Antenatal and Postnatal Group Care during the First 1000 days  

New model of care 

Ante- and postnatal Group Care is a healthcare model which provides medical care as well as interactive learning and an opportunity for participants to share their joys and concerns in a supportive environment. This creates a social support network beyond the realms of health care. Group Care is generally provided by two facilitators, one of whom must be a qualified health care provider such as a midwife.   

The Group Care Model has demonstrated significant positive effects on outcomes and benefits for both pregnant women, newborns and families. What’s more, the model has been shown to increase work satisfaction and it has the potential to strengthen the role of the midwife.  

Randomised studies have shown a trend towards a decrease in preterm births for those receiving Group Care compared to traditional care (1,2,3). Some studies also found reduced disparities in preterm birth rates for Black women, relative to White and Hispanic women (1,2,3). Studies also suggest that marginalised and/or under-served groups can benefit more from Group Care (3,4). There is some evidence suggesting a reduced occurrence of low birthweight in babies born to women who participated in antenatal Group Care (5). Group Care participants tend to have a reduced likelihood of caesarean section births and a lower likelihood of newborns being admitted to the neonatal intensive care unit. Postnatal Group Care has shown to increase child immunisation rates and improve attendance and weight-related outcomes in children across all demographics (6,7,8). Service providers describe Group Care as a model which has an enhanced capacity to meet families’ needs.

The Group Care_1000 project  

Despite the existing and growing global evidence, implementation of Group Care is generally small-scale and has not yet penetrated global health systems. The Group Care for the First 1000 Days project (GC_1000), aimed to bridge this gap by implementing ante- and postnatal Group Care in health systems in seven countries spread around the world and transforming lessons learned during the project into supportive tools for global implementation. The project focused on four action areas: Understanding local contexts and health systems, capacity-building, the process and it’s impact, co-creation of tools. 

The results of the GC_1000 project showed the complexities of adopting and adapting Group Care in diverse settings and emphasised the critical role of committed personnel such as midwives, leadership, community engagement, cultural sensitivity and the support of policymakers and all organisational staff levels for the successful implementation of ante- and postnatal Group Care. 

Why is Group Care important for midwives 

Lessons learned from the GC_1000 project clearly show that the experiences of midwives and other health care professionals involved, are essential to the implementation of Group Care. It profoundly changes the midwives’ role from that of a traditional didactic one, to one that is facilitating and uses the strength and knowledge already present in the group. It is not always easy to lose the familiar role of expert in all things concerning pregnancy and birth. It requires training and practice and learning to trust that the group will come up with the answers. The model empowers pregnant women and new parents to look after themselves as well as each other, thereby encouraging the flattening of traditional medical and hierarchical structures. 

Group Care sessions allow midwives and other maternity care providers to spend more time with pregnant women and parents, to get to know them better and enabling stronger relationships by listening to their stories and some of the challenges they may face. Trust and continuity of care(-r) is created by stable facilitators and group members, ensuring that information shared stays within the group, as well as ensuring that care is midwife-led. Because the model requires two facilitators, it encourages midwives to work together and collaborate with other professionals who provide care to young families. Midwives have reported the Group Care experience to be a liberating experience and the art of listening and asking questions in order to empower pregnant women and families, ultimately results in greater work satisfaction for midwives.  

Tools 

The tools developed in the project are based on the project results and freely available on the GC_1000 website: 

• A policy brief to inform policymakers and stakeholders 
• A strategic implementation Toolkit for a global audience  
• Country-specific blueprints 
• Virtual learning modules 
• Leaflets and video’s explaining the model 

To share continuing insights about ante- and postnatal Group Care, a Community of Practice (CoP) is available to connect those with interest in Group Care. This free online community, housed within the World Health Organization’s IBP Network, supports all CoP members to share resources, strategies, and innovations so that collectively we can make Group Care a reality throughout the world.  

We encourage you to utilise these resources to inform yourself about Group Care. By joining the CoP, you will become part of a global community working towards the implementation of Group Care and which will support you in its planning, implementation, and scale-up.  

Changing maternity care for the benefit of women and families worldwide, is both exciting and challenging but will also improve the work satisfaction of midwives and help strengthen their role.