Since my last blog we have been very busy on the Mums-Power project, so I decided it was high time that I provided an update on our progress.
It was with some relief that, after months of research and ‘blue skies thinking’, we moved in April from the neat and tidy realm of theory and good ideas to the messy and complex world of ACTION AND REALITY. But before I leap into what we've been learning from this process, let me first describe what we've been testing.
A group booking appointment: How and why?
The key intervention that we began testing in April was the concept of a group booking appointment. Typically, the first official check-up in pregnancy – usually referred to as a booking appointment – is a one-to-one appointment with a midwife, lasting between 45 minutes – 2 hours due to the quantity of information and form-filling that needs to be covered in this initial interaction. Much of this is general information which midwives have to offer every woman, covering topics such as: what blood tests do they need to have and why? What foods can and can’t they eat? What will their antenatal care pathway look like? Since this information must be delivered over and over again, it is usually (and understandably) provided in a fairly rushed and perfunctory manner. Women find it overwhelming and easy to forget.
In the group booking appointment that we are testing, a midwife delivers the general information to a small group of 3-6 pregnant women during a 30-minute ‘group briefing session’, before the women proceed to their one-to-ones with a midwife. This is partly about transforming the way in which information is shared: we are testing ways to make this a more enlivening experience for both clinicians and women. What happens, for example, if you use interactive visuals? How can you facilitate the shift from ‘information sharing’ to learning, ensuring that women have absorbed the important pieces of information that they are being fed? How do you encourage and empower women to ask questions about the information they are receiving and to take more control of their own levels of informed-ness?
Naturally, the idea of a group booking appointment also stemmed from a consistent theme emerging from our research: that services should be more explicitly concerned with supporting the social aspects of women's experiences. Participants of our co-design workshops spoke of the inestimable benefits that their attendance of antenatal classes and coffee mornings that connected them with other pregnant women had reaped: pregnancy, many of them said, could be a very lonely time, and the highlights of their journey came at those times when they felt it to be a shared and special experience. They complained, however, that networking opportunities often come too late in pregnancy, and in many cases women had to seek them out or even pay for them off their own bat; what about those women who are particularly vulnerable or isolated, or busy, or ill-informed, or new to an area, who might lack the ability or confidence to be do this, or even fail to realise what they are missing out on? Through integrating a ‘social element’ into maternity care at an early stage, our group booking is in part aiming to address the social inequalities that play out within the health system.
All of this is fairly logical, and the idea of a group booking appointment is certainly not rocket science, nor is it particularly new – in America, the CentringPregnancy model represents a compelling example of maternity care that not only brings groups of women together, but actually ensures that the same group meet consistently throughout their pregnancy. The model has been successful, and continues to be scaled up year on year.
However, the practicalities of implementing such an ostensibly simple concept as a group booking within a system as gargantuan and bureaucratic as the NHS make it tough. In the second part of this update, I will elaborate on what we've been learning.