthweight (LBW) and neonatal intensive care unit (NICU) visits. Because women were not assigned to the CenteringPregnancy group, a propensity score analysis ensured that the inference of the estimated difference in birth outcomes between the treatment groups was adjusted for nonrandom assignment based on age, race, Clinical Risk Group, and plan type. A series of generalized linear models were run to estimate the difference between the proportions of individuals with adverse birth outcomes, or the risk differences, for CenteringPregnancy group prenatal care participation. Estimated risk differences, the coefficient on the CenteringPregnancy group indicator variable from identity-link binomial variance generalized linear models, were then used to calculate potential cost savings due to participation in the CenteringPregnancy group. Results This study estimated that CenteringPregnancy participation reduced the risk of premature birth (36 %, P < 0.05). For every premature birth prevented, there was an average savings of $22,667 in health expenditures. Participation in CenteringPregnancy reduced the incidence of delivering an infant that was LBW (44 %, P < 0.05, $29,627). Additionally, infants of CenteringPregnancy participants had a reduced risk of a NICU stay (28 %, P < 0.05, $27,249). After considering the state investment of $1.7 million, there was an estimated return on investment of nearly $2.3 million. Conclusions Cost savings were achieved with better outcomes due to the participation in CenteringPregnancy among low-risk Medicaid beneficiaries.