Sensitive Midwifery - Issue 44 - October 2019

Pregnancy It was shown by the WHO in 2016 that a positive pregnancy experience as described on page 12 optimises maternal and newborn health considerably. Midwives in particular are well- placed to o ff er and implement all three of these components, though many midwives wonder just how they will be able to implement such a service in the busy, under-resourced reality of their days. Midwives make a plan In 1993, a busy American antenatal nurse-midwife, Sharon Rising, realised that she was repeating herself almost the whole day and that it was hard for her to keep to her schedule. She had already figured out that antenatal care is more than a ‘check-up’. Women wanted relevant information and support too. Sharon wanted to provide more e ff ective prenatal care and so started with antenatal care groups which she called CenteringPregnancy ®. This model was neither just a health check, nor just antenatal classes, and there are now 580 health facilities in the USA which have implemented this model of antenatal care. CenteringPregnancy ® and similar antenatal models have subsequently spread far and wide. Indeed, many midwives began to challenge the individualised antenatal check-up model, unwittingly implementing similar or partial versions of the CenteringPregnancy ® model worldwide, including in South Africa. A variety of names were used, like group prenatal care, pregnancy circles, and pregnancy clubs. Group-based antenatal care allows women to get the care they need, in a supportive and respectful setting. It empowers them to make healthy decisions, allowing them to drive the content of their care, be more informed, learn from each other and even to participate in their own care. How group antenatal care works Normally, a group will have eight to 12 women at a similar stage of pregnancy. There will be five to 12 group sessions over the course of a pregnancy and each session takes around 90 to 120 minutes. Each session will include the three components; namely, physical assessment (consisting of some self- assessment elements and a physical examination with a professional), education, and peer support. Not only does this way of giving antenatal care decrease the number of preterm births, but research also shows that it increases prenatal satisfaction and that women make better health decisions in pregnancy and beyond. Midwives too report greater satisfaction, an increase in the quality of care, and better relationships with the women in their care. The WHO recommends that more research on this type of antenatal care is done, because it has already shown so many benefits and good results. Making circles in South Africa A midwife from the Netherlands, Margot van Dijk, introduced the concept of group pregnancy care sessions to the Healthy Mom and Baby Clinic (HMBC), located in the thriving town of Je ff reys Bay, in 2014. Prior to this, HMBC had o ff ered birth and breastfeeding classes, but they weren’t integrated with the health checks and there wasn’t that much group participation. It took some doing to get the model going smoothly. Dates had to be booked; the new approach needed to be posed to women to test their interest; work methods had to be structured; and informational materials made or collected. Nowadays, almost 75% of all women coming to HMBC for antenatal care join the groups. Each session’s educational slot uses di ff erent work methods and exercises, to encourage women to participate, and think independently. For instance, one session includes the ‘forbidden box’, a crate filled with food and beverages. Each woman is given a few products, reflects on their suitability in pregnancy and then shares her thoughts with the group. Soon the rest of the group add to the discussion, sharing their previous and current pregnancy experiences and helping each other to reach conclusions, facilitated by a caring and knowledgeable maternity professional. HMBC’s five group sessions cover: • Healthy eating and lifestyle for pregnancy and post-pregnancy • Relationships, family planning and dental health • Breastfeeding • Labour and birth (birthing partners attend too, to air their concerns and learn how they can be supportive) • Postpartum period and depression Continued on page 14 13 eSensitive Midwifery Magazine Issue 44