Women's experiences of group antenatal care in Australia-the CenteringPregnancy Pilot Study

Objective: to describe the experiences of women who were participants in the Australian CenteringPregnancy Pilot Study. CenteringPregnancy is an innovative model of care where antenatal care is provided in a group environment. The aim of the pilot study was to determine whether it would be feasible to implement this model of care in Australia. Design: a descriptive study was conducted. Data included clinical information from hospital records, and antenatal and postnatal questionnaires. Setting: two metropolitan hospitals in Sydney, Australia. Participants: 35 women were recruited to the study and 33 ultimately received all their antenatal care (eight sessions) through five[CH1] CenteringPregnancy groups. Findings: difficulties with recruitment within a short study timeline resulted in only 35 (20%) of 171 women who were offered group antenatal care choosing to participate. Most women chose this form of antenatal care in order to build friendships and support networks. Attendance rates were high and women appreciated the opportunity and time to build supportive relationships through sharing knowledge, ideas and experiences with other women and with midwives facilitating the groups. The opportunity for partners to attend was identified as important. Clinical outcomes for women were in keeping with those for women receiving standard care; however, the numbers were small. Conclusion: the high satisfaction of the women suggests that CenteringPregnancy is an appropriate model of care for many women in Australian settings, particularly if recruitment strategies are addressed and women's partners can participate. Implications for practice: CenteringPregnancy group antenatal care assists women with the development of social support networks and is an acceptable way in which to provide antenatal care in an Australian setting. Recruitment strategies should include ensuring that practitioners are confident in explaining the advantages of group antenatal care to women in early pregnancy. Further research needs to be conducted to implement this model of care more widely. © 2009 Elsevier Ltd

Group versus conventional antenatal care for women

© 2015 The Cochrane Collaboration. 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 as high among women who were allocated to group antenatal care, but this outcome was measured in only one trial. In this trial, mean satisfaction with care in the group given antenatal care was almost five times greater than that reported by those allocated to standard care (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 positively viewed by 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

New Air-Launched Small Missile (ALSM) Flight Testbed for Hypersonic Systems

A new testbed for hypersonic flight research is proposed. Known as the Phoenix air-launched small missile (ALSM) flight testbed, it was conceived to help address the lack of quick-turnaround and cost-effective hypersonic flight research capabilities. The Phoenix ALSM testbed results from utilization of two unique and very capable flight assets: the United States Navy Phoenix AIM-54 long-range, guided air-to-air missile and the NASA Dryden F-15B testbed airplane. The U.S. Navy retirement of the Phoenix AIM-54 missiles from fleet operation has presented an excellent opportunity for converting this valuable flight asset into a new flight testbed. This cost-effective new platform will fill an existing gap in the test and evaluation of current and future hypersonic systems for flight Mach numbers ranging from 3 to 5. Preliminary studies indicate that the Phoenix missile is a highly capable platform. When launched from a high-performance airplane, the guided Phoenix missile can boost research payloads to low hypersonic Mach numbers, enabling flight research in the supersonic-to-hypersonic transitional flight envelope. Experience gained from developing and operating the Phoenix ALSM testbed will be valuable for the development and operation of future higher-performance ALSM flight testbeds as well as responsive microsatellite small-payload air-launched space boosters

From worry to hope : an ethnography of midwife – woman interactions in the antenatal appointment

Better outcomes for mother and baby observed in 'midwifery continuity of carer' programmes are attributed to positive midwife-woman relationships formed within these models, but this effect is not fully understood. Like midwife-led care, continuity of midwifery carer in Australia continues not to be seen as mainstream. To advocate for and better understand this continuity of carer model, this study used video ethnography framed by feminism and a critical approach. Midwife-woman interactions in a number of late pregnancy antenatal appointments were observed and filmed. These were at two Sydney hospitals with either the midwifery continuity of carer programme or in standard maternity care. Focus groups and interviews were undertaken. Thematic and content analysis techniques were used. Worry was a common feature of the antenatal appointment. It reflects the worry pregnant women report: worry about pregnancy, their baby, uncertainty about birth and transition to motherhood. 'Dysfunctional' or 'iatrogenic' worry occurred with system-focused midwives invested in standardised/medicalised tasks, whereas 'functional' worry occurred with woman-centred midwives invested in the woman. Hope creation was also seen, although less frequently. It occurred when worry was moderated and linked with adaptation of standardised and medicalised appointment factors, including environment, time, and midwife investment (how she interacted with the woman). Regardless of where they worked, some midwives were 'adaptive experts', but in most instances the midwives in continuity had greater opportunity to adapt. This adaptation resulted in midwife-woman interactions being bidirectional and shared, with discussing and storytelling taking place, rather than one-way midwife telling. These shared interactions created connection, or reflected the connection created by continuity of carer. This study showed the benefit of the midwifery continuity of carer programme. It provided opportunity for midwives to adapt, worry was moderated, and women appeared more hopeful. Being more hopeful may enable women to better manage their labours and parenting, creating these improved outcomes

The experiences of midwives involved with the development and implementation of CenteringPregnancy at two hospitals in Australia

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.Aims : The aims of the study were to describe the experiences of the midwives who were part of the first Australian CenteringPregnancy Pilot Study and to inform the future development of CenteringPregnancy. Background CenteringPregnancy is a model of group antenatal care that has evolved over the past two decades in North America. A pilot study that explored the feasibility of implementing CenteringPregnancy in Australia was undertaken in 2006-2008. I was the research midwife employed to coordinate this study and I explored the experiences of the midwives who were participants as the focus of my Master of Midwifery (Honours) research. Method : An Action Research approach was undertaken to study the implementation of CenteringPregnancy in Australia. This included a qualitative descriptive study to describe and explore the experiences of the midwives who were participants. The study was set in two hospital antenatal clinics and two outreach community health-care centres in southern Sydney. Eight midwives and three research team members formed the Action Research group. Data collected were primarily from focus groups and surveys and were analysed using simple descriptive statistics and thematic content analysis. Findings : CenteringPregnancy enabled midwives to develop relationships with the women in their groups and with their peers in the Action Research group. The group antenatal care model enhanced the development of relationships between midwives and women that were necessary for professional fulfilment and the appreciation of relationship-based care. The use of supportive organisational change, enabled by Action Research methods, facilitated midwives to develop new skills that were appropriate for the group care setting and in line with a strengths-based approach. Issues of low staffing rates, lack of available facilities for groups, time constraints, recruitment difficulties and resistance to change impacted on widespread implementation of CenteringPregnancy. Conclusions : The experience of the midwives who provided CenteringPregnancy care suggests that it is an appropriate model of care for the Australian midwifery context, particularly if organisational support and recruitment strategies and access to appropriate facilities are addressed. The midwives who undertook CenteringPregnancy engaged in a new way of working that enhanced their appreciation of relationship-based care and was positive to their job satisfaction. Implications for practice Effective ways to implement CenteringPregnancy models of care in Australia were identified in this study. These included a system of support for the midwives engaging in facilitating groups for the first time. It is important that organisations also develop other supportive strategies, including the provision of adequate group spaces, effective recruitment plans and positive support systems for change management. In the light of current evidence the development of continuity of care models which enhance the relationship between an individual women and her midwife, it is important to explore the effects of group care on this unique relationship

The St. George Homebirth Program: An evaluation of the first 100 booked women

Background: The St. George Homebirth Program was the first publicly funded homebirth model of care set up in New South Wales. This program provides access to selected women at low obstetric risk the option of having their babies at home. There are only four other publicly funded homebirth programs operating in Australia. Aims: To report the outcomes of the first 100 women booked at the St. George Homebirth Program. Methods: A prospective descriptive study was undertaken. Data were collected on the first 100 women who gave birth between November 2005 and March 2009. Two databases were accessed and missing data were followed up by review of the relevant charts. Results: Of the first 100 booked women, 63 achieved a homebirth, 30 were transferred to hospital or independent midwifery care in the antenatal period and seven were transferred intrapartum. Two women were transferred to hospital in the early postnatal period, one for a postpartum haemorrhage and one for hypotension. One baby suffered mild respiratory distress, was treated in the emergency department and was discharged home within four hours. Conclusion: The St. George Hospital homebirth program has provided reassuring outcomes for the first 100 women it has cared for over the past four years. Wider availability of this service could be achieved provided there is the appropriate close collaboration between providers and effective processes for consultation, referral and transfer. The outcomes of women and babies in publicly funded homebirth programs deserve further study, and the development of a national prospective database of all planned homebirths would contribute to this knowledge. © 2009 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Women’s views on partnership working with midwives during pregnancy and childbirth

This is the Accepted Manuscript version of the following article: Sally Boyle, Hilary Thomas, and Fiona Brooks, ‘Women׳s views on partnership working with midwives during pregnancy and childbirth’, Midwifery, Vol. 32: 21-29, January 2016, which has been published in final form at: https://doi.org/10.1016/j.midw.2015.09.001. This manuscript version is made available under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License CC BY NC-ND 4.0 ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.Objective: To explore whether the UK Government agenda for partnership working and choice was realised or desired for women during pregnancy and childbirth. Design: A qualitative study was used to explore women’s experience of partnership working with midwives. Data was generated using a diary interview method throughout pregnancy and birth. Setting: 16 women were recruited from two district general hospitals in the South East of England. Findings: Three themes emerged from the data: organisation of care, relationships and choice. Women described their antenatal care as ‘ticking the box’, with midwives focusing on the biomedical aspects of care but not meeting their psycho-social and emotional needs. Time poverty was a significant factor in this finding. Women rarely described developing a partnership relationship with midwives due to a lack of continuity of care and time in which to formulate such relationships. In contrast women attending birth centres for their antenatal care were able to form relationships with a group of midwives who shared a philosophy of care and had sufficient time in which to meet women’s holistic needs. Most of the women in this study did not feel they were offered the choices as outlined in the national choice agenda (DoH, 2007). Implications for Practice: NHS Trusts should review the models of care available to women to ensure that these are not only safe but support women’s psycho-social and emotional needs as well. Partnership case loading models enable midwives and women to form trusting relationships that empowers women to feel involved in decision making and to exercise choice. Group antenatal and postnatal care models also effectively utilise midwifery time whilst increasing maternal satisfaction and social engagement. Technology should also be used more effectively to facilitate inter-professional communication and to provide a more flexible service to women.Peer reviewe

A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression

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

Getting more than they realized they needed: a qualitative study of women's experience of group prenatal care

<p>Abstract</p> <p>Background</p> <p>Pregnant women in Canada have traditionally received prenatal care individually from their physicians, with some women attending prenatal education classes. Group prenatal care is a departure from these practices providing a forum for women to experience medical care and child birth education simultaneously and in a group setting. Although other qualitative studies have described the experience of group prenatal care, this is the first which sought to understand the central meaning or core of the experience. The purpose of this study was to understand the central meaning of the experience of group prenatal care for women who participated in CenteringPregnancy through a maternity clinic in Calgary, Canada.</p> <p>Methods</p> <p>The study used a phenomenological approach. Twelve women participated postpartum in a one-on-one interview and/or a group validation session between June 2009 and July 2010.</p> <p>Results</p> <p>Six themes emerged: (1) "getting more in one place at one time"; (2) "feeling supported"; (3) "learning and gaining meaningful information"; (4) "not feeling alone in the experience"; (5) "connecting"; and (6) "actively participating and taking on ownership of care". These themes contributed to the core phenomenon of women "getting more than they realized they needed". The active sharing among those in the group allowed women to have both their known and subconscious needs met.</p> <p>Conclusions</p> <p>Women's experience of group prenatal care reflected strong elements of social support in that women had different types of needs met and felt supported. The findings also broadened the understanding of some aspects of social support beyond current theories. In a contemporary North American society, the results of this study indicate that women gain from group prenatal care in terms of empowerment, efficiency, social support and education in ways not routinely available through individual care. This model of care could play a key role in addressing women's needs and improving health outcomes.</p