My first appointment in London was with Dr Jane Stuart, Trial Manager, First Steps RCT Study, at Birkbeck, University of London. The RCT study is trialling the Family Nurse Partnership program, delivered in a group mode. Later in the week, I will be attending one of the group sessions and talking to nurses and clients about their experiences of the group approach.
Group FNP (gFNP) uses Family Nurse Partnership resources, materials and its approach to provide a structured learning program for groups of vulnerable women, incorporated with maternity care from early pregnancy until their child is 1 years old.
gFNP is provided by two Family Nurse Partnership nurses, one of whom is also a midwife. The group sessions last for 90 minutes, followed by or preceded by medical checks relevant to the pregnancy or to child development. Following the Centering Pregnancy model of working, many of the checks are completed by the clients themselves, guided by the FNP nurses.
I was very interested to hear more about the Centering Pregnancy model of antenatal care.
Centering Pregnancy is a model of group antenatal care, which I first heard about in Pennsylvania. Women receive the same physical care and screening as in individual consultations, but in a group setting.
There are eight sessions during the antenatal period, at 16, 25, 28, 31, 34, 36, 38 and 40 weeks. In addition, there is a reunion one month after the birth. Additional appointments occur where needed.
The sessions are two hours long and each group consists of between eight and 12 women who have a similar expected date of delivery (EDD). The sessions comprise an initial 40 minutes when the women arrive, during which time they can socialise and get involved in self-care activities. They are offered an abdominal palpation. The subsequent time is timetabled as discussion time. Women who require individual attention for physical, psychological or social reasons can be seen in private at the end of the session.
The room is set up with a circle of chairs, a mat and cushions at the edge of the room for the abdominal palpation, a refreshment area and a desk-height table for blood-pressure estimation. The room also has toilet and hand-washing facilities nearby. Prior to each session, the midwives familiarise themselves with the needs of the women, for example by obtaining the results of any screening tests.
An important part of Centering Pregnancy is the woman’s active involvement in the physical aspects of care and record-keeping. Women measure and record their own or each other’s blood pressure, test their urine for protein, estimate their gestation using an obstetric wheel and document the discussions in their maternity notes. These activities are overseen by one of the midwives.
The group discussions follow a set format of topics ranging from healthy eating, awareness of mental health and breastfeeding. There are also discussions about pregnancy, birth and beyond and accessing advice, support and information for a lifetime. Partners are invited to some, but not all, sessions to provide an opportunity for sensitive discussions such as domestic abuse.