Group midwife appointments??

[xoxoemzxoxo]

Hiya,

Recently found out I am pregnant with my first child 🙂 I have just received my booking in appointment with the midwife however it says it is a group appointment rather than a one on one appointment. Has anyone else been given this? I am very confused right now!

I think group appointments are a new thing being introduced. IMO totally wrong. No doubt will be presented with a positive spin, but it’s yet another cost-cutting idea. I wonder who came up with this suggestion. There’s a lot to be said for group learning, but this is a medical appointment, not a social gathering. I remain to be convinced.

I'm a midwife and have never heard of this. I can't fathom how you would conduct a booking appointment in a group! Some of it is general information-giving, which I suppose could work in a group setting, but a significant amount of time is spent gathering a detailed medical history and asking quite personal questions. It would be a gross breach of confidentiality to expect women to answer these in a group (and I'm pretty confident you won't be expected to!).
If you're happy to, OP, please report back as to what happens in the appointment; I'm very curious about how the powers that be intend to make this work!

This wouldn't work unless they hand out queationaires at tue start foe everyone to complete and then do a group session to diacuas all the general information. And maybe at the end you jave a chance to speak 1-1 with any specific / personal questions.
Sounds like another way to cut costs.

I am super lucky to be at a birthing center in a very small town. I have the same modwofe the entire pregnancy and very long 1-1 sessions.

Could it mean group of midwives rather than patients? Where I am we don’t have one point of contact but rather a group of them with a single phone number.

Otherwise I cannot fathom how they would even do the booking appointment, you’re being asked some very sensitive and confidential questions that you may not want other patients to know!

I can’t talk about booking appointments as that sounds like that is what this is, but group antenatal care is being offered at hospitals across the country. It’s optional, but they run like this:

Women are allocated into groups of 8-12 with due dates around the same time. They are given times, dates and the names of the two midwives who will run the sessions for their entire pregnancy. So they can book each session in straight away. The sessions are two hours long each and combine antenatal care and antenatal education classes.

Women are taught how to take their own BP and dip their urine and are supported with this (gives you an insight into what is normal for your body, why it’s done, what it means etc) and are then encouraged to help themselves to snacks. The sessions are held in circles where you talk/ do activities based on whatever is important to the women there- nausea, body image, scans, feeding choices but with a content plan for the whole schedule, so you cover everything you would in normal appointments and more.

One midwife sits in the circle and the other takes women aside to a private area where they feel and listen to the baby and talk privately with the woman about anything she wants.

There has been lots of research globally on these and they have been shown to increase satisfaction in antenatal care for both women and midwives, an increased sense of empowerment in women and a range of clinical benefits including a reduction in premature birth and bizarrely pre eclampsia. The care model also creates a community and support network for those women of other women with similarly aged babies.

It isn’t for everyone and would never be offered as a sole care option, but I’ve seen these in practice and they’re pretty special. Women lifting other women up and midwives having more time to be with women rather than trying to squeeze everything into too short appointments.

This sounds fantastic. I haven't heard anything about it! Might ask our community matrons if it's on their radar at all...

@Bumblebee413 o god, I can see how some women would like that but I would absolutely HATE every second of that.

I had a prebooking in appointment where they went through a load of leaflets and then booked the actual booking in appointment. I can't see how the booking in could be anything but a one to one appointment, some of the questions about your medical history are very in depth and they need to do the dv screening etc.

Oh my god me too 😂 sounds like my idea of hell!

Please do report back @xoxoemzxoxo on what it consists of.

I couldn't imagine anything worse than what @Bumblebee413 describes in terms of the "circle". I've had two tricky pregnancies (the second with preeclampsia) and the majority of my appointments have been spent discussing my personal health and medical care, including my mental health. It would be horrible to be talking to a midwife about anxiety, poor physical or mental health, potentially getting upset, but then having to go back into the circle to discuss body image with a bunch of other women who just happened to fall pregnant at the same time as me.

@ProjectKettle I think if the sessions @Bumblebee413 is describing are optional, then that's great. I personally only knew 2 women who had been pregnant in recent years and they had had exceptionally amazing pregnancies and made me feel really really shit for not doing crossfit until 34 weeks. My own mum had me at 21 and her pregnancy had been a breeze so I had NO ONE to talk to. No one.

Once I was in my late second trimester and went to some group antenatal classes and met lots more "average" women, I felt a ton better and I found it mega helpful to listen to others' experiences and plans etc.

I would have liked something like that a lot earlier on in my pregnancy and I would have jumped at the opportunity.

I did NCT, so don't get me wrong, i see the benefit of meeting other pregnant women, but i just dont think that it should be confused with proper antenatal care. I just read a couple of studies on group antenatal care after seeing this thread. The University of East London did one, where the "private" discussion time was 3-5mins. Two hour sessions with 12 women is an average of 10mins each. I just personally dont think that is long enough. Maybe they should be offered as an optional add on rather than an optional in place of.

@Bumblebee413 does that mean every midwife appointment is a 2 hour session rather than 15/20 minutes? I can't imagine having the time for that, you'd be spending about 5 times as much time attending antenatal appointments as a normal 1-1 schedule surely!

I absolutely get it not being for everyone- I would have loved it for my first pregnancy but I’m not sure I’d want the same for a second. Everyone is so different too. The nice thing is being able to offer a choice of care models like this I find. Options are good!

@ProjectKettle I absolutely get you. There are so many questions and concerns that you come across when first hearing about the model. The one to one aspect is generally just listening in and palpating- a lot
of the questions you may get are applicable to the whole group, so once both midwives have done their checks, you rejoin the circle and anonymously bring up questions for the whole group to discuss if the woman agrees. If not and you need longer than you have to discuss things that come up, then you ask them to stay afterwards and speak with them privately. In practice you wouldn’t believe how rarely this happens. There are also far more disclosures of domestic violence in a group setting than I’ve ever personally had in private appointments. Safety is one of the topics discussed and the women own the conversation. One group even assisted a mother to leave her partner off their own backs. Others have given each other lifts to sessions and helped each other out in other ways.

I know it sounds strange but you get to know women really well
in this setting. You see them interact with others, open up about their support system and you spend at least an hour with them (whilst the other midwife does her half of the checks) talking through what’s important to them/ how they’re feeling about different aspects of pregnancy and maternity care.

@biscuitcat it’s 90 minutes to 2 hours each time. My Trust send out a qr code link to maternity action rights in case any employers have a problem with it- they can’t, you’re legally entitled to it. But again, that just isn’t going to suit everyone. It is in place of antenatal classes, so you wouldn’t need to attend those too.

Also @biscuitcat, that’s kind of the point- you get more face to face time with a midwife and the opportunity to talk through things in depth that realistically you can’t even touch on in 15-20 minutes. Like, contraception, exercise, sex in pregnancy, travel, vaccines. All important things and so much nicer to talk through in depth rather than directing to leaflets.

So I gave them a call to discuss this morning. The booking in appointment is definitely a one on one session so that's good news! However all my follow up appointments will be basically what bumblebee413 had described.
Whilst I can see how some women may benefit from this having 2 hour appointments I just don't feel like it will be right for me. I don't see how that is practical for working mothers who struggle to get out of work for appointments that will be 2 hours long? I suffer from social anxiety and in a group setting I will just hide at the back and not say anything and feel too anxious to take any information in. Also if something went wrong with the baby at an appointment how are you going to feel having a whole group of women that you have to walk past afterwards? (a close friend lost her baby at 32 weeks so this is a big thing in my mind)

Thanks @Bumblebee413 ! I think I agree with you, for a first pregnancy I can really see the benefit but maybe less so for subsequent ones. Lovely stories too about the groups helping each other, that must be so rewarding for the midwives.

Dear boss, you know how I'm allowed time off for antenatal appointments, well apparently, it's two hours!!

That would go down well!

On another note though, I used to commission and observe a lot of consumer focus groups. It never ceased to amaze me how much personal information women were willing to divulge to complete strangers. If the mw are trained to warm the group up to get them talking, I can see it would work. I would absolutely hate it though!

Tell them that and ask for 1:1 appointments.

Personally i think any kind of forced group activity when pregnant is a truly terrible idea. I didnt tell anyone other tham very close friends and family I was pregnant until 24 weeks. I'd have hated this.

They should make adjustments for people who are not okay in group situations. If they don't that really needs raising as is potentially inadvertently denying a proportion of women suitable antenatal care.

@xoxoemzxoxo you can absolutely opt out of this. Don’t feel any pressure at all, just let them know at your booking. You need to feel happy and calm in all aspects of your care and this doesn’t sound to be the way for you. The midwives won’t mind at all so don’t spend any time worrying.

At the very first meeting rules are set. One of those is that nothing confidential is discussed with the group. It’s also discussed that some times women may have to leave early and may do so straight after their private checks, which they legitimately do anyway sometimes. When there have been concerns about baby’s heart rate or even rarer if the midwife hasn’t been able to find one, the women have gone to the hospital straight from the appointment and have each wanted different things afterwards, so it is guided by them.

One was texting the ladies in the group to tell them that the baby was fine even before the midwives knew, if there has been a loss it is either communicated with the group if that is what the woman wants or midwives simply say that the model of care wasn’t for her and she has left the group. People move house etc too so there are naturally people who leave and like I said, if they don’t enjoy the group setting. There have been ladies who have lost their babies but still wanted to stay in touch with the group as they’d all grown so close and were a great support network and the group decided that they wanted that too.

The above is one of the biggest worries for midwives too until they hear about how it has worked in practice. Again, can’t say this enough, you do you :) For some people and midwives this are model brings a lot of joy, for others it just isn’t their thing for any number of completely valid reasons. Well done for going back and asking for answers x

@Antsinmypantsneedtodance there are alternatives- women can just choose traditional care.

@xoxoemzxoxo thank you for the update, that is absolutely insane. Group sessions are lovely optional additional thing to do but they should absolutely not replace your actual appointments!

I don't know you are meant to get actual specific help or juggle that with work. That would stress me out so much.

NHS really does not give a fuck about women.

Me either! Especially as my GP told me due to my hypothyroidism and being over 35 I should be classed as a high risk pregnancy!

I'm sure it will all get sorted when I go to my booking in appointment and explain that a group setting is not for me

You can't blame NHS cost cutting because I'm a midwife and it's popular where I work in Canada. The original model is called Centering Pregnancy. The sessions are great for information giving and for creating connections amongst mums, and there is good evidence behind the model. But it's not for everyone! I am sure you can opt out.

Thank you for explaining! It does seem good for people who are very social and maybe already had a baby or have no friends that are pregnant etc but it doesn't seem right for everyone