Redefining Prenatal care: The “Group Antenatal Care”

OBG-Speculum:    2024                       ISSN no.

Vol -2, Issue -1  

Dr Aradhana Singh

Pregnancy is indeed a natural phenomenon, a beautiful journey of creating new life. Ideally, it should be a time of joy and wonder for women.

However, the pregnancy related morbidity and mortality in low middle income countries including India, still remains high. The conventional individual prenatal care is intended to prevent poor perinatal outcomes and provide education to women throughout pregnancy, childbirth, and the postpartum period through a series of one-on-one encounters between a woman and her obstetrician. Concerns regarding increasing health care costs, health care provider availability, dissatisfaction with wait times, and the minimal opportunity for education and support associated with the individual care model have given rise to interest in alternative models of antenatal care.

One such concept called group antenatal care (GANC) has been identified as an innovative model for delivering effective antenatal care1. 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 labour and delivery, initiate breastfeeding and accept postpartum contraception more often. 

The GANC Model: Combining Individualized Care with Group Support

GANC takes a two-pronged approach. After an initial individual visit where standard services like check-ups and baseline information gathering occur, women are invited to participate in group sessions. These groups typically consist of 8-12 women with similar expected delivery dates2. The screening process during the initial visit helps identify any potential high-risk factors. Women with these factors will receive personalized care plans developed in consultation with a physician. This ensures that their specific needs are addressed throughout their pregnancy journey.

Structure with Flexibility: Tailored Sessions and Open Discussions

Each GANC session is carefully structured to maximize its effectiveness. The first 30 minutes are dedicated to individual needs. Women perform self-assessments (weight monitoring, blood pressure checks) and receive brief one-on-one consultations with a physician to discuss their results and any specific concerns.

Following these individual check-ins, the group gathers for a facilitated discussion focused on general health questions and shared pregnancy experiences. The content of these sessions is planned to align with the gestational age of the women, ensuring relevant information is covered. However, the beauty of GANC lies in its flexibility. Discussions can adapt to incorporate issues that women themselves want to bring up, fostering a sense of open dialogue and peer support.

Beyond Clinical Care: The Power of Shared Experiences

This group setting allows women to learn from each other's experiences. Imagine a woman experiencing morning sickness finding comfort and practical advice from others who have successfully managed it. Sharing tips on safe exercises like walking or pregnancy yoga, coping mechanisms for dealing with family dynamics, or even home remedies for common discomforts - GANC facilitates this invaluable exchange of knowledge and support.

Knowledge from Every Corner: A Wellspring of Information

Educational workshops within the group setting cover crucial topics like timely vaccinations, the importance of folic acid, iron and calcium supplements, and healthy dietary choices incorporating fresh produce and whole grains. GANC sessions also offer a chance to discuss postpartum contraception and breast feeding and improved acceptability. This collective knowledge, shared by healthcare professionals and fellow mothers, equips women with the tools they need to navigate the physical changes of pregnancy with confidence.

Reduced Anxieties and a More Positive Experience

GANC can be a powerful tool for reducing anxieties commonly associated with pregnancy. By normalizing the physical and emotional experiences shared by many women, the group setting can alleviate anxieties and allow women to focus on the positive aspects of this natural wonder. They can find comfort in knowing they're not alone and gain valuable coping mechanisms from their peers.

Models of group antenatal care have been implemented in a number of countries and evidence shows that participants view it positively; for example, in the USA, UK, Australia and Iran3. There is a substantial body of research documenting improved outcomes. Randomized clinical trials (RCTs) of GANC conducted in the USA showed a 33% risk reduction for preterm delivery4. GANC group also had more health-related knowledge, higher breastfeeding initiation rates and satisfaction with care, and had more condom use and fewer repeat pregnancies at six months postpartum.

The preponderance of evidence suggests that GANC may have more impact on birth outcomes for disadvantaged groups5, which may make it an appropriate strategy for reducing health disparities in India.

The positive impacts of GANC derive from the group process which enhances learning, promotes healthy behaviour change, builds women’s sense of control over their own health, develops a supportive network, and creates a collaborative physician-client relationship through continuity of care2,6.

References:

1.  Sharma, J., O’Connor, M. & Rima Jolivet, R. Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis. Reprod Health 15, 38 (2018). https://doi.org/10.1186/s12978-018-0476-9.

2.  Rising S, Kennedy H, Klima C. Redesigning prenatal care through centering pregnancy. J Midwifery Womens Health. 2004;49:398–404.

3.  Sawtell, M., Wiggins, M., Wiseman, O. et al. Group antenatal care: findings from a pilot randomised controlled trial of REACH Pregnancy Circles. Pilot Feasibility Stud 9, 42 (2023). https://doi.org/10.1186/s40814-023-01238-w.

4.  Ickovics JR, Kershaw TS, Westdahl C, Magriples U, Massey Z, Reynolds H, et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstet Gynecol. 2007;110:330–9.

5.  Wiggins, Meg, et al. Group antenatal care (Pregnancy Circles) for diverse and disadvantaged women: study protocol for a randomised controlled trial with integral process and economic evaluation. BMC Health Services Research . 2020, Vol. 20, 919 .

6.  Excellence, NICE: Institute for Care. Antenatal care: NICE guideline. [Online] 2021. [Cited: May 16, 2022.] https://www.nice.org.uk/guidance/ng201/ .