A randomised controlled trial comparing group to individual prenatal care

INTERVENTION: Pregnant women are randomised to: 1. Standard individual prenatal care 2. Group prenatal care Control: Standard Prenatal Care Women randomly assigned to individual prenatal care will receive a standard schedule of one‐on‐one prenatal visits with a physician. The timing and frequency of visits will be decided by each womens' physician, although it is anticipated that they will follow the clinical practice guidelines, Healthy Beginnings: Guidelines for Care during Pregnancy and Childbirth provided by the Society for Obstetrics and Gynaecologists of Canada (SOGC). Women with high medical risk pregnancies will be referred for obstetrical care. Intervention: Group Prenatal Care Women randomly assigned to group prenatal care will receive an initial individual prenatal visit with a physician to confirm their pregnancy and subsequently will be grouped with 8 ‐ 12 other women who are at a similar stage in pregnancy. Each group will meet with a health care provider for nine group sessions including one‐on‐one time with the provider for a prenatal check‐up, time to conduct self measurements of their weight and blood pressure and a group discussion covering a topic appropriate to their stage of pregnancy. The group discussion will be co‐facilitated by the physician and a perinatal educator who will encourage group members to participate in discussing topics of interest related to pregnancy, childbirth, parenting, and personal growth. These group sessions will take place at approximately 16, 20, 24, 28, 32, 34, 36, 38 weeks gestation and 2 weeks postpartum. Women will also receive individual prenatal visits at 37 and 39 weeks gestation. Women with high medical risk pregnancies will be referred for obstetrical care. CONDITION: Maternal mental health ; Mental and Behavioural Disorders ; Post‐natal mental disorders PRIMARY OUTCOME: 1. Maternal mental health: depression and anxiety ‐ measured at study intake (prior to 20 weeks gestation), third trimester (32 ‐ 36 weeks gestation) and 4 months postpartum ; 2. Maternal psycho‐social health:; 2.1. Social support and stress ‐ measured at study intake (prior to 20 weeks gestation) and 4 months postpartum ; 2.2. Parenting morale and parenting self efficacy ‐ measured at 4 months postpartum SECONDARY OUTCOME: 1. Rates of infant birth outcomes (low birth weight, small for gestational age, preterm birth) ‐ measured at birth ; 2. Rates of breast feeding, uptake of parenting classes/supports, attendance at well child visits, immunisation rates ‐ measured at 4 months postpartum INCLUSION CRITERIA: 1. Pregnant woman living in Northeast Calgary 2. Less than 20 weeks gestation at study intake 3. Able to communicate in English, Punjabi, Mandarin, Hindi, Arabic, Urdu or Spanish