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United States: Group Antenatal Care Promotes Breastfeeding

The CenteringPregnancy® Program conducted at the University of Illinois in Chicago provides health promotion, group-peer support, a collaborative patient-provider relationship, and self-management training and activities. The programme aims to increase women’s psychosocial well-being and healthy behaviour in order to reduce adverse maternal and infant outcomes and disparities.

This is a local pilot project that replaces the individual-visit model of antenatal care for poor, obstetrically low-risk women with a group-visit model. The target population comprises 110 low-income African-American women who receive antenatal care in an urban public health clinic. Funding has been provided by the March of Dimes, Illinois Chapter, and ongoing support is provided by insurance reimbursement of antenatal services.

The group antenatal-care model consists of 10 two-hour visits beginning at 16–18 weeks and continuing until delivery, following the recommended schedule for antenatal care. Each group of pregnant women is led by a nursemidwife and a co-facilitator, either a clinical nursing-support staff member or a graduate nursing student. At each group visit, the women practise selfcare skills such as measuring their weight and blood pressure, each woman undergoes a short assessment with the nurse-midwife provider in the group space, and the remaining time is used to discuss concerns as a group, ask questions and explore the new roles of pregnancy, parenting and motherhood. The women also receive health information on keeping themselves safe and healthy during pregnancy and beyond.

Focus groups of pregnant women, providers and health-centre staff report that the programme has benefi ted the women who participated, despite implementation challenges such as scheduling changes. The women report that they enjoy sharing their pregnancy experience with other women. Compared to women in individual care, the women in CenteringPregnancy attended considerably more antenatal visits (9.7 versus 8.3) and gained appreciably more weight during pregnancy (32.2 pounds versus 28.5 pounds). They were also significantly more likely to have initiated breastfeeding during hospitalization (59% versus 44%); at hospital discharge 44% were breastfeeding exclusively, compared to 31% of the women in individual care.

 

Explore the entire Compendium of Primary Care Case Studies (2009) published by the World Health Organization.