Group based antenatal care : expectations, attitudes and experiences from parents’ and midwives’ perspective

Abstract

Group based antenatal care (GBAC) is a model of antenatal care that has been implemented in Sweden since year 2000. Sparse research has been conducted in Sweden but in the USA, where the model is more common, the research has found that women ́s satisfaction with GBAC is higher than with standard individual care (SC). The purpose of this thesis was to study women’s expectations of antenatal care and parents’ experiences of GBAC in Sweden. Midwives attitudes and thoughts about GBAC and their work in SC were also investigated.

Method: In Study I, 28 parents who received GBAC were interviewed about their experiences and qualitative content analysis was used to understand and describe their responses. Studies II and III are based on the controlled clinical trial (CCT), which was conducted in 12 clinics in different geographical areas in Sweden between 2008-2010. The design of the study consisted of midwives who were randomized to GBAC or SC and women in both groups evaluated the given care. Study II compared 700 women ́s expectations of antenatal care before the intervention in the CCT with 3061 women in an earlier national cohort (KUB) and also compared expectations in women who later received GBAC or SC. Study III was based on two questionnaires given to women before the intervention in the CCT and six months after birth. The study explored differences in mothers’ satisfaction with the two models of antenatal care. Descriptive and comparative statistics were performed in studies II and III. In Study IV structured interviews were used to explore 56 midwives attitudes to GBAC. Descriptive statistics and quantitative content analysis were used.

Results from Study I showed that parents valued that their medical needs were fulfilled, and they felt prepared for childbirth but not for parenthood. Parents appreciated their midwives for their medical knowledge but were critical of their awareness of gender issues. In GBAC parents had opportunities to socialised with other couples and when sharing their situations with each other, they felt more normalized. They also recommended this model for all parents. The expectation of content of care in Study II showed changes since the National cohort 10 years ago. Currently women have lower expectations in health related issues and in attending parental classes but higher expectation about information. They also have a higher expectation that during antenatal care midwives will treat them with respect and support their partner’s involvement. Two significant differences were found between GBAC and SC in the CCT: women who later received GBAC had higher expectations about information on breastfeeding and the importance of attending parental classes. Regardless of model of care, women in CCT had lower expectations of continuity of caregiver and there were also fewer women who preferred more visits then recommended compared to women in the national cohort.

In comparison between GBAC and standard care in Study III, there were no significant differences in general satisfaction between the two models. In GBAC, women reported significantly less deficiencies with all information, except information about pregnancy. Women in GBAC reported more engagement from the midwives, that they were taken more seriously and that they had more time to plan the birth. Women in GBAC was also more satisfied with antenatal care in supporting contact with other parents and that the care helped them in initiating breastfeeding. Women reported deficiencies in almost 50% of antenatal care content regardless of model. Midwives in Study IV weighed pros and cons of initiating GBAC and considered the model inappropriate for immigrants and well-educated parents. They also expressed organisational barriers to implement the model. The majority of the midwives reported high work satisfaction and 55% requested to run GBAC.

In conclusion, the findings of this thesis found few differences in women’s expectations about the content of care between GBAC and SC, but expectations have changed over the last ten years. Parents who experienced GBAC appreciated the group model. Similar overall satisfaction in both models of antenatal care suggests that GBAC can be introduced without altering women ́s satisfaction with antenatal care but midwives viewed constraints to implement GBAC.