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Hi Kevin! Brynn from the Midwife on Wheels (MOW) project (the American version of Motorcycles and Midwives). What sort of partnerships have you developed with other organizations working the health supply chain in Uganda? I'm thinking of organization like Living Goods... I'm wondering if there's an opportunity to leverage the brand and knowledge of partner groups in the scaling of this idea.

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Brynn commented on Midwife on Wheels (MOW)

Kate Rushton Great questions. The Centering Healthcare Institute (https://www.centeringhealthcare.org/) offers training, certification, and implementation support/curriculum for practices. CenteringPregnancy has very specific and well-studied recommendations for meeting frequency (monthly), group size (8-12) and curriculum for prenatal visits. Centering also has a separate postpartum "parenting" curriculum/certification. Some organizations, such as the March of Dimes, are developing less rigid curriculum and guidance for group prenatal care which should be available early next year.

Otherwise, there are some upfront costs to training and getting Centering site certification, but otherwise the costs of the program are limited to van upkeep and maintenance, meeting materials, and Nurse Midwife salary/hours. Ideally, the MOW would integrate with existing health care provider so the MOW led group prenatal care meetings could replace some prenatal visits at the clinic. Again, while several practices in the Bay Area offer group prenatal care onsite at the hospital or clinic, very few offer these services in the community.

An OBGYN/midwife generally spends 10-20 minutes with a patient during a prenatal appointment. Let's average the two and say a clinician can do 4 prenatal visits per hour (note: very little education happens during these visits - 15 minutes is enough time to screen for problems but does little to generate health). If a Centering meeting is 90 minutes, we would want at least 6 women in the group to match productivity of traditional prenatal visits in the same time period.

By offering counseling (e.g. nutrition, exercise, breastfeeding prep, parenting prep) and social support, group prenatal care offers more value to women than traditional prenatal care.