Getting Ready For Baby-The

Implementation and Evaluation of

a Group Based Antenatal Care

Model Siobhan Slavin Public Health Agency NI

Dr Jenny McNeill School of Nursing & Midwifery,

Queen’s University Belfast

Current antenatal care

• Antenatal care & education

recognized as mechanisms to

improve maternal and infant

outcomes

• Foundations are laid during

pregnancy & early childhood

• Early intervention is key

• Existing research suggests that

parents were not satisfied with

provision of care

• Attendance at antenatal education

could be optimised

Group Antenatal Care-the evidence • Limited evidence generally

• Catling et al 2015-

acceptable to women/no

adverse outcomes

• Some evidence to support-

WHO 2016

• Individual studies suggest

women are more satisfied,

possibly some impact on

LBW, may reduce waiting

times and increase

continuity

NI Journey to Introducing Solihull Approach Antenatal

Parenting Programme for First Time Parents

Births – Summary

Overweight/obese, 2016/17: 18% of P1 girls 25% of P1 boys

2010/11: 1.8%

2016/17: 7.6%

2016/17: 13.3%

2010/11: 15.5%

Highest live birth rate in United Kingdom, 2016

% births by HSCT, 2016/17

Graphics downloaded from:

thenounproject.com

46.9% of infants breastfed (partial/total), 2016/17

Highest: • Infant

mortality rate

• Fertility rate

Lowest: • Still birth

rate • % breast

fed at discharge

Across the UK/RoI, 2016:

Messages from parents

Trusted Relationships: Smaller number of

health professionals

More preparation

Practical parenting Emotional impact:

Antenatal & post-natal depression

Use pregnancy to facilitate social

networks

Consistent Information needs to be

provided in a range of formats

Home visiting is essential

Include Dads

• Opportunity for investment first discussed April 2013

• Recognition that women attend for antenatal care but not always education therefore we needed to change how we provide education

• Attended study day on “centering pregnancy” and established that transformation in form of group based care and education was way forward

• Reviewed the various group based models available e.g centering and FNP but neither of these fully fitted the needs

The aim of implementation of the strategy is better maternity care for all women

• Right person right place depending on risk assessment • Better informed - true partnership • More choice – Place of birth - Lead professional - Midwife as 1st contact • Early public health and pre-conceptual messages

Journey of Appointments

• Antenatal Core Care Pathway

• Early contact with midwife

• Booking appointment at 10 weeks gestation

• Minimum of 10 antenatal appointments for a primigravida (1st time mother)

• Minimum of 7 antenatal appointments for a multigravida

Group based

programme

Highlight the importance

of infant mental health

Solihull Antenatal Parenting

Group

Provide social opportunities for expecting

parents

Combine healthcare assessment and parent education

Better engage fathers

Opportunities for midwives and others to

work together

New Approach- Antenatal Parenting Programme

The Journey to Parenthood

Parents attend Pilot of Group Based Care and Education

Solihull Training for Midwives

Early Days…..

The Bayview Babes

Evaluation

• Service Evaluation

• Outcomes Based

Accountability (OBA)

Approach

• How much did we do?

• How well did we do it?

• Is anyone better off?

• Research evaluation

OBA: how much did we do ?

• 4929 women have attended GRfB

• 427 groups between Oct 16 – September 18

• Around 30% of first time mothers booked

• Average 10/12 women per group

• 23 sites in 5 Trusts

Is anyone better off ?

• 61% Getting ready for baby mothers breast feeding on discharge as opposed to 47% maternity population

• 99% attendees thought group based care and education was a good idea

• 97% enjoyed shared experience of group

• 98% felt well prepared for interacting with and nurturing their baby

• 99% valued having the same team of midwives

How well did we do it? -impact on parents

“GRfB programme was fantastic, I really enjoyed each session and chatting to the other mums to be. The fact that it tied in around the antenatal appointments really helped. I was so glad of this support as I no longer have my mum and was very nervous about beginning the journey without her to call on for advice. This programme gave me lots of confidence before the arrival of my baby and gave me a good insight of what to expect. I would definitely recommend it to any first time mums to be”

Postnatal questionnaire: baby 4 ½ months old

Delivering

continuous care –

increased job

satisfaction

Increased networking

Recognising the value of partnership

The APPLE Project

research evaluation of ‘Getting Ready for Baby’

Project Team

School of Nursing & Midwifery/School of

Social Sciences, Education & Social

Work, QUB:

• Kyrsten Corbijn van Willenswaard

• Fiona Lynn

• Lorna Lawther

• Fiona Alderdice

• Aideen Gildea

• Sharon Millen

APPLE:

A Parent & Professional

Learning Evaluation

• Project Advisory Group

The APPLE Project

Objectives

• Identify challenges to implementing

change to universal services

• Comparative evaluation of group

antenatal care & education versus

standard care including an economic

evaluation

• To identify professional perspectives

involved in delivering the interventions

• To identify parent perspectives of the

3+ review

• To identify critical success factors

Measurement tools used

• Health related quality of life (EQ-5D-5L

• Social Support Index

• Depression, Anxiety & Stress Scale (maternal & partner)

• Revised Prenatal Distress Questionnaire

• Prenatal Attachment Inventory

• Prenatal Adequacy Index

• Maternal Postnatal Attachment Scale

• Karitane Parenting Confidence Scale (maternal & paternal)

• Paternal Antenatal Attachment Scale

• Paternal Postnatal Attachment Scale

• Routine Data Collected

• Type of antenatal care

• Feeding intention and feeding choice

• Type of birth

• Analgesia

• Gestation at birth/weight

• Admission to NICU

• Smoking status

Phase 2: profile of women

• Average age 26-35yrs

• Ave gestation to see HCP: 8

weeks

• Most women planned

pregnancy and happy to be

pregnant

• 62% prefer to see the same

midwife

• Most felt confident about

looking after their baby >75%

for women & ~50% for

partners

• Approx 25% women reported

feeling anxious or depressed

• 80% of partners planned to

attend appointments

Phase 3: perspectives of midwives “as a professional

I feel like I get so

much out of it,

because that

continuity is really

good and it’s

good to know

you’re really

helping

somebody,

especially people

who have really

complex needs”

“I just can’t get over

how engaged the

partners are, they

just love it and they

get just as much out

of it as the women”

Phase 3: perspectives of midwives “The sustainability

should have been

thought about

before, at the

start, and it

should have been

included as part

of the pilot. Really

now, coming to

the end, all

systems go and

you’ve got to the

end of March and

you’re in a panic

situation to get

this done.”

“That’s the thing

about the program,

it’s aimed at

everybody, you’re

not excluding

anybody”

Thank you

j.mcneill@qub.ac.uk

Siobhan.Slavin@hscni.net