Centering pregnancy: An alternate model of prenatal care

Posted on: 03/31/2014

 


By Marge Tracy, Nurse Midwife

Pregnancy and childbirth are normal physiologic events that women’s bodies are designed to accomplish. That being said, pregnancy and childbirth are also events that cause many physical discomforts, emotional changes, times of great joy and expectation as well as fear and anxiety.

One role of a midwife is to provide prenatal care as well as delivery and postpartum services. Prenatal care encompasses the services women receive that monitor their health and that of their developing baby. It should also include meeting their educational, social and emotional needs during this very important time in their life. Women who receive early, comprehensive prenatal care generally have healthier pregnancies and better birth outcomes.

Traditional prenatal care has been typically provided in offices with a long initial assessment followed by shorter monthly, biweekly & finally weekly visits until delivery. While this method does provide adequate physical assessment it often leaves little time for the education or emotional support that pregnant women need.

We tend to address the things we, as medical providers value, but that is not always what is most important to a particular woman at a particular time. It is fine for me to discuss proper nutrition or fetal testing, but if at that visit the woman is worried about her relationship or job or whatever, she is not really hearing what I am saying.

Centering Pregnancy is an alternative model of prenatal care. It includes the components of prenatal care; risk assessment, education and support but offers them in a group setting. The initial prenatal visit remains as a private exam where a complete history, physical exam and lab work are obtained. Following that, women with similar due dates are assigned to a group that meets 10 times, starting at approximately 14 weeks gestation and ends with a postpartum session after all participants have delivered. Each session lasts between 1 to 2 hours. It is facilitated by a provider and nurse or other helper. In the initial session group guidelines are reviewed. Women sign a confidentiality statement that basically says “what happens in group stays in group.” They are taught to take their own blood pressure, weight, urine check. They decide common concerns and goals for their group. At each session the woman takes responsibility for charting her own statistics before being taken to the side of the group for an assessment by the provider. Her baby’s heart rate and growth are measured. She has that opportunity to voice any personal concerns that she does not wish to share with the group and follow up to that is arranged. If her concerns are more common in nature she is encouraged to “save that thought or question” for group time. After all assessments are completed all the women come together for a discussion time where concerns are addressed and education appropriate for the time of gestation is done.

Bringing women out of exam rooms and into groups makes an atmosphere of free exchange, facilitated learning and mutual support and respect. In group we talk about what concerns the mothers, not just what concerns the healthcare providers. Every participant has something to offer so the potential for learning and support is multiplied by all the resources of the group. Problems are identified. Solutions are discussed. Successes are celebrated and challenges or crises are made more bearable with the support of your group. Data has shown that women in group prenatal care are more proactive and confident in their abilities to manage their health care needs. They frequently have better outcomes such as fewer preterm deliveries and low birth weight babies, higher rates of breastfeeding initiation and success, and better success with avoiding harmful behaviors such as smoking or substance abuse. Not surprising is that women enjoy this type of care much more than the traditional model.

Over the past few years The March of Dimes has recognized the value of group prenatal care in improving outcomes for mothers and babies. About three years ago our practice at Auburn Obstetrics and Gynecology applied for a grant to implement the program. We were awarded a March of Dimes Grant in 2012 to help train our midwives and nurses as facilitators, purchase materials and basically start the program. We were also able to set up a “Centering space” at Auburn Community Hospital where our groups are held. Initially women were hesitant. They worried that the group would take away the “me time” of an individual appointment or that they would be forced to share information with others that they did not want to. We have encouraged all of our pregnant patients to at least try one group. That has been the selling point! Once women see that they are in a safe environment where everyone is treated with respect and as an equal participant they begin to open up to one another in ways I have never seen happen in a typical office setting. They challenge one another to be stronger and healthier, to speak up for themselves, to find the way that is “right for them.” They challenge me, and the other midwives, to see each woman as our equal; each with as much to offer us as we offer them.

We have received an overwhelmingly positive response to Centering. Comments on evaluations run the gambit. “I never felt alone in what I was going through.” “If I didn’t think of a question, or was afraid to ask it, someone else would.” “It was a great way for me to bond with my second baby; something special for this pregnancy.” “I have made friends I would have never met without Centering.” As a midwife, the plus for me is seeing women become healthier and more confident in their roles as mothers, and knowing it was from each other that they gained the wisdom and strength.

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