Imagine having a pregnant woman come into the community health center saying, “I’m worried about my headache.” She has received her antenatal care according to the centering- group care model. “We talked about headaches in our group and I now know that this headache is different from the malaria headaches that I often get.” The clinical staff quickly check her blood pressure, which was very high,-and immediately refer her to the nearest hospital. Or imagine that during the postnatal session of the group, the women share with the midwife their concerns about another group member possibly suffering from depression.

Group health care is a manner of Maternal Newborn and Child Health (MNCH) provision that goes beyond the traditional one-to-one care. With a group of 8 to 12 women, the saying applies “when you get to know everyone, you get to care about everyone”. As the group meets together, 8-10 times during pregnancy, continuing during the postnatal period for baby and women’s health care, the sharing and caring amongst the members becomes quite profound. Women share concerns and life experiences that they never disclosed before; not with a care provider and not even with their family or friends. The privacy and security of the group creates a safe environment for talking, leading to creative solutions generated by the group itself. As each person’s confidence grows the resultant empowerment is expressed through improvement in health behaviors for herself and her family.

For me, there was a clear reason to develop and implement a group model of care: a model resulting in better care-and-health outcomes and higher satisfaction with the care provision. I had been a practicing nurse-midwife for over twenty years and knew there was a better way to provide care than the traditional one where throughout the day I was answering the same questions at each individual antenatal care checkup. I envisioned a care model that would empower women to make their own decisions about their health care needs; a care model that would unite women in support of each other, a care model that would encourage women to share the knowledge I knew they had with others. The model I developed, CenteringPregnancy®, is relationship-centered, building on the knowledge and wisdom present in the group, and where  cultural values and norms that influence health behavior are respected. Although the midwifery care provider remains accountable, her role has changed. She[1] becomes a group member and takes on a facilitation role instead of the traditional didactic and health promotion role. Because of the growing connection and the strong trust in the group, it can meet needs that a health care provider is not always able to provide. This calls for a re-evaluation and adaptation of the traditional care provider’s identity. But at the same time, this innovative role brings more far-reaching satisfaction to her work because the care provider is an eyewitness to sustainable relationships being forged in the community, promoting healthy behavior.

Perhaps the real question is: why wouldn’t we want to provide the best possible care for the women and families that we serve? Group care brings joy to all the participants and supports a sense of community whereby long-lasting relationships start and may carry on for years.

The stories in this book reinforce for all of us what we all already knew. Group care is a powerful and innovative way of providing and receiving (maternity) care.

Sharon Schindler Rising, nurse-midwife, secretary & treasurer of Group Care Global

Silver Spring, MD, USA

[1] ”she” is used here realizing that there also are many men who are providing midwifery care and also acknowledging many physicians who also provide human-centered “midwifery” care.