Experiences of group antenatal care in the context of the NHS in England: what are the mechanisms by which it functions in this context?

Pregnancy Circles address key deficits in contemporary maternity care, including the lack of time and relational or informational continuity of care, the lack of informed choice, and loss of opportunities to enhance empowerment through health knowledge, social support, and confidence in caring for one's own health, in decision-making, and in seeking support. Importantly, midwives felt that facilitating group care enhanced their professional satisfaction and development and collaboration across boundaries, features associated with service safety and resilience. Fidelity in terms of the midwives' skills and confidence in using a facilitative approach was important and was underpinned by continuity. Midwives' and women's empowerment were found to be mutually supportive rather than in tension. Scaling up Pregnancy Circles as a standard care option in the National Health Service may support positive care experiences; however, further research is needed to monitor the longer-term impact and service and public health implications.