Innovation in prenatal care: a global review of implementing group prenatal care and impacts on women, children, and health care providers

Introduction

Traditional prenatal care is focused on individual appointments between the pregnant person and health care provider. However, in the past 15 years, group-based prenatal care has been garnering interest and is being implemented around the world. The group-based model of prenatal care was developed in the 1990s by nurse-midwife Sharon Schindler Rising, known as CenteringPregnancy®, with its three core elements, namely clinical health assessment, interactive group-based learning, and community building (1). Group prenatal care brings together 8 to 12 pregnant persons of similar gestational age to learn about their bodies, their pregnancy, take leadership in their health care through learning how to take and report their own health vitals, socialize with people having a shared experience, and to receive a health assessment (2, 3). All groups are conducted in a circle, and most groups are facilitated by obstetric providers, especially certified nurse-midwives and nurse practitioners (4).

Rising originally designed the group model of prenatal care to address gaps identified in prenatal care, such as limited focused provider-patient time, lack of education about what to expect in pregnancy and birth, limited opportunities for women to socialize and gain support from others during a similar stage of pregnancy, and disparities in health outcomes for low-income women (3). Documented success in improved neonatal and maternal health outcomes in the United States, including reduced preterm birth, improved breastfeeding initiation and duration, and decreased cesarean delivery, raised interest in implementing the model more broadly across different contexts (2, 5).

Regardless of global location, a group model of prenatal care empowers women to have a role in their health, improve satisfaction with their prenatal care, and offer peer connection and support (6). In low-and middle-income countries (LMICs) specifically, the group prenatal care model is intended to overcome barriers to accessing pregnancy education and prenatal care by alleviating time constraints of one-on-one sessions and increasing trust in providers through group interactions (7).

A strong body of global research now exists to show the impact of group prenatal care on a range of health outcomes and the experiences of women, newborns, and providers in offering and receiving care. This mini-review summarizes that research, and Supplementary Table S1 outlines the articles, study location, and study details for all articles included in the review.

Methods

This mini-review used a narrative review (8) approach to identify and synthesize data from articles with the intention to answer the following question: how does a group model of prenatal care in international settings around the world impact the health and experiences of women, children, and providers? Peer-reviewed original and review articles were identified from PubMed and Google Scholar with key words of “centering pregnancy”, “group prenatal care”, “group postnatal care”, and “group care”. Titles and abstracts were screened for relevance to the review objectives, followed by assessing the full text of potentially eligible articles. Articles were included if they were published in English, the research was conducted outside of the United States, and the research focused on impacts of a group model of care for pregnant and parenting women or the session providers as required by the scope of this review. A date range was not specified as analyzing a group prenatal model of care is a newer area of research, especially outside of the United States.

Since this study was conducted as a narrative mini-review rather than a formal systematic review, quantitative measures of the study selection process, including the number of records screened and excluded at each stage, were not prospectively documented. Nevertheless, predefined eligibility criteria and thematic relevance guided the identification and selection of studies to promote methodological transparency and ensure comprehensive coverage of the relevant literature. All selected articles were synthesized under three main themes: perspectives of and health impacts for women participating in group sessions, health impacts for the children of women participating in group sessions, and perspectives of and impacts for providers implementing group sessions.

Impact of group care model of prenatal care on women

The impact of a group model of prenatal care for women greatly aligns with the tenants on which the model was built. The group model of prenatal care consistently increases women's sense of empowerment (9–19) and social support (9, 10, 12, 18–22). Empowerment is often connected with having greater participation in one's own health, greater engagement with health care providers as well as other pregnant people, and the space to ask questions and be heard (23). Social support is often tied to improved mental health. The mental health impact of group prenatal care has been repeatedly recorded through observing an increase in happiness and subsequent decrease in depressive symptoms during pregnancy (24), lower rates of post-partum depression (25), and decreased stress and concern for labor and delivery (26, 27).

In addition to the mental health implications of group prenatal care, women who attended group sessions were more likely to return and consistently receive prenatal care throughout their pregnancy (9, 26, 28–30), utilize other health care resources (31), and deliver in a hospital (29). Group sessions also promoted a more equal and improved relationship between women and their health care provider, which contributed to feelings of empowerment (19, 20). Through these improved relationships and regular prenatal care sessions, women experiencing group care have greater levels of knowledge about birthing, the post-partum period, and parenting when compared to women who received individualized prenatal care (10, 11, 20, 27, 31–33). This improved knowledge was especially prominent among vulnerable and high-risk populations, such as adolescent and low-income mothers. Through increased knowledge and repeated exposure to health messaging in sessions, women attending group prenatal care also had improved health literacy (34), and were more aware of danger signs during pregnancy (17, 18, 24, 35). Increased knowledge of danger signs led to higher healthcare utilization but also emphasized a need for more preventative health behaviors.

Women in group prenatal care were more likely to talk to their partners about reproductive health (36), use modern family planning methods post-partum (37), and put into practice better health behaviors overall (16, 26, 31, 38). These health behaviors included less alcohol consumption after birth, increased physical activity, and increased healthy eating. The increased knowledge, preventative health behaviors, and early action to warning signs had many positive physical health outcomes for mothers as well. Women in group prenatal care had lower prenatal weight gain (25) and were less likely to have pre-eclampsia (9) and gestational diabetes (39). While some studies found rates of cesarean sections remaining the same regardless of prenatal care delivery method (40), one study found lower rates of cesarean section for women in group care (25). Whether mental or physical, the evidence is clear that group prenatal care has a positive influence on the health of women during pregnancy as well as postpartum, regardless of location.

Impact of group care model of prenatal care on infants

While most research has been focused on the impact on the health of pregnant women and postpartum mothers, some studies have also assessed the influence of group prenatal care on the infant. Outcomes range from maternal practices influencing child health to direct infant birth outcomes such as prematurity and low birth weight. A group model of prenatal care was seen to increase maternal practices influencing their child's health regardless of health behavior or location. Mothers with a known positive HIV status who received group prenatal care were more likely to take steps to prevent HIV transmission during birth (41) and get their infant tested for HIV after birth, although this latter finding was not statistically significant (42). Additionally, mothers who attended group prenatal care sessions were more likely to use insecticide treated nets over their infant's crib (43) and immunize their child (28, 44). Women who received group prenatal care also had higher intention to and initiation of breastfeeding with the goal to exclusively breastfeed (25, 39, 45, 46). Each of these behaviors fosters infant health after birth. Multiple studies found that mothers who attended group prenatal care sessions were more likely to know newborn danger signs and seek help if they noticed a concern (9, 47).

Results vary in terms of the influence of group prenatal care on infant birth outcomes in low- and middle-income countries. Some studies show that there is a lower risk of premature birth and low birth weight of the infant due to group care participation (45), while other studies show these health outcomes are comparable (25, 48). One study focused specifically on adolescent mothers found that the age of the mother had a larger influence on infant health than the delivery method of prenatal care (49).

Regardless of the maternal behaviors that influence their child's health, higher income countries specifically showed less of an overall difference in infant birth outcomes in relation to the way in which prenatal care was delivered but emphasized the importance of needing to study the impact of group prenatal care on providers (40).

Impact of group care model of prenatal care on health care providers

While the benefits of a group model of prenatal care are seen for women and children, the impact on health care providers is varied, although overall is reported as being positive. Many providers expressed enjoying facilitating the group sessions, mentioning an opportunity to build stronger relationships and increase communication with their patients (10, 50, 51) while in a more comfortable setting than what is typical (50, 52). Some studies showed that their providers had increased personal and professional fulfillment (10, 51, 53) from leading group sessions. For many, this was due to a change of pace, or an opportunity to not just “clear the queue” but have more in-depth interactions with patients (10). This increased fulfillment was also a result of providers feeling that they were able to offer higher quality care to their patients because of the group care sessions (10, 54, 55). Specifically, increased quality of care was reflected when providers were able to still tailor the group care sessions to the individuals within the group, instead of only offering generic information. When tailoring occurred, providers were able to increase their cultural understanding of who they were serving (56).

Tailoring was one of the largest challenges for many providers in facilitating groups, though, as there may be a variety of women in the room who all have unique experiences and health literacy levels (50, 57). Other challenges to facilitation included time management (22) and other soft skills necessary for facilitation (58), such as managing when women offered incorrect advice to their peer (22), or group dynamics became challenging to manage (21). Additional facilitation challenges included limited physical space for the group (59), typical practice standards that providers were used to following not aligning with the group model and causing inner turmoil (22), and the inability to see as many individual patients with time taken by the group (59).

Overall, some providers found leading the groups to be taxing (22), and this extra responsibility did not lower their workload. At the same time, providers expressed happiness or excitement that women were able to find peer support and receive more education through the group model (50–53, 56).

Limitations

While many studies have identified the influence of a group model of prenatal care on the health and experiences of mothers, children, and providers, this is the first review, to our knowledge, to summarize the impact across all categories. Despite this novel approach towards assessing the literature to date, we acknowledge the limitations of this mini-review. First, this is a mini-review, not a full systematic review or meta-analysis. While the articles were identified and included through a structured process, the review was not registered, so selected studies may be subject to selection bias and all eligible studies may not be captured. Second, this mini-review was focused solely on contexts outside of the United States, limiting the knowledge base from where much research has been conducted on a group model of care. Third, while all international settings were eligible to be included, much of the research was conducted in low- or –middle income settings. This may limit the generalizations of the findings from this review. Fourth, while most studies focused on health and experiences of women and children were based in rigorous methods, many of the studies focused on provider experiences were evaluating feasibility, acceptability, and perspectives through less rigorous methods (see Supplementary Table 1). Despite these limitations, this mini-review offers important insight into the impact of utilizing a group model of prenatal care.

Conclusion

This mini-review outlines and highlights the impact of a group model of prenatal care with evidence generated throughout the world. Group prenatal care has a clear influence on the health of pregnant and postpartum women through empowerment, social support, mental, and physical health. The health care experience for women through group prenatal care is generally very positive and even transformative, leaving mothers with a broader social network, more information about their bodies and resources, greater trust in health care providers, and a stronger sense of their abilities to be engaged in their health decisions.

Through both maternal behaviors and infant birth outcomes, group prenatal care positively influences the health of developing pregnancy as well as the infant postpartum. Longitudinal research is needed to demonstrate the medium and long-term impact group prenatal care can have on children's health.

Widespread integration of a group prenatal care model would contribute to the urgent need to improve the health and outcomes of pregnant and postpartum people as well as their infants, around the world. For integration to be successful, health care systems need to consider the resources needed for implementation, including time and space for groups and facilitation training for health care providers to effectively facilitate groups. Buy-in by and satisfaction with group care by health care providers, administrators, patients, and the larger community are necessary for this systems transformation to be accepted, fostered, and ultimately demanded by these key stakeholders.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fgwh.2026.1910318/full#supplementary-material

Supplementary material Supplementary material at the source

Footnotes

Edited by: Tabassum Firoz, Yale New Haven Health System, United States

Reviewed by: Esnath Mwayiwawo Kapito, Kamuzu University of Health Sciences, Malawi