The Problem That Needs Addressing
Despite decreasing maternal mortality in the past decade supported by a higher proportion of births attended by skilled attendants, poor quality of care [QoC] remains a problem as avoidable maternal and newborn death has increased in proportion in health facilities. While substantial progress has been made, countries need to expand their agendas to go beyond survival, with a view to maximizing the health and potential of their populations. Focus is needed on the pregnant women and families as well as on the midwives and other clinicians.
The most recent WHO guidelines state that “A woman’s experience of care is key to transforming antenatal care and creating thriving families and communities”, while further stating, “Crucially, ANC also provides the opportunity to communicate with and support women, families and communities at a critical time in the course of a women’s life”. Specifically, in Guideline E.3, Group ANC “Group antenatal care provided by qualified health-care professionals may be offered as an alternative to individual antenatal care for pregnant women in the context of rigorous research, depending on a woman’s preferences and provided that the infrastructure and resources for group antenatal care are available”. It is clear from this that in order to develop successful innovative models towards improving maternal and child outcomes, there must be cohesive, well developed models that require adherence to those processes which have shown success.
Groups provide a vehicle for individuals to share personal experiences and to receive support from others who may personally resonate to the issues. They also provide a way for the efficient dissemination of information. In a group setting the participants may imagine a different solution to issues based on the sharing of other perspectives. Care that happens in groups using a facilitation model is relationship-centered, sharing the dynamic of the visit among all in the group.
Groups are a powerful and fun way to provide and receive care. One of the African project directors states, “The trust the women created with the midwives is amazing. They now continue to call the midwives for any advice about their family health problems.”
Professional Association Statements
American College of Nurse-Midwives (ACNM)
In August 2016, the ACNM reaffirmed its 2010 Position Statement on Models of Group Prenatal Care stating that “Midwives of ACNM are encouraged to implement evidence-based models of group prenatal care to improve women’s experiences and satisfaction with prenatal care and to improve pregnancy outcomes.”
American College of Obstetricians and Gynecologists (ACOG)
In March 2018, ACOG issued a Committee Opinion, stating that “Bringing patients with similar needs together for health care encounters increases the time available for the educational component of the encounter, improves efficiency, and reduces repetition. Evidence suggests patients have better prenatal knowledge, feel more ready for labor and delivery, are most satisfied with care in prenatal care groups, and initiate breastfeeding more often [than women in traditional one-on-one prenatal care].”