Date of Award

Spring 2026

Degree Type

Thesis

Director of Thesis

Dr. Deborah Billings

Second Reader

Dr. Sarah Law

Abstract

Group prenatal care (Group Care) has been associated with improved maternal experiences and select clinical outcomes, yet less is understood about how it functions within high-resource health systems and what mechanisms underlie its impact. This study examines how Group Care is implemented in the United Kingdom and the Netherlands, with particular attention to professional roles, relational dynamics, and health system context.

I employed a qualitative, comparative design and conducted four semi-structured interviews with midwife researchers involved in Group Care implementation in both countries. Data were analyzed thematically, with attention to cross-context similarities and differences.

Findings indicate that Group Care operates through three interrelated processes. First, it involves a reconfiguration of professional authority and knowledge production, in which clinicians shift from didactic roles toward facilitation; and knowledge is co-produced through group member interactions. Second, trust emerges as a foundational mechanism of care, enabling participation, disclosure, and collective meaning-making. Notably, trust is distributed across participants, clinicians, and the group itself rather than an exclusive focus on the health care provider. Third, these relational and professional shifts unfold within health systems that are not structurally designed to support them, generating tensions related to time, organization, and resource allocation. These same dynamics were observed across both national contexts despite differences in health care system structure.

Group Care functions not only as an alternative model of prenatal care, but as a relational and epistemic reorientation of care delivery. Its implementation reveals a misalignment between relational approaches to care and healthcare systems organized around efficiency and standardization. These findings suggest that improving maternity care may require not only adopting new models, but reconsidering how care is structured, valued, and evaluated within high-resource settings.

First Page

1

Last Page

71

Rights

© 2026, Samantha J. Kohlmann

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