By Ellen Tilden, R.N., C.N.M., M.S.
Many pregnant women seek to experience a positive, natural birth and to find confidence and balance in mothering, but some find themselves unprepared for the work of birth and the transition to motherhood more complex and solitary than expected. Standard prenatal care doesn’t always help. It can be a rushed and superficial experience, inadequate to address the concerns that emerge during pregnancy. Several studies demonstrate that the dominant model of prenatal care in the United States lacks scientific evidence and doesn’t serve families as well as it could.
To help expectant mothers experience healthy pregnancies, feel prepared for birth and make an informed transition into motherhood, nurse midwives at Oregon Health & Science University (OHSU) now offer group prenatal care.
The first group prenatal care model, Centering Pregnancy, was developed in 1989 by nurse midwife Sharon Shindler-Rising. Research on this model consistently demonstrates high patient satisfaction and good pregnancy outcomes. As our team at OHSU initiated group care, we used Centering Pregnancy’s model but modified the discussion topics and format to better address our patients’ needs. Dana, 34, who experienced group care, commented:
“Being a part of this diverse group of women was, without reservation, the best health care experience I have had. Every visit combined an opportunity for confidential questions to be answered, as well as meeting as a group. I felt so connected to the other women — it was a comfort to know that others were going through exactly what I was! It was more than a health care group – we created a community of strength, support and confidence in pregnancy and birth, regardless of our backgrounds or birth plans.”
When a woman selects group prenatal care, her first two visits are conducted privately. At about 16 to 20 weeks, the group phase of care begins. Generally there are five to eight women in each group, all with similar due dates. Some are experiencing a first pregnancy, others are already mothers. Variety in experience and background helps create lively, thoughtful conversations.
We gather for eight two-hour sessions. In the first hour, each woman meets briefly with her midwife in a semi-private area of the room where individual concerns are discussed and baby’s growth and heartbeat are evaluated. When not interacting with the midwife, patients socialize and enjoy snacks and tea, weighing themselves, receiving blood pressure checks and exploring educational materials. During the second hour, the nurse midwife facilitates group discussion on a variety of topics regarding pregnancy, birth and parenting. Many women bring their partner, friend or mother while others attend alone.
Many women have asked what it’s like to be part of this kind of prenatal care. Jessica, who was in our first group, offers the following reflection:
“I found the additional time with the midwives dramatically enriched my pregnancy. It would be impossible for a single expectant mother to voice all of her concerns in single 20-minute office visits. However, since so many women share the same thoughts during pregnancy, much more is covered in a group setting. Topics introduced by the midwives often expanded or morphed into very different, and valuable, conversations … . Knowing that the other expectant moms were undergoing the same experiences at roughly the same time as me, with the same fears, expectations, and excitement, was incredibly supporting.”
How does group prenatal care make a difference? While we do not yet have enough quantitative data to draw firm conclusions, it is our team’s experience that group prenatal care patients are generally confident, resilient and well-informed during the work and joys of birth. Many group care patients report that the skills and information they gained through group care proved invaluable during labor.
Rosa, 28, offers: “I worked with contractions all night. There were several points when I said out loud, ‘I do not think I can do this anymore,’ and I would remember in group how we discussed every woman reaching that point. This is progress, I would think.”
Does any of this influence the larger work of mothering?
Jessica, 38, says: “Hearing from the other mothers in group that breastfeeding is hard at first but gets easier helped me through those first few months, and I’m still nursing our 15-month-old. The richness of my birth experience has absolutely made me a better mom.” This, of course, is an essential goal in pregnancy care – creating a strong foundation for the work and joys of mothering.
For information about OHSU’s group prenatal program, visit ohsuhealth.com/midwifery (click on “Our Services” then “Group Prenatal Care Option”).
Ellen Tilden, R.N., C.N.M, M.S., is a certified nurse midwife at OHSU Hospital who specializes in maternity care and normal labor, including water birth; well-woman exams, gynecology and family planning; and group prenatal care. She also is an instructor in the OHSU School of Nursing’s No. 1-ranked Nurse-Midwifery Program (U.S. News & World Report’s “Best Graduate Schools 2012″).