Testing the effectiveness of REACH Pregnancy Circles group antenatal care: protocol for a randomised controlled pilot trial

Abstract

BackgroundAntenatal care is an important public health priority. Women from socially disadvantaged, and culturally and linguistically diverse groups often have difficulties with accessing antenatal care and report more negative experiences with care. Although group antenatal care has been shown in some settings to be effective for improving women’s experiences of care and for improving other maternal as well as newborn health outcomes, these outcomes have not been rigorously assessed in the UK. A pilot trial will be conducted to determine the feasibility of, and optimum methods for, testing the effectiveness of group antenatal care in an NHS setting serving populations with high levels of social deprivation and cultural, linguistic and ethnic diversity. Outcomes will inform the protocol for a future full trial.MethodsThis protocol outlines an individual-level randomised controlled external pilot trial with integrated process and economic evaluations. The two trial arms will be group care and standard antenatal care. The trial will involve the recruitment of 72 pregnant women across three maternity services within one large NHS Acute Trust. Baseline, outcomes and economic data will be collected via questionnaires completed by the participants at three time points, with the final scheduled for 4 months postnatal. Routine maternity service data will also be collected for outcomes assessment and economic evaluation purposes. Stakeholder interviews will provide insights into the acceptability of research and intervention processes, including the use of interpreters to support women who do not speak English. Pre-agreed criteria have been selected to guide the decision about whether or not to progress to a full trial.DiscussionThis pilot trial will determine if it is appropriate to proceed to a full trial of group antenatal care in this setting. If progression is supported, the pilot will provide authoritative high-quality evidence to inform the design and conduct of a trial in this important area that holds significant potential to influence maternity care, outcomes and experience.Trial registrationISRCTN ISRCTN66925258. Registered 03 April 2017. Retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s40814-018-0361-x) contains supplementary material, which is available to authorized users.

Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study

“…For example, whether the observed benefits can be attributed to the quality of the relationship between the midwife and woman, or other factors such as place of care. Other specialist models of maternity care, for example group antenatal care such as 'centring pregnancy' and 'pregnancy circles', and family nurse partnerships are currently being trialled to explore their impact on outcomes for women with social risk factors [41][42][43][44][45]. It is hypothesised that culturally safe and community-based models of care which adopt a life course approach might help to reduce maternal and neonatal health inequalities, enhance care and improve women's experiences of maternity care [46][47][48].…”

A systematic review of providers’ experiences of facilitating group antenatal care

“…bespoke models have been developed in both highand low-income countries. Globally, all models tend to include a relatively stable group of pregnant women meeting in a group space, performing self-assessment checks and having extended face-to-face time with a provider in a facilitative fashion that prioritizes peerto-peer learning and support [3][4][5]. GANC visits follow the national standard antenatal care schedules, yet allow women 15-20 face-to-face hours with the same antenatal care provider as opposed to the current traditional care average of two and half hours of time with a provider (who may not always be the same) [6][7][8][9][10][11].…”

How do women with social risk factors experience United Kingdom maternity care? A realist synthesis

“…There remains a paucity of evidence and professional agreement with respect to what models of care are effective in meeting specific population needs, and why some are more effective than others. Group antenatal care has also been identified as a possible way of reducing health inequalities for socially disadvantaged women, but the evidence to date is limited . It is not known whether tailored models of care improve outcomes related to social deprivation, for example, the duration of breastfeeding, parent‐infant bonding, and childhood obesity.…”