‘Expecting and Connecting’ Group Pregnancy Care: Evaluation of a collaborative clinic

Craswell, Alison; Kearney, Lauren; Reed, Rachel

doi:10.1016/j.wombi.2016.03.002

Cited by 24 publications

(21 citation statements)

References 30 publications

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“…The multicentre RCT by Ickovics et al [81] was published too late for inclusion in our search, and we are aware of another recently commenced RCT evaluating CenteringPregnancy™ in the USA. Other group antenatal care schemes have also been evaluated [19, 82]. …”

Section: Discussionmentioning

confidence: 99%

Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models

Symon

Pringle

Downe

et al. 2017

BMC Pregnancy Childbirth

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BackgroundAntenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models.MethodsA protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions.ResultsOf 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irrespective of health state or complications); Restricted ‘lower-risk’-based provision model (midwifery-led or reduced/flexible visit approach for healthy women); Augmented provision model (antenatal care as in Universal provision above but augmented by clinical, educational or behavioural intervention); Targeted ‘higher-risk’-based provision model (for woman with defined clinical or socio-demographic risk factors). The first category was most commonly tested in low-income countries (i.e. resource-poor settings), particularly in Asia. The other categories were tested around the world. The trials included a range of care providers, including midwives, nurses, doctors, and lay workers.ConclusionsInterventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproduc...

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Section: Discussionmentioning

confidence: 99%

Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models

Symon

Pringle

Downe

et al. 2017

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…This is the second phase of a larger study evaluating the ‘Expecting and Connecting’ service and the earlier phase (qualitative findings) are reported elsewhere [11]. All pregnant women who attended a ‘booking-in’ appointment within the local, public health care service were given an opportunity to opt-in to the ‘Expecting and Connecting’ group pregnancy care service, run at the campus of a local university or attend another of the conventional service models available at the local public hospital.…”

Section: Methodsmentioning

confidence: 99%

“…Qualitative studies on group antenatal care have reported high maternal satisfaction, peer support and the value of shared experience associated with group antenatal care [11], especially models that include continuity of care [12]. Women accessing midwife-led group antenatal care models demonstrate healthier pregnancies [10, 13] and improved antenatal care attendance amongst disadvantaged groups [14] compared to conventional antenatal care.…”

Section: Introductionmentioning

confidence: 99%

The relationship between midwife-led group-based versus conventional antenatal care and mode of birth: a matched cohort study

Kearney

Craswell

Reed

2017

BMC Pregnancy Childbirth

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BackgroundMidwife facilitated, group models of antenatal care have emerged as an alternative to conventional care both within Australia and internationally. Group antenatal care can be offered in a number of different ways, however usually constitutes a series of sessions co-ordinated by a midwife combining physical assessment, antenatal education and peer support in a group setting. Midwife-led group antenatal care is viewed positively by expectant mothers, with no associated adverse outcomes identified in the published literature for women or their babies when compared with conventional care. Evidence of an improvement in outcomes is limited. The aim of this study was to compare mode of birth (any vaginal birth with caesarean birth) between pregnant women accessing midwife-led group antenatal care and conventional individual antenatal care, in Queensland, Australia.MethodsThis was a retrospective matched cohort study, set within a collaborative antenatal clinic between the local university and regional public health service in Queensland, Australia. Midwife-led group antenatal care (n = 110) participants were compared with controls enrolled in conventional antenatal care (n = 330). Groups were matched by parity, maternal age and gestation to form comparable groups, selecting a homogeneous sample with respect to confounding variables likely to affect outcomes.ResultsThere was no evidence that group care resulted in a greater number of caesarean births. The largest increase in the odds of caesarean birth was associated with a previous caesarean birth (p < 0.001), no previous birth (compared with previous vaginal birth) (p < 0.003), and conventional antenatal care (p < 0.073). The secondary outcomes (breastfeeding and infant birth weight) which were examined between the matched cohorts were comparable between groups.ConclusionsThere is no evidence arising from this study that there was a significant difference in mode of birth (caesarean or vaginal) between group and conventional care. Group care was associated with a lower risk of caesarean birth after controlling for previous births, with the highest chance for a vaginal birth being a woman who has had a previous vaginal birth and was in group care. Conversely, the highest risk of caesarean birth was for women who have had a previous caesarean birth and conventional care.

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“…Evaluations of gANC indicate that women attend for appointments more regularly and report higher levels of satisfaction compared to conventional care (Craswell et al, 2016;Risisky et al, 2013;Teate et al, 2011;Trudnak et al, 2013;Wedin et al, 2010). Women appreciate the companionship and peer discussion, which normalises their pregnancy symptoms and experiences (Andersson et al 2013, Kennedy et al 2009, McNeil et al 2012, Teate et al 2011.…”

Section: Introduction/backgroundmentioning

confidence: 99%

“…Similarly, physicians who took part in Centering Pregnancy™ in the USA described increased satisfaction with this mode of care provision, believing it enabled them to provide richer care (Mcneil et al, 2013). Whilst agreeing with the benefits, Australian midwives also described facilitating gANC as mentally exhausting (Craswell et al, 2016).…”

Section: Introduction/backgroundmentioning

confidence: 99%

`It makes sense and it works': Maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles)

et al. 2018

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‘Expecting and Connecting’ Group Pregnancy Care: Evaluation of a collaborative clinic

Cited by 24 publications

References 30 publications

Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models

Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models

The relationship between midwife-led group-based versus conventional antenatal care and mode of birth: a matched cohort study

`It makes sense and it works': Maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles)

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