Group Prenatal Care: Creating a Positive Experience When There is Risk of Preterm Delivery

Group Prenatal Care: Creating a Positive Experience When There is Risk of Preterm Delivery

By: M. Bardett Fausett, MD

Colonel, US Airforce (retired)
Maternal Fetal Medicine Community Medical Center       Missoula, MT

People do obstetrics because it’s usually a joyful process. Usually, but not always.

Most of us who have been doing this for any length of time have seen the catastrophes and complications that can come with pregnancy, be it hemorrhage or preeclampsia or most commonly, preterm delivery. For much of the public, having a baby is seen as totally normal—an experience where things don’t go wrong. Having a discussion with patients about risks feels like a ‘downer’ in this happy time. So as providers, we are not talking enough about complications like preterm birth, because we want a woman’s pregnancy to be a positive experience. But there are women who can benefit from this conversation and knowing they are at risk of preterm birth.

Now, we have a way to identify women early who are at risk of preterm delivery; we couldn’t do that before. Now, we can target that important conversation about preterm birth risk; we couldn’t do that before. This is the same kind of conversation I would have with women with a prior preterm delivery or a short cervix. We don’t want to have the conversation with everyone. But we do want to talk about it with women who have real risk.

Simply knowing who is at risk of delivering early allows us to use the tools we have at hand to manage that risk—more frequent visits, patient education, timing of steroids, TVU for cervical length monitoring, and other strategies. One important preventive measure that we should do more with is group prenatal care (for example Centering®). Several studies have shown that women who receive prenatal care in a group vs. traditional one-on-one setting actually have a reduced rate of preterm delivery. This is particularly true in several high-risk populations. So if you can identify women at risk, and put those women in in group prenatal care, it’s a simple, cost-effective way to make a difference, and to change the experience, and potentially the outcome, into a positive one.

Women enjoy group prenatal care. Some women are initially anxious about the idea of group prenatal care, because they feel they will lose the intimacy of the one-on-one interaction with their doctor or their midwife. It turns out that with group care the provider ends up having about 10x the amount of facetime with each patient than they would have in a one-on-one setting. Think about it: What time do women have with their doctor or midwife? They come in, they go through the intake process, get weighed & measured, the technician or the nurse asks them questions, the doctor comes in, measures their tummy, listens to the baby, asks them about any problems and then sends them out. In a group care situation, that assessment gets done pretty quickly, and then there’s plenty of time for people to talk about things that are bothering them, some of which they would never have the time or opportunity to bring up in a traditional setting, because the provider doesn’t have two hours to talk to them. There’s always room for some one-on-one time with the provider over in the corner when taking measurements and listening to the heartbeat when they have some confidential or personal issue.

What is it about group care that can reduce risk? Part of it may be education, part of it may be stress reduction being in this small tribe of women that come together to meet—they realize they are not all alone in what they are going through in their pregnancies. It’s actually one of the only primary prevention strategies that we have. And we don’t use it enough, partly because it’s a dramatic shift in our mindset of delivering care, and partly because we just don’t know who is at risk unless they have a prior preterm delivery or a short cervix.

As a provider, I have really enjoyed group care. I loved the change in my day, going from the one-on-one rapid turnover, to being able to sit down with these women. I got to know them a lot better and we really came to enjoy each other. Most of the ‘care’ actually comes from the other women in the group. They empower and educate one another. It becomes much more of an intimate relationship between provider and patients because we can talk about other stuff that you wouldn’t normally talk about. Sometimes they cry, and give each other hugs. It is really neat to bond with the moms as they bond together. There’s a lot of education and interaction that goes with group care. In the end, they feel the intimacy of the prenatal care was a lot better because they had this group discussion where they could actually get to emotions and feelings that may be hard to get to in a quick visit the way one-on-one care is structured today.

Right now, we are not doing enough to impact preterm birth from a societal perspective, from a research perspective, from a provider perspective. We can’t fix it very well when it happens. But there are preventive therapies, like group prenatal care, that can turn it into a positive experience for women, with a positive outcome. Predicting risk early allows us to have the difficult conversation with the right women—the women who are at risk—and implement primary prevention strategies that work.