Adolescent Health

Strategies for effective group prenatal care with pregnant adolescents

Most females receive prenatal care via a traditional model focused on screening for health-related complications. A healthcare provider (HCP) offers this care on an individual and regular basis throughout the pregnancy. At minimum, each visit involves assessment of maternal weight and blood pressure (BP), fundal height, and fetal heart rate. The initial visit is more comprehensive than subsequent visits, and includes taking a personal and family history, conducting a complete physical examination, and ordering laboratory tests. Education is provided about prenatal care and avoidance of risky behaviors. Subsequent visits include screening for problems and provision of information about nutrition, pregnancy complications, childbirth, and infant care. When indicated, special fetal assessment tests may be recommended and the need for genetic counseling discussed.1

In 1993, CenteringPregnancy (CP) was introduced as an alternative model for delivering prenatal care.2,3 The CP model provides comprehensive prenatal care to small groups of women at similar points in their pregnancies. For participants in this group prenatal care (GPC) program, learning and support are enhanced by group dynamics and by the HCP’s leadership.Compared with traditional care, CP has been associated with improved patient satisfaction, knowledge, and attendance; similar or superior maternal/newborn health outcomes; and greater affordability.4-10

The advent of the Affordable Care Act of 2010, with its provision of access to healthcare for additional millions of Americans, has created a distinct need for innovative, cost-effective, high-quality prenatal care models. GPC can be both safe and affordable, provided at convenient times for better access, and directed at meeting a group’s special needs. GPC is ideal for pregnant adolescents: Management of adolescent pregnancy in group settings has been shown to foster optimal maternal and neonatal outcomes.4-7,11,12 The authors, with many years’ experience in delivering prenatal care to adolescents using the group model, discuss their own program.

Background information on CenteringPregnancy

The authors’ adolescent GPC approach was based on principles of CP. According to Rising,developer of CP, attending prenatal sessions can result in better pregnancy outcomes, with less maternal stress, lower rates of substance abuse, improved labor progress, higher infant birth weights, and higher 5- minute Apgar scores. The CP model, which includes essential components of traditional prenatal care within a group framework, integrates three major components of prenatal care: health assessment, interactive learning, and community building.13 CP groups comprise 8-12 females at similar points in their pregnancies. After a one-onone prenatal visit with an HCP, participants attend regular group sessionslasting 1.5-2 hours, usually held in the late afternoon or early evening, for the remainder of their care. The sessions, typically led by an HCP and a nurse, meet every 4 weeks until the 28th week and then every 2 weeks until delivery.

At the start of every group session,

each participant has a quick

private visit with a nurse and an

HCP for checks of weight, BP, fundal

height, and fetal heart tones

and for an opportunity to ask personal

questions. During this time,

the other participants chat or

watch an educational video. Once

individual checks are done, the

group session begins. Topics discussed

include nutrition, exercise

and relaxation, discomforts of

pregnancy, childbirth preparation,

infant care and feeding, postpartum

concerns, contraception,

communication/self-esteem, and

parenting skills. Participants are

encouraged to ask questions,

which can help others with similar

concerns,12 and they are invited to

bring a partner or a family member.

Additional prenatal visits are

necessary only if problems with

the pregnancy arise or if a participant

requires a confidential private

exam.

The CP structure comprises 13

essential elements,14 which are

also used in the authors’ prenatal

program: (1) Health assessment occurs

within the group space; (2)

Women are involved in self-care activities;

(3) A facilitative leadership

style is used; (4) Each session has

an overall plan; (5) Attention is

given to the core content, but emphasis

may vary; (6) There is stability

of group leadership; (7) Group

conduct honors the contribution of

each member; (8) The group is conducted

in a circle; (9) Group composition

is stable but not rigid; (10)

Group size is optimal to promote

the process; (11) Involvement of

family support is optional; (12) Opportunity

for socializing within the

group is provided; and (13) There is

ongoing evaluation of outcomes.

Primary differences between CP

and traditional prenatal care are

the time spent in care and the opportunity

for group interaction.

Traditional visits usually last

5-10 minutes, whereas CP visits

are about 90 minutes long. This

amount of time allows participants

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