Group Prenatal Care in Mexico: perspectives and experiences of health personnel

Authors

  • Midiam Ibañez-Cuevas Instituto Nacional de Salud Pública
  • Ileana Beatriz Heredia-Pi Instituto Nacional de Salud Pública
  • Evelyn Fuentes-Rivera Instituto Nacional de Salud Pública
  • Zafiro Andrade-Romo Instituto Nacional de Salud Pública
  • Jacqueline Alcalde-Rabanal Instituto Nacional de Salud Pública
  • Lourdes Bravo-Bolaños Cacho Instituto Nacional de Salud Pública
  • Xochitl Guzmán-Delgado Instituto Nacional de Salud Pública
  • Laurie Jurkiewicz University of California San Francisco
  • Blair G Darney Oregon Health & Science University

DOI:

https://doi.org/10.11606/s1518-8787.2020054002175

Keywords:

Prenatal Care, Maternal-Child Health Services, organization & administration, Primary Health Care, Qualitative Research

Abstract

OBJECTIVE: Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel’s perspective. METHODS: We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication). RESULTS: The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women’s care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico’s implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women. CONCLUSION: Analyzing the GPC model’s implementation in Mexico, from the health care personnel’s perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training.

Author Biographies

  • Midiam Ibañez-Cuevas, Instituto Nacional de Salud Pública

    Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México

  • Ileana Beatriz Heredia-Pi, Instituto Nacional de Salud Pública

    Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México

  • Evelyn Fuentes-Rivera, Instituto Nacional de Salud Pública

    Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México

  • Zafiro Andrade-Romo, Instituto Nacional de Salud Pública

    Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México

  • Jacqueline Alcalde-Rabanal, Instituto Nacional de Salud Pública

    I Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México

  • Lourdes Bravo-Bolaños Cacho, Instituto Nacional de Salud Pública

    Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México

  • Xochitl Guzmán-Delgado, Instituto Nacional de Salud Pública

    Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México

  • Laurie Jurkiewicz, University of California San Francisco

    University of California San Francisco. San Francisco General Hospital. Department of ObGyn & Reproductive Sciences. San Francisco, CA, USA

  • Blair G Darney, Oregon Health & Science University

    Oregon Health & Science University. Department of Obstetrics & Gynecology. Portland, OR, USA

References

Heredia-Pi I, Serván-Mori E, Reyes-Morales H, Lozano R. Brechas en la cobertura de atención continua del embarazo y el parto en México. Salud Publica Mex. 2013;55 Supl 2:S249-58. https://doi.org/10.21149/spm.v55s2.5122

Heredia-Pi I, Servan-Mori E, Darney BG, Reyes-Mpraçes H, Lozano R. Measuring the adequacy of antenatal health care: a national cross-sectional study in Mexico. Bull World Health Organ. 2016;94(6):452-61. https://doi.org/10.2471/BLT.15.168302

Pisanty Alatorre J. Inequidades en la mortalidad materna en México: un análisis de la desigualdad a escala subestatal. Salud Publica Mex. 2017;59(6):639-49. https://doi.org/10.21149/8788

Teate A, Leap N, Rising SS, Homer CSE. Women’s experiences of group antenatal care in Australia - the CenteringPregnancy Pilot Study. Midwifery. 2011;27(2):138-45. https://doi.org/10.1016/j.midw.2009.03.001

Banta D. What is the efficacy/effectiveness of antenatal care and the financial and organizational implications? Copenhagen (DNK): WHO Regional Office for Europe; 2003.

Organización Mundial de la Salud. Recomendaciones de la OMS sobre atención prenatal para una experiencia positiva del embarazo. Washington, D.C: OMS; 2018.

Rising SS, Kennedy HP, Klima CS. Redesigning prenatal care through CenteringPregnancy. J Midwifery Women’s Health. 2004;49(5):398-404. https://doi.org/10.1016/j.jmwh.2004.04.018

Rising SS. Centering Pregnancy: an interdisciplinary model of empowerment. J Nurse Midwifery. 1998;43(1):46-54. https://doi.org/10.1016/s0091-2182(97)00117-1

Sharma J, O’Connor M, Rima Jolivet R. Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis. Reprod Health. 2018;15(1):38. https://doi.org/10.1186/s12978-018-0476-9

Abrams JA, Forte J, Bettler C, Maxwell M. Considerations for implementing group-level prenatal health interventions in low-resource communities: lessons learned from Haiti. J Midwifery Womens Health. 2018;63(1):121-6. https://doi.org/10.1111/jmwh.12684

Klima C, Norr K, Vonderheid S, Handler A. Introduction of CenteringPregnancy in a public health clinic. J Midwifery Womens Health. 2009;54(1):27-34. https://doi.org/10.1016/j.jmwh.2008.05.00

Novick G, Womack JA, Lewis J, Stasko EC, Rising SS, Sadler LS, et al. Perceptions of barriers and facilitators during implementation of a complex model of group prenatal care in six urban sites. Res Nurs Health. 2015;38(6):462-74. https://doi.org/10.1002/nur.21681

Gaudion A, Menka Y, Demilew J, Walton C, Yiannouzis K, Robbins J, et al. Findings from a UK feasibility study of the CenteringPregnancy model. Br J Midwifery. 2011;19(12):796-802. https://doi.org/10.12968/bjom.2011.19.12.796

Kania Richmond A, Hetherington E, McNeil D, Bayrampour H, Tough S, Metcalfe A. The impact of introducing CenteringPregnancy in a community health setting: a qualitative study of experiences and perspectives of health center clinical and support staff. Matern Child Health J. 2017;21(6):1327-35. https://doi.org/10.1007/s10995-016-2236-1

Patil CL, Abrams ET, Klima C, Kaponda CPN, Leshabari SC, Vonderheid SC, et al. CenteringPregnancy-Africa: a pilot of group antenatal care to address Millennium Development Goals. Midwifery. 2013;29(10):1190-8. https://doi.org/10.1016/j.midw.2013.05.008

Teate A, Leap N, Homer CSE. Midwives’ experiences of becoming CenteringPregnancy facilitators: a pilot study in Sydney, Australia. Women Birth. 2013;26(1):e31-6. https://doi.org/10.1016/j.wombi.2012.08.002

Baldwin K, Phillips G. Voices along the journey: midwives’ perceptions of implementing the CenteringPregnancy model of prenatal care. J Perinat Educ. 2011;20(4):210-7. https://doi.org/10.1891/1058-1243.20.4.210

Jolivet RR, Uttekar BV, O’Connor M, Lakhwani K, Sharma J, Wegner MN. Exploring perceptions of group antenatal Care in Urban India: results of a feasibility study. Reprod Health. 2018;15(1):57. https://doi.org/10.1186/s12978-018-0498-3

McNeil DA, Vekved M, Dolan SM, Siever J, Horn S, Tough SC. A qualitative study of the experience of CenteringPregnancy group prenatal care for physicians. BMC Pregnancy Childbirth. 2013;13 Suppl 1:S6. https://doi.org/10.1186/1471-2393-13-S1-S6.

McDonald SD, Sword W, Eryuzlu LE, Biringer AB. A qualitative descriptive study of the group prenatal care experience: perceptions of women with low-risk pregnancies and their midwives. BMC Pregnancy Childbirth. 2014;14:334. https://doi.org/10.1186/1471-2393-14-334

DeCesare JZ, Jackson JR. Centering Pregnancy: practical tips for your practice. Arch Gynecol Obstet. 2015;291(3):499-507. https://doi.org/10.1007/s00404-014-3467-2

Heredia-Pi IB, Fuentes-Rivera E, Andrade-Romo Z, Bravo-Bolaños Cacho ML, Alcalde-Rabanal J, Jurkiewicz L, et al. The Mexican experience adapting CenteringPregnancy: lessons learned in a publicly funded health care system serving vulnerable women. J Midwifery Womens Health. 2018;63(5):602-10. https://doi.org/10.1111/jmwh.12891

Andrade-Romo Z, Heredia-Pi IB, Fuentes-Rivera E, Alcalde-Rabanal J, Bravo- Bolaños Cacho L, Jurkiewicz L, Darney BG. Group prenatal care: effectiveness and challenges to implementation. Rev Saude Publica. 2019;53:85. https://doi.org/10.11606/s1518-8787.2019053001303

Arias Valencia MM. La triangulación metodológica: sus principios, alcances y limitaciones. Invest Educ Enferm. 2000;18(1):13-26.

Noreña A, Alcaraz Moreno N, Rojas JG, Rebolledo-Malpica D. Aplicabilidad de los criterios de rigor y éticos en la investigación cualitativa. Aquichan. 2012;12(3):263-47.

Wilunda C, Scanagatta C, Putoto G, Montalbetti F, Segafredo G, Takahashi R, et al. Barriers to utilisation of antenatal care services in South Sudan: a qualitative study in Rumbek North County. Reprod Health. 2017;14(1):65. https://doi.org/10.1186/s12978-017-0327-0

Consejo de Salubridad General (MEX). Norma Oficial Mexicana NOM-004-SSA3-2012, Del expediente clínico. México, D.F; 2012.

Garretto D, Bernstein PS. CenteringPregnancy: an innovative approach to prenatalcare delivery. Am J Obstet Gynecol. 2014;2010(1):14-5. https://doi.org/10.1016/j.ajog.2013.10.002

Kaczorowski J, Goldberg O, Mai V. Pay-for-performance incentives for preventive care: views of family physicians before and after participation in a reminder and recall project (P-PROMPT). Can Fam Physician 2011;57(6):690-6.

Published

2020-12-12

Issue

Section

Original Articles

How to Cite

Ibañez-Cuevas, M., Heredia-Pi, I. B., Fuentes-Rivera, E., Andrade-Romo, Z., Alcalde-Rabanal, J., Cacho, L. B.-B., Guzmán-Delgado, X., Jurkiewicz, L., & Darney, B. G. (2020). Group Prenatal Care in Mexico: perspectives and experiences of health personnel. Revista De Saúde Pública, 54, 140. https://doi.org/10.11606/s1518-8787.2020054002175