scispace - formally typeset
Search or ask a question
Journal Article

'No decision about me without me': centering pregnancy.

01 Nov 2010-The practising midwife (Pract Midwife)-Vol. 13, Iss: 10, pp 15-18
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.
Citations
More filters
Journal ArticleDOI
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 Selection criteria All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included.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.

162 citations

Journal ArticleDOI
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.

112 citations

Journal ArticleDOI
TL;DR: In the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment and screening, but respondents reported that they felt unprepared for the first few weeks after birth.
Abstract: Background group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000. Objective to investigate parents' experiences of group antenatal care in four different clinics in Sweden. Method a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used. Settings the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden. Participants the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme. Findings three themes emerged, ‘The care—combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care'. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, ‘The group—a composed recipient of care', showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, ‘The midwife—a controlling professional', showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals. Key conclusions in the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment and screening. Parents identified that the groups helped them prepare for birth but not for parenthood. The group model created a forum for sharing experiences and helped participants to normalise their pregnancy symptoms. Implications for practise the midwife's role in facilitating group-based antenatal care demands new pedagogical strategies and approaches.

58 citations

Journal ArticleDOI
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...

24 citations

Journal ArticleDOI
TL;DR: Examining the breastfeeding experiences of 14 grandmothers, 23 women of Bangladeshi origin and 28 health practitioners to illuminate how public health recommendations can be modified for diverse populations suggested that while many of the women's needs were similar to the majority population, much current breastfeeding support is not culturally sensitive.
Abstract: Breastfeeding, by improving health outcomes and life chances for women and children, is a key strategy for addressing health inequalities. National evidence-based public health recommendations for breastfeeding exist in the UK (NICE (2008)Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households. NICE public health guidance 11. London: National Institute for Health and Clinical Excellence). The need to tailor interventions to the needs of diverse disadvantaged population groups is an overarching principle informing these recommendations. However, there is little evidence on how to achieve such tailored services. This qualitative paper examines the breastfeeding experiences of 14 grandmothers, 23 women of Bangladeshi origin and 28 health practitioners to illuminate how public health recommendations can be modified for diverse populations. The findings suggested that while many of the women’s needs were similar to the majority population, much current breastfeeding ...

2 citations


Additional excerpts

  • ...An interesting model for providing group care during pregnancy and involving families in ‘conversations’ about breastfeeding, ‘Centering Pregnancy’ (see, for example, Gaudion and Menka, 2010), could be explored for this population of women....

    [...]

References
More filters
Journal ArticleDOI
TL;DR: Ten essential elements have been defined, which contribute to the success of this model of prenatal care delivery, and implications for clinical practice and further research to link it with perinatal health outcomes are suggested.
Abstract: CenteringPregnancy is a model of group prenatal care that provides more than 20 hours of contact time between the childbearing care provider and a cohort of pregnant women with similar due dates. During this time, each woman has the opportunity to build community with other pregnant women, learn self-care skills, get assurance about the progression of her pregnancy, and gain knowledge about pregnancy, birth, and parenting. Ten essential elements have been defined, which contribute to the success of this model of prenatal care delivery. These elements correspond with the Institute of Medicine's 2001 challenge to improve the quality of health care in the United States. Foundational perspectives provide potential explanations for the model's growing influence and success. Implications for clinical practice and further research to link it with perinatal health outcomes are suggested.

181 citations

Book ChapterDOI
01 Jan 2010

57 citations


"'No decision about me without me': ..." refers background in this paper

  • ...For the midwife, the skill is in facilitating confidence in the women and their partners, believing in them and knowing when to intervene and when to keep quiet (Leap 2000)....

    [...]