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Abstract

Background: Group antenatal care (GANC) is a midwife developed model of antenatal care wherein participants receive clinical care, education, and support in a group setting. It offers an opportunity to provide people with midwifery care and a positive pregnancy experience, in line with global health policy directives. This thesis foregrounds previously unexplored perspectives of midwives facilitating GANC, considering the effect of GANC on job satisfaction and changes to midwifery role and identity, with a view towards understanding the sustainability and feasibility of this model for midwives in diverse contexts.

Design and methods: The research used three-phased mixed methods design. The first phase was a systematic review of the existing global qualitative evidence (n=19) around healthcare providers’ experiences of facilitating GANC. The results, analysed thematically, highlighted knowledge gaps and informed the next two phases. A cross sectional survey of midwives that facilitate GANC in the U.S. and the Netherlands (the first countries to integrate GANC as part of normal care) was followed by in-depth interviews. The findings were integrated at three points; gaps identified in the review informed survey development, qualitative interviews were used to dive deeper into survey findings and integrated again at analysis.

Findings: The systematic review identified themes relating to provider role, workload and satisfaction. Most surveyed midwives (n=82/125: U.S.) and (n=66/101: Netherlands) found facilitating GANC more satisfying than standard care and stated they could take more time within the visit and deliver more quality care this way. Many also found it to be more work than facilitating standard care. In follow up interviews American (n=12) and Dutch (n=9) midwives described facilitating GANC as meaningful midwifery work, that allowed them to develop relational care by taking time, holding space, and using facilitation skills. Midwives facilitating GANC experienced a network of support with participants, fellow midwives and other professionals that enabled an enjoyable experience of antenatal care as transformative and empowering for the participant women and families. Midwives in both nations identified funding as a primary sustainability barrier, amongst other organisational pressures. Midwives also expressed concerns that the work midwives undertake in GANC is not sufficiently valued as work, by colleagues and the system.

Conclusions: Future policies should consider the positive potential of GANC implementation to offer job satisfaction to midwives as well as the ability to optimize their professional skillset. Furthermore, valuing and funding midwifery work in the antepartum period through support of models like GANC that align with midwifery philosophy could strengthen quality maternity care systems in multiple contexts.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RT Nursing
Departments:	School of Health & Psychological Sciences > Midwifery & Radiography School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses Doctoral Theses

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