In a hard spot: providing group prenatal care in two urban clinics

Objectives: CenteringPregnancy (Centering) group prenatal care has been demonstrated to improve perinatal outcomes and provide a positive experience of care for women, but it can be difficult to implement and sustain in some clinical settings. The purpose of this study was to examine the challenges encountered when Centering group prenatal care was provided, and the responses of Centering group leaders to these challenges.

Design: this was a longitudinal, qualitative study using interpretive description. Data collection included participant-observation and interviews with group leaders and women receiving group prenatal care.

Setting: two urban clinics providing care to low income women in the northeastern United States.

Participants: interview participants were 23 pregnant women (primarily African-American and Hispanic) receiving group prenatal care; other participants were 24 significant others and support staff participating in groups, and two nurse-midwife group leaders.

Findings: the clinics did not always provide full resources for implementing Centering as designed, creating numerous challenges for the group leaders, who were committed to providing group prenatal care. In an attempt to sustain the model in the face of these limitations, the group leaders made a number of compromises and modifications to the Centering model.

Key conclusions: the limited clinic resources and resulting modifications of the model had a number of downstream effects, some of which affected relationships within groups, participation, and group cohesion.

Implications: modifications of the Centering model should be undertaken with caution. Strategies are needed to enhance the success and sustainability of Centering in varied clinical settings so that the benefits of the model, which have been demonstrated under more controlled circumstances, can be conferred to women receiving routine care during pregnancy.