Stories from  group care in The Netherlands

Michelle (27): ‘It is easier to talk to someone with the same experience’


 “It was wonderful to see how quickly you can get to know each other. The first group meeting was somewhat awkward. You don’t know each other at all. The only thing that you have in common is that you are pregnant. But because of the Centering model, we soon started talking about discomforts, things we came up against or what worried us during pregnancy.”


Easier to ask

“Every meeting had a specific theme, for example minor complaints during pregnancy. The midwife started the conversation, but before we knew it, our stories flew back and forth across the room. Because we recognized so much in each other, it was easy to say what we wanted to share. Nothing was thought of as strange. That made me feel more secure and free to ask questions.”


Good exchange

“During my first pregnancy, I only experienced the one-to-one visits with the midwife. When I was able to join a Centering group during my second pregnancy, the exchange between women specifically appealed to me. And it really worked. For me it meant that I retained information much better and I thought deeper about certain topics.”


Impact

“One of the women who already had a baby, told us that she only heard about the birthing stool after giving birth. It seemed better for her to use the birthing stool for her second birth because the first time she found it hard having to lie on her back all the time. That really had an impact on me. If the midwife had encouraged me to use the birthing stool, I don’t think I would have accepted her advice as easily. I wasn’t really keen on a birthing stool, but this story made me look at it differently.”


My story

The 20-week ultrasound scan was discussed during one of the sessions. With my first child, spina bifida was discovered with that scan.  We decided to terminate the pregnancy. My story made the other women more aware of the fact that the 20-week scan is more than just having a fun look at the baby. One woman who had decided not to have the 20 week scan, changed her mind. She didn’t realize how much could be seen during the scan. And when a small abnormality was seen in another woman’s scan, she was able to talk to me about it. It is easier to talk to someone who has had a similar experience.”


Encouragement

I also received support from one of the women in the group. I am a nurse and when I started experiencing pelvic instability, I found it really difficult to talk about it at work and indicate that I needed to work less or change my duties. One of the women in the group had the same problem but she approached it differently. This encouragement was what I needed to talk to people at work.

 

 

Merel (35): ‘I wanted to contribute during my second pregnancy’


 “The contact with people in the same life phase and environment seemed to me and my husband the biggest advantage of Centering. Our friends live far away. We followed the entire program together for both of my pregnancies. The midwifery practice also encouraged this. The men’s input was totally different compared to that of the women. This was really good for the group balance.”

Standing up for yourself


“In my first group, there were women who were pregnant for the second or the third time. We found the mix very pleasant. So with my second pregnancy, we chose to join Centering again. This time we wanted to contribute to the group. And it worked. It happened that a woman from our group took action when she felt that her maternity aid nurse didn’t really fit in with her family. Because of our experience, she knew that she had a say in this and stood up for herself.”


Confidence

“There was a woman in our second group who had not been able to breastfeed her first baby. Now expecting twins, she had no confidence about breastfeeding. We had some huge success stories in the group about breastfeeding. This gave her so much confidence, that with the right support she was able to breastfeed both her babies. She was really happy. Of course the midwife could have encouraged her or referred her to a breastfeeding consultant, but she indicated that the group really made the difference.”


Less abstract

“I gave birth at home with my second pregnancy even though I had concerns. But the positive stories from the group combined with the theoretical discussions with the midwife reassured me to go for it. The experiences of others make these type of choices less abstract. The group members stimulate each other to think deeper about certain things. When one of the babies in the group was born too early, we talked about it and if it is possible to prevent this and what are the warning signs.”


Reassurance

“While everyone is still on maternity leave, the women from the second group have a weekly coffee date. Sometimes we talk about the physical discomforts we experience after birth. You can’t always talk to your friends about these things and you don’t call the midwife or family doctor for every single complaint. Having all gone through the same experience, there is a great understanding for each other in the group. This gives us more confidence. And when a story is so different from the others, we know it might be a good idea to seek professional advice.”


Jacomijn (36): ‘Sometimes someone asked me a question that made me think’

 “The idea of sharing experiences with other women really appealed to me. But to be honest, after the first couple of sessions I was in doubt whether to continue or not. For me pregnancy is an intimate thing. I really had to get used to being in a group with 9 strangers.”


Kind word

“The aim of centering is that you really do it together and share things in the group. I had some difficulty with that at the beginning because there were some things I preferred to discuss one-to-one. I felt very insecure because of a previous miscarriage. It wasn’t easy for me to discuss this in the group. But after we got to know each other this feeling went away. When I did have the confidence to share my story, I was supported. Everybody had a kind word for me.”


Light hearted

“I noticed that every woman experiences pregnancy differently. Sometimes you hear ‘fine, you have that too’ and another time it is more like ‘oh can it be that way too’. I learned a lot from this. I found pregnancy to be very uncomfortable with this big belly and all the discomforts that go along with that. Others experienced the same but were more light- hearted about it. This helped me to look at things differently”


Better prepared

“When we talked about a certain subject, the midwife would start by asking a question to the group. Only after everyone had their say, would she join in adding her knowledge to the conservation. I found the different perspectives that came up in the conversations, very helpful. Sometimes someone would ask a question that would really make me think. Of course this doesn’t happen during an individual consultation. Because of this, I was better prepared for the birth: for example knowing that the midwife is not always immediately present at the start of labor. The practical tips we exchanged in the post-birth app group were also very helpful, about sleeping, baby phones, or swaddling.”


Group help

“We discussed very personal things with each other, bringing us closer together. Some things touched me. One woman had a very hard time after giving birth. Together as a group we looked at how we could help her. What she needed the most was babysitting so she could have time for herself and rest. I ended up babysitting for her once a week for six months.”

 

Zinzi (32): ‘All my questions were answered by the group’

 “I doubted whether or not to join Centering. I thought that I would like the individual contact with the midwife much more than the group participation. On the other hand, I intentionally became a single mother and my network was not so big. It could be a good way to get in touch with other mothers. So I decided to give it a go. The midwife told me I could always decide to stop, if I didn’t like it.”


Opening up

“Because I have a history of depression, I felt very insecure at first; would I be able to handle motherhood? I was able to open up in the group and talk about my doubts. Now I am used to this and I work as an ‘experience expert’ at a community mental health organization. If you are an open person, others usually open up as well. What really helped me was our app group where I could say what I needed to say anytime, night or day. Otherwise I might have fallen into another depression.”


Suddenly alone

“The contact we had with each other after we all had our babies was very helpful. Suddenly I found myself at home on my own, with a baby, without a partner. I had no one to turn to when I felt insecure about something. I was the first one with a baby in my family and in my group of friends. I could always turn to the group with all my questions: they were my ‘surrogate partner’. Maybe I overdid it a bit with my questions, but they really didn’t mind. There was always someone available. That was really nice.”


Not ashamed

“One of the topics we addressed in the group, was postnatal depression. Someone in the group told us that she had gone through this after her first pregnancy. It was very emotional, but is was also very good that it was talked about. This created awareness about the fact that pregnancy is not always that pink cloud that you imagine it to be. You don’t have to feel ashamed when it gets tough. Nobody experiences a perfect pregnancy. For some women this was a real eye opener.”


Beacons of light

“With my second pregnancy, I joined the Centering group again. I did it for fun but I also learned new things even the second time around. Just like during my first pregnancy, I experienced extreme nausea. The evenings with the group were my beacons of light. Regardless of how I felt, I went. Because I enjoyed it so much and the atmosphere was so very positive. It really helped me.”

 

Together is more!

It is the first meeting of the new group. Frederique enters the room somewhat uneasy. She hides her belly in a dress that is far too big for her and her eyes are cast downwards. She is not sure what to do and shuffles discreetly to the nearest chair she can find. The midwife is busy examining one of the other women, but can’t help noticing the timid figure in the room.


Frederique is the last one to join the midwife for her abdominal examination. The large dress reveals a beautiful little belly. The midwife tries to make contact with her but Frederique does not open up. In silence they quietly listen to the baby’s heartbeat together.


The midwife wonders if Frederique’s extreme shyness might prevent her from being able to join in. But the power of the group proves to be strong enough. The women in the group begin to talk. They tell each other who they are and how they feel about being pregnant. This encourages Frederique to talk. Shy at first, but with the group’s encouragement, she tells her story. She talks about the town where she grew up and how she unexpectedly became pregnant, how her family abandoned her and that she is all alone.


The group is noticeably touched. Frederique looks relieved. “It is the first time that I don’t feel alone having people around me who are interested enough to ask me things and who want to help me.”


Frederique comes more and more self-assured to the following group sessions. The group app is in full swing and coffee dates are made. The group sends each other tips about common pregnancy ailments and support each other to achieve personal goals. Frederique is able to stop smoking, to stop drinking Red Bull, and to eat a healthy meal at least twice a week.


The midwife: “I really wondered how Frederique would experience being in the group. Would she be able to find her place? Would we be able to make her feel comfortable enough? But it was really special to see what happened in the group. At a certain point during the first meeting, I realized I hadn’t said anything for 15 minutes. The group didn’t need me, they did it themselves. I realized that this care model improves the health of the mother and child so much more compared to the ‘old fashioned’ care model. Frederique’s positive experience was the result of the power of Centering. Together really is more! “

 

Twins

The Centering group holds a postnatal meeting for the women to get together one last time. It is a large group of 15 women. Birth stories are shared and new topics are discussed, such as feeding, coping with a new baby and family planning. One of the participants is Maartje. It was her second pregnancy and this time with twins. Her first child is 2 years old and her partner has a demanding full-time job. The twins, 2 boys, are healthy and Maartje is very pleased about how the birth went. Still, the tears well up in her eyes. Maartje is having a hard time and confesses that she cries a lot. Two small babies and a toddler who is constantly demanding attention. She can’t seem to get anything done, not even prepare daily meals. She often reverts to simple meals as store bought pizza. Her partner does his best in the evenings. But it is not enough. Sadly she asks the group, “How will I ever manage?”.


“What makes it so difficult for you? What are the most difficult moments? Is there anything you can delegate?” The group takes the lead asking analytical questions. They finally decide that together they can lend Maartje a helping hand. For example, taking care of one hot healthy meal a day, so that she doesn’t have to shop and cook herself. This is not a lot of extra work for the other mothers in the group. In this case it is advantageous that the group is larger than average. With 14 women, everyone only needs to cook a little extra once every 14 days. The group sets up a schedule and for the next month, a prepared meal  is brought to Maartje and her family each evening


The midwife: “I can’t offer this type of care unless I open up a soup kitchen. It is ‘only’ about a plate of food, but in the meantime Maartje feels enormous support.”


Teenager

Group care is sometimes used to see if people are receptive or self-reliant. However, this is not a goal in itself but a simple way to assess to what extent something is understood, without having to ask explicitly. For example: Can someone read and write? Are they able to achieve a set goal?


This is the case with Sofie, a 14 year old girl who is unintentionally pregnant by her 17 year old boyfriend Daan. She joins the group with her mother. Sofie will continue to live at home where she will care for and raise the baby with the help of her mother. Sofie’s mother does not have much confidence in her daughters mothering skills. The group consists of 11 other women between the ages of 22-40 years old.


During the first group session, every women receives a workbook. It contains a lot of health information and has space where the results of the pregnancy check-ups can be recorded. There are also assignments as preparation for the group sessions and Sofie takes these very seriously. After all, she is used to doing her homework tasks for school. She always comes to the sessions prepared. She is able to answer many of the questions asked by the other group members. After a few sessions, it is clear that the other women have developed respect for Sofie, trusting her knowledge and information, treating her as an equal and not as just a pregnant kid. This strengthens her self-confidence and sense of responsibility. Sofie’s mother’s attitude also changes. She sees her daughter maturing, gaining the respect of the others in the group. It makes her more confident about Sofie becoming a mother, making it easier to have an adult conversation with her daughter about the division of responsibilities and tasks after the baby is born.

The midwife: “It is impossible to generate a dynamic like this during one-to-one care. During traditional antenatal care, there is just not enough time to foster this kind of relationship. It happened here, right in front of my eyes without any extra effort on my part. The group gave Sofie the self-confidence she needed to care for her baby. This group still meets regularly.


Domestic violence

In each group, domestic violence is a topic for discussion using a number of statements. Now it is this group’s time to discuss the subject. The women in the group work well together and really enjoy each other’s company. They say themselves, “we have a good click”. They see each other outside of the group and communicate using WhatsApp. The subject domestic violence is discussed calmly without any issues emerging.


A few weeks later Aaf, one of the women in the group, invites the midwife for coffee. Aaf lives in one of the apartment complexes in the city that has a bad reputation. She tells the midwife that she is trapped in a violent relationship. Her partner beats her and they fight often. On some occasions, the police has come to investigate. Aaf feels unsafe. “Do I want my child to grow up in this kind of circumstance?” She has discussed her situation with the group. “I don’t want this anymore, but how do I get out of this. How do I do that?” She tells the midwife that with support from the group she decided that her partner can move in with his brother. Her partner has accepted this solution. The group helped her to move his things to his brother’s house. When this was done, the group advised her to inform the midwife about what had happened. They thought it was the right thing to do.

The midwife: “This woman created her own support network and together they found a solution for her problem. The group discussion made her think further. She was able to end the situation in the safest possible way for herself, her child and her partner.”


Itchy hands

The group counts 10 participants. Today is the last session when all the women are still pregnant. At the end of it, one of the women has something to say “I can’t go home like this. I will sit and worry if everything is going to be alright because you talked about itchy hand palms and foot soles. You have to be careful when you feel this, right? And get yourself checked?” she asks worriedly. She nudges Anja, the woman next to her. “If you don’t tell them, I will!”

Anja has joined the group even though she receives her care in the hospital due to her history of having a still birth. Anja has been experiencing itchy hand palms and foot soles for a while. Not a nice feeling, but she forgot that it could be a sign of serious problems. She has not said anything about this during the sessions or to the midwife. But she has complained about the discomfort to her fellow group members. Stammering, she now talks about her complaints.

The midwife refers Anja directly to the hospital for examination. Her serum bile acids[1] are seriously raised. Because of this and her history, her labor is induced.

The midwife: “Social control within the group brought this woman’s complaints to light. The topic of itching hand palms and foot soles is not a standard subject during one-to-one care. It doesn’t happen that frequently and we simply don’t have the time. This is not the case for group care where there is more time and opportunity to bring up this issue. ”


Failure to progress

Ayla is pregnant with her first child and has enjoyed participating in the group care sessions held by her local midwifery practice. Her labor is induced due to high blood pressure. Her blood pressure is stable and the CTG [heart trace] shows that her baby is in good condition. She has reached a dilation of 6 cm but this has taken a long time. The obstetrician on-call thinks that progress is too slow and proposes to carry out a cesarean section. It scares Ayla. She contacts the midwife on call in her practice. “Why do I need a cesarean? What does it mean that my labor is too slow?” Ayla asks the midwife despairingly. “Everything seems to be fine, my baby is doing well, and my blood pressure is good. I don’t want a cesarean section, at least not yet. I can cope with my contractions. The amniotic fluid is good too.” The midwife explains to her that from a distance she cannot make an accurate judgement about the situation. But she does explain to her, that if the situation is the way Ayla describes it, she could probably wait a little longer, especially if she and the baby are doing well. “Talk to them”, she advices Ayla. “Make a deal with the obstetrician about how much longer you can try.” Ayla talks to the doctor, who agrees to postpone the operation. Ayla waits, keeps moving, showers, and walks around. Eventually she has a cesarean section but at the moment when Ayla is ready for it.


The midwife: “The medical outcome is the same: A healthy mother, a healthy baby and a cesarean section. But her birth experience was probably much better than when the cesarean section had been carried out earlier. Ayla learned a lot during the group sessions in which we discussed the birth and what you may or may not want. Ayla looks back on the birth with pride and satisfaction. She knows she did everything she could to have the best birth experience. She kept the control over this event.”


Pesto troubles

It is not uncommon to have women in the group who have an unhealthy diet. Therefore healthy eating is an important theme during group sessions. The current group has a participant who has very unhealthy eating habits. Maaike doesn’t like much. Pasta with ready-made pesto from the local supermarket is one of the few things she manages, as well as white bread with chocolate cream, sweets and potato chips.


During the group discussion, it is Maaike who asks, “What can I do to eat healthier?” “You can make your own pesto”, one of the women in the group remarks. “Fresh basil is a step in the right direction.” “Try rocket in your pesto”, suggests another participant. “You’ll find lots of recipes on the internet”, says another woman.


One of the assignments during group care is that every week each participant places a photo of a meal she is most proud of in the group app. This encourages the other participants to think about what they eat. It is how they learn from each other.


Four weeks later the group comes together again. Maaike says that she tried out a salad: the recipe also contained pesto! She proudly adds the photo to group app.


The midwife: “Maaike realized she needed to change. Especially for the benefit of her child. During pregnancy, people are more open to change. We use that to our advantage. Moreover the assignment doesn’t cost me any time at all. Inspired by the group Maaike started to experiment. She is still not the best example of a healthy eater, but her trying out other things is a huge step forward!”


Partner meeting

One of the participants in the new group is Nienke. A healthy lifestyle is very important to her. She is a professional coach and works in a clinic for substance abusers. She feels connected to the group and is excited but also a little stressed. Especially the feeling that she has no control over what is to come.


Nienke is in a good stable relationship with a man who is very involved with the pregnancy. The group invites their partners twice to participate in the group: one session when they discuss the birth and another session when a father coach joins in as co-facilitator. During the session with the father coach, the group splits up. The women in one group and their partners in the other. They discuss separately what their expectations are about having a baby. How will a baby affect their relationship? How did your parents raise you? How will you and your partner organize things? Important themes are discussed. Nienke’s partner Fons attends the sessions.


During the last group session approximately 6 weeks after all the women have given birth, Nienke talks about the impact of the partner sessions and how important they were to her and her husband. Together they often spoke about the issues that were raised during these sessions: their expectations, how to raise the baby. They also talked about scary and difficult issues. She remarks enthusiastically that they were very happy with all the tips and the presence of the father coach.


The midwife: “I was really surprised. This well-educated couple with a stable and honest relationship. I caught myself thinking that for them it would be a normal thing to discuss these kind of things with each other. But apparently not. This meeting had an enormously positive effect, even on them.”


Smoking cessation

Bianca, a women with a lower educational level is part of a group with mostly higher educated women. Bianca smokes, even during her pregnancy. It is always up to the women to decide for themselves what information they share with the group. Bianca wants to share that she still smokes and that she finds it hard to stop. The group response is judgmental but also supportive. They see her dilemma but also ask how they can be of help. Having the group’s support, Bianca decides to quit smoking.


The midwife makes an extra effort in this group when smoking during pregnancy is discussed. She brings a CO-meter* to the session. When someone breaths out into the meter, it shows if that person has smoked. With every positive beep the group cheers loudly!


During each session, Bianca proudly informs the group how she is doing. She is still not smoking. And every time, the women in the group applaud for her. She shines with pride.


The Midwife: “This support has been fantastic. Group feedback made it possible for her to permanently quit smoking!”


*Carbon monoxide (CO) is an odorless gas. When cigarette smoke is inhaled, CO is absorbed into the blood stream via the lungs. Too much CO in the blood is unhealthy because it binds easier to the red blood cells than oxygen, taking away essential oxygen for the body.


By comparing CO results, the theme ‘smoking during pregnancy’ is easier to discuss during the group care sessions. The test can also be an encouragement for those who have just stopped smoking. Especially because 48 hours after the last cigarette, CO levels are the same as those of a non-smoker!

 

Together

Rachel is a quiet sensitive woman. She was raised by her mother, a single parent. Her father left soon after she was born. Rachel is now pregnant for the first time. She is in a relationship where she feels there is not enough support and commitment. She wonders how healthy her relationship really is and if she should stay in it.


To orientate herself, she asks the midwife if, in addition to the group sessions, it would be possible to get in touch with other single mothers. Meeting these other single mothers gives her a lot of strength and self-confidence.


Rachel is somewhat surprised when her partner Alvaro agrees to come to the group partner session. A father coach is present during this meeting.


This session has considerable impact on this couple’s relationship. Alvaro is able to show his interest in her pregnancy and feels more engaged because of this session. In an email to the midwife Rachel describes how happy she is and that she no longer feels so alone:


 “Happily, Alvaro and I are now doing much better. This gives me more confidence that we can work things out together. It was good to realize that it is no longer just about ourselves but about us. The recent partner session contributed greatly to this. Great idea to add a father coach to the Centering sessions.”


The midwife: “Rachel and Alvaro now talk to each other about their future and how things will be once the baby is born. It surprises me every time that only one session for the partners with the father coach can have such an enormous impact. It really has added value.”


Difficult childhood

The group is made up of strong women, all who appear to be in good relationships. Nil feels a bit like an outsider. She had a difficult youth. She bursts out in tears during the fourth meeting when domestic violence is discussed. She shares with the group what she went through as a child. She talks about the foster families in which she grew up because her own parents were unable to raise her. She talks about the mental health problems she has because of this. And now she finds herself in a difficult relationship. She is struggling with this. Because what will this do to her child?


The group listens. They think she is very brave. A couple of the women invite her for coffee after the session. She attends pregnancy swimming classes with another woman from the group.


The midwife: “It was beautiful to see how the group took care of Nil. The invitations for coffee and visits with each other. That is the added value of group care and something I can’t offer. It was special how she opened up to the group and had the courage to ask for help. Clearly a bond of trust was created in the group. Nil even shared that she was in counseling for attachment problems. It was heartwarming to see how she landed in the warm embrace of the group.”


Powerful collaboration

Tara is an insecure 18 year old young woman. She lives at home with her mother. Tara is unintentionally pregnant by her boyfriend who disappeared when he heard the news. She seems vulnerable.


Tara is eager to join antenatal group care. She finds herself in a group of strong women who happen to live in her neighborhood. They are not the type of women she usually hangs out with in her social life.


This group is special because for the first time, a primary care midwife facilitates the sessions together with a hospital-based midwife; a powerful collaboration.

Towards the end of her pregnancy, Tara’s baby is in breech position. Tara is nervous. She is very happy that the hospital midwife is part of her group. She explains to her how things work in the hospital. Tara goes into labor. Progress is slow. Together with Tara and her mum, the doctor decides it is better to perform a cesarean section. The tension is visible on Tara’s face. When she is being wheeled to the operating theater, she happens to see the hospital midwife from the Centering group. “My midwife!” shouts Tara excited. “You have to be with me” she begs her. The midwife is able to arrange it and goes with her to the operating theater. Tara feels calmer and more supported.


The midwife: “This story shows the power of collaboration between primary and secondary care in Centering. The hospital became more familiar to Tara making the referral less stressful for her. In the past 4 years, I have run into her regularly. Every time I see her, it strikes me how well she looks and what a strong woman she has become. She says time after time how relieved she was when she saw her midwife in the hospital corridor. It was a very important event for my hospital colleague as well. How special it was for her to experience how her presence could make someone so happy. What a difference that makes in your work. Unlike what she is used to, she now sometimes already knows some of the women who are referred to the hospital, like during birth. Tara is still in touch with the women from the group. They are still supporting each other and they celebrate their children’s birthdays together. One of the participants has even become Tara’s best friend.”


Too early

Dunya is pregnant with twins. The group is very excited and sympathizes with her. But Dunya doesn’t get enough time to enjoy her pregnancy. She goes into labor at 25 weeks gestation. Despite hospital treatment to stop or delay her labor, she gives birth to 2 daughters. The babies are admitted to the neonatal intensive care unit (NICU) of a university hospital. Dunya visits them every day. She keeps the group updated in the WhatsApp group. She shares pictures and the group is empathetic. One baby develops a bowel infection and the other suffers from serious lung problems. Both babies are too weak to survive.


Dunya shares the news in the group app. She receives poems, cards and lots of tender love and attention. The group does not forget her. At every session, they light 2 candles in remembrance, one for each of Dunya’s babies.


The midwife: “It is very common that when parents experience this type of loss, they are afraid to leave the house. They shut themselves off and even the family finds it hard to make a visit. The group was very open giving Dunya a lot of support. Not a single woman left the group because of this sad event. Nobody was afraid to step down from her pink cloud.”


[1] Cholestasis of pregnancy is a condition marked by (severe) itchiness without skin changes (apart from scratch marks), combined with raised serum bile acids. A relation exists between cholestasis of pregnancy and serious fetal complications. (Guideline Cholestasis of Pregnancy, NVOG 2018).

Breastfeeding

Lieneke is pregnant for the second time. Her first baby was breastfed. But it didn’t go the way she wanted it to. “It was always a hassle. I never had enough breastmilk and had to give supplementary feeding”, she explains. Lieneke does not have fond memories of the supplementary feeding, especially the thought of giving her baby formula makes her unhappy.


Lieneke gives birth at home to healthy son. The boy is put to the breast straight after birth and he seems to be drinking well. However in the following days, the breastfeeding does not go well again. The baby loses too much weight. The midwife, knowing that it won’t be easy for Lieneke, still advises her to start with breast pumping and supplementary feeding. She recommends formula until Lienke is able to produce enough breast milk. There is no local breast milk bank.


But Lieneke explains that she has already sorted it out with the women in her group. She has posted a message in the actively used postnatal group app with a request if anyone has enough breast milk to give to her or would pump extra for her. One mother offered her help. For a few days, this mother pumps just enough extra for Lieneke and her son. It is enough for supplemental feeding for the next few days until he is back up to his birthweight. After a few days Lieneke has enough breastmilk of her own and the problem is solved!

The midwife: “It is wonderful seeing how Centering lowers thresholds and enables women to support each other. I did advise her to ask the donor mother about infectious diseases explaining that screening for infectious diseases is standard protocol by the mother milk donor banks.”

 

 

Sharing loss

All the participants in the group have given birth and proudly share their photographs in the group app. Only Dorien has yet to give birth. Her labor starts a week after her due date. At home she puffs away the contractions, in the shower, on the stairs. Initially all goes well. When she is fully dilated, her waters break. The amniotic fluid is meconium stained, quite heavily. The midwife supervising the birth, is worried about the baby’s heartbeat. She calls an ambulance and they rush to the local hospital.


Once in the labor room, the CTG [fetal heart trace] shows that the baby is in distress. The obstetrician performs an emergency Ventouse extraction. Joost is born without any signs of life and the pediatrician is unable to resuscitate the boy.


When the couple are back home, the midwife visits them. They talk about the birth and their incredible loss. Dorien says softly that she wants to inform the group. Together with her husband she composes a text for the group app. The group is in shock and deeply saddened. Many virtual hugs and comforting words follow in the app group.


The customary postpartum group session takes place soon after Joost is born. All the new mothers with their babies will be there. Dorien wants to go as well, despite her intense loss. She has a little photobook of her son that she brings to the session. The group is pleased to see Dorien. They cry together when she talks about the birth of Joost, the loss and the terrible sorrow. The group admires the photographs. They embrace her, comfort and support each other.


The midwife: “It is often difficult for mothers who have lost a child, to meet pregnant women or new mothers. But it just happened naturally in this group. The first step is already taken in a comfortable safe environment.”


Don’t complain

Sometimes the women in the group complain. Pregnancy can be so difficult. One woman complains about backache, and the other about constipation, sore legs, Braxton hicks [practice] contractions. “I hope I will have the baby early” is an often heard remark. “When you give birth early, the baby is smaller and birth will be easier” is what a lot of the women think.


Marije goes into labor at 30 weeks gestation and is the first in the group to give birth. Much too early. Initially mother and baby remain in a university hospital, far away from their home. After a while, Marije can go home and the baby is moved to the local hospital. Four weeks after giving birth, Marije visits her group to talk about her birth and to proudly show them the photos of her daughter. All the other women in the group have not yet given birth and eagerly awaiting the moment. Marije tells them that it wasn’t easy at all, despite the fact that her labor came early and her daughter was small. She talks about her concerns and how she worries about her fragile little girl. The feeds are also not easy. Marije explains to them what it means to have a premature baby. So many things did not come easily for her or the baby. She missed out on a lot, she wasn’t able to hold her baby after the birth. “You have to make an extraordinary effort to nurture and hold your baby. Things that come naturally when the birth is normal. It is not easy at all when the baby comes early. You shouldn’t complain so much”, she says to the group.


After a long time, the baby comes home to Marije. The little baby girl has been in the hospital for 6 weeks. The other women in the group have already all given birth. When they meet again for the postnatal session, it is a celebration and everyone has their baby with them. Marije is there on her own.


The midwife: “Marije showed the group what it means to have your baby prematurely. Her experience gave everyone more insight and convinced them that it is much better to let nature take its course. They realized that giving birth early is not easy at all. While everyone had already given birth, Marije was still traveling back and forth to the hospital every day. Moreover, I have never seen so much effort go into successful breastfeeding as in this group!

 

Together not alone

It is the second time Maroushka takes part in group antenatal care. At that time, she had chosen for planned single motherhood (PSM). She got pregnant using artificial insemination with donor sperm.


Being pregnant again, she really wants to join group care again. Maroushka has a complicated history with mental health problems. She has put her past behind her and is employed locally as an ‘experience expert’. On the surface she seems to be a bit of an outsider in the group.


During the session when domestic violence is discussed, she talks frankly about her mental health problems and what she has gone through. This encourages the other participants to share stories about their unhappy or happy childhoods.


Mandy is also in the group. She listens carefully to Maroushka’s story. Based on the remarks she makes, it is obvious that she too has had a difficult past and did not have it easy in her young years. She has very little contact with her family.


Maroushka is very sensitive to this and she takes Mandy under her wings. They meet regularly for a coffee in the local shopping center and support each other.


After a difficult birth, Mandy is struggling. She seems on the brink of a postnatal depression. An arrangement is made to give her extra support. Maroushka also drops by regularly to see how she is. She talks with her, helps her. Mandy is experiencing support from the group through the group app. Thanks to all the support given, she manages and gets better. At the postnatal reunion session, she tells the group how difficult it had been but thanks to them, she felt she was not alone.


The midwife: “I was concerned about how the sessions would go with 2 participants with complicated histories. But the group handled it very well and created a great support network. Moreover, I got to know the women much better than I would have in standard one-to-one care. The women in the group really supported each other. I just stood on the sideline and watched it unfold.”

 

 

Smoking & domestic violence

The topic of ‘smoking’ is discussed during the first group session. It is a mixed group of women from various backgrounds. Two of them smoke. One of them is a health scientist. She is very aware of this bad habit but finds it really hard to quit smoking. The midwife knows Lydia, other woman who smokes, from a previous pregnancy. At that time, she had the feeling that something just wasn’t quite right with Lydia, but couldn’t put her finger on it.

During the intake, Lydia is a bit reluctant to accept the offer to join group care. “As long as you don’t talk about smoking again”, she agrees angrily, “…and don’t start up again about me quitting smoking. I know it is not good for me. I just can’t do it, so stop it.”


The midwife reassures her. The subject is on the agenda, but participants are not directly confronted about their behavior. “It remains your choice”, she reassures Lydia.


During the first session, the group opens “the forbidden box”. It is a box with objects associated with things that are or are not “forbidden” in pregnancy. It contains objects like a bottle of cola, a cigarette, hair dye, a paint brush and a sauna voucher. One by one, each participant picks something from the box. The subject that it symbolizes is addressed in the group discussion. When the cigarette is chosen, they talk about what exactly happens to the baby when you smoke? Why is it so hard to stop? The health scientist talks openly about her situation and really understands what the problem entails. The group acknowledges that for some people, it is very difficult to quit smoking. Lydia doesn’t say much and keeps a low profile. The group leaves to go back home.


At the start of the next meeting, Lydia stands up in the circle “I have quit smoking”, she declares. Her face is beaming with pride: she had to tell them! Spontaneously the group follows her example and everyone stands up and applauds her. They enthusiastically clap their hands acknowledging Lydia’s personal strength.


Lydia sticks to her resolution not to smoke during the entire pregnancy. But the midwife cannot shake the nagging feeling about her.


During the fourth session, when the group is really beginning to bond, domestic violence is discussed. Again Lydia is very quiet. When they discuss the subject of “mental health problems” during the eighth session, Lydia starts to cry softly. She explains that she and her partner fight a lot at home. They hit each other, but actually he hits her more often. The group is visibly upset. At this point, the midwife intervenes. Together they figure out how they all can best support Lydia.


The midwife makes a home visit. With Lydia’s consent, the family doctor is informed and she is referred to a psychologist.


The midwife: “The open atmosphere in the group gave Lydia courage to ask for help and enough confidence to know that she was going to really get the help she needed. Lydia and her husband got on track for counselling, receiving more attention and support. I have seen this woman grow. It is not about who is at fault, but about how to solve the situation together.”

 

Saying goodbye / farewell

The last session before birth has taken place. They all use the group app to let each other know how they are doing. They are all looking forward to the postnatal reunion session where they get to admire each other’s baby. Only Yara has not yet given birth.


One of the midwives from the practice is present when Yara gives birth in the hospital. It is a difficult birth and the baby dies during the last part of the birth process.


Without telling the midwives, Yara sends a message to the group: “The worst thing you can imagine, has just happened to me. My baby is dead.” The women are in shock and call the midwife one after the other, in tears.


What to do with the postnatal session? The midwife decides to organize 2 sessions: one where all the new babies will be there and another one where only the mothers, including Yara, will be present. She also become a mother.


It is an emotional session and they close it with a ceremony. “Centering is like a tree, it is the trunk of life: a family tree”, the midwife explains. Everybody receives a slice of the tree trunk. On one side of the slice, the name of the child is written and on the other side, all the names of the babies in the group, including ‘Jesse’, Yara’s son. Yara also receives a drawing of her slice of the trunk to take home.


The midwife: “It was such a beautiful session. We called the names of all the children out loud. For Yara, it was part of her grief process but above all, it was a confirmation of her son’s birth and an affirmation of her motherhood.”


Social safety net

The midwife is aware of Leontien’s mental health history. The group also knows about it as she told them about it herself during the second session. Fortunately her pregnancy goes very well and her son Finn is born at home. Only her response to Finn is distant. Leontien is tired and she leaves her son’s care to her husband. Leontien remains tired, even in the following days. Despite her tiredness, she finds it hard to fall asleep. She struggles with the breastfeeding, making her feel insecure. The midwife is worried. The family doctor is informed and he prescribes sleep medication. But Leontien is afraid to take it. However, she does use the group app to tell that she is not doing very well.


The midwife plans extra postnatal visits and arranging a longer period of help from the home maternity aid. The family doctor has also arranged a visit from a primary health care psychologist. There is periodic contact between all the care providers.


Seven weeks later, Leontien doesn’t show up for the postnatal meeting. This worries the

midwife because Leontien gave no notice. Does the group know how she is doing?


The stories start to flow. They are in regular contact with Leontien. Even the grandmother of one of the new babies helps out. She babysits her granddaughter, so one more doesn’t make a difference! One of the new mothers often picks Leontien up to go for a walk together with their baby carriages. They all have their own busy lives. But they take turns and it works out well!


The midwife: “Leontien would have never had this social safety net if she had attended traditional one-to-one antenatal care!”


Winter coats

It is a cold winter month when the new groups starts. Not everybody is warmly dressed when they enter the room. ‘Handling your finances’ is a standard topic during group care sessions. The things you need for the baby are expensive. How do you spend your money wisely? Margie says she finds it hard to make do with the small income she has. She could use a new winter coat, “but with a new baby on the way… I just can’t afford it”, she sighs sadly.


“I have one over from my sister,” offers one of the participants, “you can have it if you want.” Other women have clothing to offer. Margie is not the only one in the group that could use some new clothes. Before you know it, the group is busy swapping winter coats and other articles of clothing. Margie is not out in the cold anymore.


The midwife: “This doesn’t happen with traditional antenatal care! And Margie did not have to feel ashamed because the other women were also interested in the clothes.”

 

Limited Dutch

One of the women in the new group has a Tunisian background. Her name is Aisha. Even though she can hardly speak Dutch, she is eager to join the group. Her neighbor at home speaks both Dutch and Arabic and can help her translate the activity workbook.


It is not easy for Aisha to follow what goes on in the group. She worries that she might be a burden, but she really wants to stay in the group. The group does not see her as a burden at all. On the contrary, “It is very important that you stay in the group”, says one of the participants. “It is great for your social contacts. Do you want to come and have tea with us?” asks Annemarie, who lives around the corner from Aisha. Aisha beams with pleasure. “Yes, I would love that”.


The group encourages her to call if she needs them. They are here to help. The Arabic speaking neighbor helps her with the group app.


The midwife spends more time with her outside of the sessions. That way she can slowly explain some things better.


The midwife: “I saw her blossom. She learned so much despite the language barrier. The group really supported her tremendously, pulling her out of her isolation.”

 

Worried

Shanti is pregnant with her third child. In her past she has dealt with mental health issues. She speaks to the midwife about this during the intake visit before the start of the group care sessions. Shanti really wants to join the group because she has recently moved and does not know many people in the area.


Half way through her pregnancy Shanti struggles with her mental health problems. After consultation with the family doctor, the midwife arranges extra support.


It turns out that group is also worried about Shanti. They decide that, on behalf of the whole group, one of them should call the midwife: “We are very worried about Shanti. Do you realize that she is in a bad state? We think you should give her extra attention and plan a visit with her”. Besides this, the group makes a schedule together arranging regular visits to keep Shanti company. They also help her with looking after her other children.


The midwife: “Very special to see that the group felt responsible and took it upon themselves to convey their concern and offer support. With the group support and the extra care provided, Shanti got better. She is doing very well.”

Stories about Group Care 

Researchers and policymakers regularly hear impressive stories about the results of group care according to the Centering model, which are not visible in research results. These stories from healthcare show in a different way how group care works. With the help of interviews with women, midwives, nurses and doctors, these powerful and often moving stories will be collected and written down during the GC_1000 project.


The process of implementing group care will start at the end of 2021. The following stories have been collected before 2020 and were published in the book "Little Pearls, short group care stories with a large impact". The book was a joint publication of TNO, the KNOV, the Centering Nederland Foundation and Group Care Global. The book was first distributed in the English version at the GC_1000 launch meeting in Leiden, Netherlands, February 2020. 


Read the full publication here:

http://groupcare.global/wp-content/uploads/2020/03/Littlepearls-interactief.pdf 




SHARE YOUR STORY


We would love to hear your group care story, big or small! Please send an e-mail to suze.jans@tno.nl to share your story.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 848147. This website reflects only the authors' view and the European Commission is not responsible for any use that may be made of the information it contains.