Together It’s Better, Taking Pregnancy Care To The Next Level

In 2016, the World Health Organization (WHO) launched its new recommendations for antenatal care with the subtitle ‘for a positive pregnancy experience’.  Wouldn’t you agree it’s interesting that they chose this subtitle? It certainly shows that the ‘experience’ is important during pregnancy.

The 2016 WHO recommendations have some key changes to previous recommendations. Now it’s advised to have eight or more ‘contacts’ in antenatal care, because perinatal deaths can be reduced by up to eight per 1 000 births when compared to the four antenatal visits of the past. The WHO now uses the word ‘contact’ instead of ‘visit’ to highlight that a woman’s ‘contact’ with her antenatal care provider should be more than a simple ‘visit’, instead focusing on an active connection between a pregnant woman and the healthcare provider. The goal is to provide empowering care and support throughout pregnancy. The new model increases maternal and fetal assessments, helping to more readily detect adverse circumstances and complications; improves communication between health providers and pregnant women; and increases the likelihood of positive pregnancy outcomes.

Not just pretty words

Evidence showed that women from high-, medium- and low-resource settings all valued having a positive pregnancy experience, the components of which included:

  • The provision of effective clinical practices (interventions, tests, dispensing nutritional supplements, etc.)
  • Relevant and timely information (dietary and nutritional advice, pregnancy ailment relief, birth preparation, etc.)
  • Psychosocial and emotional support by knowledgeable, respectful healthcare practitioners

It was shown by the WHO in 2016 that a positive pregnancy experience as described above optimises maternal and newborn health considerably. Midwives in particular are well-placed to offer and implement all three of these components, though many midwives wonder just how they will be able to implement such a service in the busy, under-resourced reality of their days.

Midwives make a plan

In 1993, a busy American antenatal nurse-midwife, Sharon Rising, from America realised that she was repeating herself almost the whole day and that it was hard for her to keep to her schedule. She had already figured out that antenatal care is more than a ‘check-up’. Women wanted relevant information and support too. Sharon wanted to provide more effective prenatal care and so started with antenatal care groups which she called CenteringPregnancy®. This model was neither just a health check, nor just antenatal classes, and there are now 580 health facilities in the USA which have implemented this model of antenatal care.

CenteringPregnancy® and similar antenatal models have subsequently spread far and wide. Indeed, many midwives began to challenge the individualised antenatal check-up model, unwittingly implementing similar or partial versions of the CenteringPregnancy® model worldwide, including in South Africa. A variety of names were used, like group prenatal care, pregnancy circles, and pregnancy clubs. For instance, Sister Lilian recalls how she would carry out important basic antenatal checks of each pregnant woman attending her antenatal classes, while waiting for all group participants to assemble.

Group-based antenatal care allows women to get the care they need, in a supportive and respectful setting. It empowers them to make healthy decisions, allowing them to drive the content of their care, be more informed, learn from each other and even to participate in their own care.

How group antenatal care works 

Normally, a group will have eight to 12 women at a similar stage of pregnancy. There will be five to 12 group sessions over the course of a pregnancy and each session takes around 90 to 120 minutes.  Each session will include the three components; namely, physical assessment (consisting of some self-assessment elements and a physical examination with a professional), education, and peer support.

Not only does this way of giving antenatal care decrease the number of preterm births, but research also shows that it increases prenatal satisfaction and that women make better health decisions in pregnancy and beyond. Midwives too report greater satisfaction, an increase in the quality of care, and better relationships with the women in their care.

The WHO recommends that more research on this type of antenatal care is done, because it has already shown so many benefits and good results.


World Health Organization, ‘WHO recommendations on antenatal care for a positive pregnancy experience’, 2016

Benediktsson J, et all, ‘Comparing CenteringPregnancy® to standard prenatal care plus prenatal education’, BMC Pregnancy Childbirth, 2013, 13