Mama Care: An Innovative Care Model for Pregnant Women with a Prenatally Diagnosed Birth Defect

The purpose of this project is to demonstrate how an adaptation of the Centering Pregnancy Model of group prenatal care, Mama Care, is being implemented in a population of patients with prenatally-diagnosed fetal congenital anomalies who are receiving care in a specialty referral center. Centering Pregnancy is an innovative approach to care delivery that integrates the three major components of prenatal care: health assessment, education and support into a unified program within a group setting.  This project was supported by the Sigma Theta Tau Maternal Child Health Leadership Academy in partnership with Johnson and Johnson and the Children’s Hospital of Philadelphia. The leadership team, Jessica Schwarz CNM, MSN (scholar), Elizabeth Froh PhD, RN (mentor) and Billie Bitowski MSN (faculty), aimed to demonstrate that an existing care model (Centering Pregnancy) can be adapted for novel use in a unique patient population. The setting of the project is the Center for Fetal Diagnosis and Treatment at the Children’s Hospital of Philadelphia where patients with prenatally-diagnosed fetal anomalies come for prenatal evaluation, care and birth.

Following an initial pilot program, the leadership team began a multi-disciplinary continuous quality improvement project. Mama Care represents a significant modification of the established Centering Pregnancy Model including reducing the number of sessions per cohort from 10 to 4 in order to accommodate the 2^nd and 3^rd trimester assumption of care which is typical in this setting. While Centering Pregnancy groups as described in the literature typically comprise 8-10 pregnant women, Mama Care groups ranged from 3 to 6 pregnant women and their support people. In adapting the model, the team prioritized adherence to the 13 Essential Elements of Centering including the use of a facilitative leadership style, stability of the group membership, and completion of health assessment within the group space. During the sessions each patient has a brief, one on one visit with the midwife in a semi-private, screened off section of the room. This encounter encompasses a blood pressure check, fetal heart rate check, fundal height measurement and weight and urine assessment and is documented in the patient’s chart.  Any additional testing that is needed by individual patients is scheduled before or after the group session. Mama Care sessions are co-facilitated by a midwife and an RN. Specific educational content addressed includes normal discomforts of pregnancy and comfort measures, labor and delivery preparation and expectations for the postpartum period.

Using a multi-method assessment including survey tools and focus groups, quantitative and qualitative data were collected to evaluate the participants’ reflections of Mama Care on their pregnancy experiences and overall satisfaction. The quantitative tool used is the 20-item Pregnancy Experience Scale. This scale is validated to measure pregnancy-specific factors related to the maternal psychological state. Qualitative data was collected at the end of the last session of each cohort in a semi-structured focus group format facilitated by the leadership mentor. A total of 15 women have participated in Mama Care during the period of data collection. Three major themes emerged from the qualitative data: (1) Connectivity and inclusiveness, (2) Enhanced learning through group process, and (3) Increased comfort with the health care team and setting.

In conclusion, implementing an innovation in a care delivery model poses challenges to the health care team and requires ongoing commitment to the change process. A significant limitation of this project includes a high attrition rate (related to earlier than anticipated delivery) in some of the cohorts which undermined the utility of the quantitative data collection tool and posed challenges within the group itself. However, focus group data continued to demonstrate a high level of satisfaction with the model. Many of the Mama Care participants have continued their relationships for weeks and even months after the closing session, enhancing support in the postpartum period. In conclusion, Mama Care offers an example of care model innovation in a uniquely challenging setting that provides enhanced value to patients and families.