These strategies should be carefully examined for translation to the United States and future research.

In 2002–2003 an attempt was made to establish ‘normal birth’ rooms within the main delivery suite/labour ward of an inner city teaching hospital, with the aim of providing a less clinical environment for low-risk women to give birth in. The innovation formed part of an initiative to increase the normal birth rate at a hospital with a high caesarean section rate. The process of change, including the promotion of midwifery-led care within the unit was explored as part of a postgraduate research project. An action research approach was used to enable midwives to identify their needs for skills development appropriate to promoting normal birth and to facilitate the exploration of problems encountered. The project formed part of a process of change that has enabled a change in the culture of the unit, increasing the profile and value attached to normal birth and decreasing the caesarean section rate.

No abstract

CenteringPregnancy® is a model of group antenatal care which was devised and developed in the United States. A feasibility study was conducted in South East London from 2008 to 2010, to assess if the model could be introduced into NHS settings, if women would be prepared to join a group model of care and to explore the views of the women, their partners and midwives who participated. This was the first time the model had been implemented in the UK. Six antenatal groups, attended by 60 women and their partners and facilitated by 12 midwives, were established for the feasibility study with a seventh group of 8 women and their partners established later to bring the learning together and inform an operational guidance document ( Gaudion and Menka, 2011 ). Women whose pregnancies were classed as low or high risk could opt for group antenatal care at the study site after discussion with a midwife at their antenatal booking visit. Integral components of the CenteringPregnancy model are the evaluations of care which women and their partners are asked to provide in late pregnancy and at one month after the birth of their baby. The midwives who facilitate the groups are also required to complete evaluation forms and to contemporaneously reflect and enhance the care they offer, if this is appropriate. Feedback from these sources, together with an evaluation of the means of learning in the development process, was very positive and has informed the ongoing roll-out of the model at the study site. The potential to conduct randomized controlled trials in the UK to assess the clinical utility and cost-effectiveness of group antenatal care compared with individual antenatal care for women in low- and high-risk obstetric populations should now be considered.

CenteringPregnancy® is an innovative model of group antenatal care devised and developed in the United States. The model differs from traditional care in that women participate in a social, supportive group process, which develops their knowledge and confidence, and increases their personal and maternal self-efficacy. Following initial studies in the US, the CenteringPregnancy model has been adapted and implemented in a number of studies internationally, with a growing body of evidence of positive results in terms of clinical outcomes, satisfaction with antenatal care, perceived knowledge of issues around pregnancy, birth and parenthood. The background to the development and implementation of the first feasibility study to be conducted in the UK is described. This includes adaptations necessary to comply with national guidance and policy recommendations for NHS maternity care, and midwifery rules and regulations. There is a need for further larger studies to assess if similar positive outcomes could be replicated in the UK maternity settings.