CenteringPregnancy in the Netherlands: Who engages, who doesn’t, and why

Abstract

Background CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved pregnancy outcomes. However, motivating women to participate in CP can be difficult. As such, we explored the characteristics associated with CP uptake and attendance and then investigated whether participation differs between health care facilities. In addition, we examined the reasons why women may decline participation and the reasons for higher or lower attendance rates. Methods Data from a stepped‐wedge cluster randomized controlled trial were used. Univariate and multivariate logistic regression models were used to determine associations among women's health behavior, sociodemographic and psychosocial characteristics, health care facilities, and participation and attendance in CP. Results A total of 2562 women were included in the study, and the average participation rate was 31.6% per health care facility (range of 10%‐53%). Nulliparous women, women <26 years old or >30 years old, and women reporting average or high levels of stress were more likely to participate in CP. Participation was less likely for women who had stopped smoking before prenatal intake, or who scored below average on lifestyle/pregnancy knowledge. For those participating in CP, 87% attended seven or more out of the 10 sessions, and no significant differences were found in women's characteristics when compared for higher or lower attendance rates. After the initial uptake, group attendance rates remained high. Conclusion A more comprehensive understanding of the variation in participation rate between health care facilities is required, in order to develop effective strategies to improve the recruitment of women, especially those with less knowledge and understanding of health issues and smoking habits.

The Effect of CenteringPregnancy Group Antenatal Care on Maternal, Birth, and Neonatal Outcomes Among Low‐Risk Women in the Netherlands: A Stepped‐Wedge Cluster Randomized Trial

“…Women who decided to participate in CP differed in several characteristics from women who did not participate. 26 Theoretically, if women had been offered CP in the control period, we would have expected a comparable distribution of CP and IC participants. If we had performed a per protocol analysis, the CP group would have been compared with all women in the control period without differentiating between these potential participants (compliers) and potential nonparticipants (noncompliers).…”

“…Women participating in CP only received more individual prenatal check‐ups if they had complications that did not require a referral to secondary care and after the last antenatal session in the period before giving birth. A previous study conducted in the Netherlands revealed that 87% of the CP participants attended 7 or more CP sessions 26 . Groups were facilitated by a certified midwife and a co‐facilitator.…”

“…A previous study conducted in the Netherlands revealed that 87% of the CP participants attended 7 or more CP sessions. 26 Groups were facilitated by a certified midwife and a co-facilitator. During each consultation, women received the same health assessments as in IC: blood pressure measure, fundal height assessment, and a check of fetal heart tones.…”

“…Previous research showed that discontinuation of CP was rare among women in the Netherlands once they began participating in CP. 26 Prior to the implementation of CP, care providers and cofacilitators received a two-day training and three half days of supervised sessions from experienced Dutch trainers who were trained by the Centering Healthcare Institute (CHI). The health care professionals from the midwifery practices also had the possibility to contact CHI for assistance and guidance whenever they were in need of additional information or help with providing CP sessions.…”

How to Support the Referral Towards Group Antenatal Care in Belgian Primary Healthcare Organizations: A Qualitative Study

“…After all, not all women are willing or able to participate. [20][21][22] In addition, not all women who accept to participate are included in the same group. This is because a group consists of women of similar gestational age, ensuring the topics of the sessions are adapted to the phases and needs of the group.…”