1. Prenatal group care within a small family medicine residency clinic
STFM Annual Conference, April 26, 2015
Nirali Bora, MD
Assistant Professor, MSU–CHM, GR Family Medicine, Spectrum Health
Navya Arepalli, MD
PGY3, GRMEP

2. Objectives
Describe benefits of group prenatal care for both patients and care providers.
Identify challenges to implementing group prenatal care at a small family medicine clinic site.
Brainstorm strategies to enhance the sustainability of group prenatal care at a small site.

3. Background Our experience Conclusions Next Steps Overview
*All patients provided consent for their pictures to be used in this presentation

4. Alternative model of care
Group Medical Visits
Alternative model of care
Used in multiple clinical sites including residencies

5. Evidence based model of group healthcare
Centering Pregnancy®
Evidence based model of group healthcare
Health assessment
Education
Support
Health assessment occurs within the group space.
Participants are involved in self-care activities.
A facilitative leadership style is used.
The group is conducted in a circle.
Each session has an overall plan.
Attention is given to the core content, although emphasis may vary.
There is stability of group leadership.
Group conduct honors the contribution of each member.
The composition of the group is stable, not rigid.
Group size is optimal to promote the process.
Involvement of support people is optional.
Opportunity for socializing with the group is provided.
There is ongoing evaluation of outcomes.

6. Studies have shown: Benefits of group prenatal care
Decreased odds of preterm birth
Improved breastfeeding rates
Increased knowledge
Increased use of postpartum contraception
Lower postpartum depression
Improved provider satisfaction

7. Clinic structure Demographics Breastfeeding rates
Spectrum Health FM Residency Center
Clinic structure
Demographics
Breastfeeding rates
- Baseline: 51.6% of patients who delivered between 7/1/2012 and 7/1/2013 were exclusively breastfeeding at 6 weeks postpartum. 92.3% of patients who are refugees were exclusively breastfeeding at 6 weeks postpartum while 22% of patients who are not refugees were exclusively breastfeeding at 6 weeks postpartum.

8. Grand Beginnings Recruitment Participants Structure
April 2014, patients with EDC October or November 2014
English speaking pregnant women at least 16 years of age
5 patients met criteria, 3 chose to participate
Participants
Structure

9. # group visits attended
Results
Birth outcomes, contraception, breastfeeding
Age
# group visits attended GP
Education
Birth
weight GA
Delivery
Birth control
Breast-feeding 6 wk PP 1 19
7/8
(delivered after 7 sessions)
G2P0
Some college
3800g
38 2/7
NSVD
condom Y 2 21
6/8
G1P0
High school
3605g
40 5/7
Nexplanon N 3 28
8/8
G3P2
3980g
39 3/7
Repeat C-section
Mirena IUD

10. Results Patient Satisfaction Patient Knowledge (pre and post)
Edinburgh
UCLA Loneliness Scale (pre and post)
Patient
Edinburgh
UCLA Loneliness Scale
Pre
Post 1 25 20 2 39 26 3 22 28

11. Patient Comments
What I liked best:
“It really taught me a lot, as a new mom I had a lot of questions. Before my baby came I was prepared.”
“Sharing and learning”
“Making friends”

12. Second group

13. Successful pilot Limitations Conclusions Recruitment Staff turnover
Lack of control group
Adequate group space
Did not have Centering®
certification or training
Resident schedule conflicts

14. Next steps Your thoughts? Collaboration with OB/Gyn residency
MSU network
Your thoughts?

15. Thank you Our patients Dr. William Stratbucker Jamie Post, RN
Nichole Lambert, MSW
Contact us:
Nirali Bora
Navya Arepalli