Thursday, March 29, 2012
Posted by: Jody Lindwall, CNM, MSN
For decades, one-on-one visits with a doctor or midwife have been the standard model for prenatal care in the United States. The visits are regular but brief. They allow just enough time to do a basic fetal assessment and answer a few questions. Major technological advances over the years have enabled obstetric providers to offer more tests, ultrasounds and procedures to monitor the health of moms and babies than ever before, but little has changed when it comes to the frequency, structure and content of prenatal visits.
Prenatal care costs in the United States now outrank every other country, and yet we rank 30th in the world in infant mortality and 41st in the world in maternal mortality. (1,2) As we work to improve these outcomes, a few key people have started to examine our standard model of prenatal care and are asking, “Is there another way to deliver care to pregnant women?”
Sharon Schindler Rising MSN, CNM, FACNM is one of those people. She developed and piloted the first group prenatal care model from 1993-1994 in New Haven, CT. In 1998, she published an article outlining this model of care and highlighting her findings that women in group prenatal care had good pregnancy outcomes and higher satisfaction with their care. (3) Rising called this model of group prenatal care CenteringPregnancy. Since then, more than 300 practices in the U.S. have implemented CenteringPregnancy groups and the numbers keep growing. (4)
CenteringPregnancy is an innovative model of delivering healthcare to pregnant women in a group setting. The level of maternity care doesn’t change. Everything that usually takes place within a routine prenatal visit happens at the group visit: belly checks, listening to the baby’s heartbeat, and answering questions. But in CenteringPregnancy, participants spend two hours with the provider instead of 10-20 minutes. They meet other women with similar due dates, share stories and learn from one another’s experiences.
Studies have shown that women who participate in CenteringPregnancy are more satisfied with their prenatal care, feel more prepared for birth and for parenting and have higher rates of breastfeeding when they leave the hospital. (5-11) One study saw a 33% decrease in the risk of preterm birth for women participating in CenteringPregnancy. (11) Another recent study also found a reduction is preterm birth rates for women in group prenatal care. (12) Another showed higher birth weights for babies who were born premature. (13) It is unclear why some of these improved outcomes have been seen, but several authors have suggested that the support and education women receive through group prenatal care decrease the stress they experience. And less stress may equal a healthier pregnancy.
Women’s Healthcare Associates believes that no two women are alike. To meet the needs of the women in our community, we must be able to offer a variety of choices. CenteringPregnancy is a great option for women whose pregnancies are at a low risk for complications, but it may not suit everyone. Some women may have conditions that could lead to a higher risk pregnancy; they may need follow-up with one-on-one visits. Others may not be as comfortable in the group setting.
CenteringPregnancy is a safe alternative to traditional prenatal care and may even improve some of our patients’ experiences with pregnancy and birth. From early prenatal care through childbirth and postpartum, it can benefit women and enrich their experience. We are very excited to begin offering CenteringPregnancy this summer on our Peterkort campus near Providence St. Vincent Medical Center.
Read more about CenteringPregnancy at Women’s Healthcare Associates, or contact our Peterkort South office and we will be happy to answer your questions and help you get started.
Jody Lindwall is a Certified Nurse Midwife and CenteringPregnancy group leader at the Peterkort South Office of Women’s Healthcare Associates, LLC in Portland, Oregon. She also provides one-on-one obstetric and gynecological care. After attending Yale University for her bachelor’s degree, Jody spent three years in Costa Rica before returning to school to study midwifery under a National Health Service Corps Scholarship. She obtained her Master of Science degree in nurse-midwifery from Vanderbilt University in Tennessee. She is dedicated to empowering women to make informed decisions regarding their reproductive health and advocating for their right to make those decisions. Jody is fluent in Spanish.
Sources: Images - Getty Images and Women's Healthcare Associates. Citations:
- MacDorman MF, Mathews TJ. Behind international rankings of infant mortality: How the United States compares with Europe. NCHS data brief, no 23. Hyattsville, MD: National Center for Health Statistics. 2009.
- Amnesty International, Deadly Delivery: The Maternal Health Care Crisis in the United States. 2010
- Rising, Sharon Schindler. Centering Pregnancy: An Interdisciplinary Model of Empowerment. Journal of Nurse-Midwifery • Vol. 43, No. 1, January/February 1998
- Centering Healthcare Institute.
- Rising SS. Centering pregnancy. An interdisciplinary model of empowerment. J Nurse Midwifery 1998; 43:46.
- Teate A, Leap N, Rising SS, Homer CS. Women's experiences of group antenatal care in Australia--the CenteringPregnancy Pilot Study. Midwifery 2011; 27:138.
- Massey Z, Rising SS, Ickovics J. CenteringPregnancy group prenatal care: Promoting relationship-centered care. J Obstet Gynecol Neonatal Nurs 2006; 35:286.
- Grady MA, Bloom KC. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. J Midwifery Womens Health 2004; 49:412.
- Kennedy HP, Farrell T, Paden R, et al. "I wasn't alone"--a study of group prenatal care in the military. J Midwifery Womens Health 2009; 54:176.
- Baldwin KA. Comparison of selected outcomes of CenteringPregnancy versus traditional prenatal care. J Midwifery Womens Health 2006; 51:266.
- Ickovics J, Kershaw T, Westdahl C, Magriples U, Massey Z, Reynolds H, Rising, S. (2007) Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics and Gynecology, 110(2), part 1: 330-39.
- Picklesimer AH, Billings D, Hale N, et al. The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population. Am J Obstet Gynecol 2012;206:415.e1-7
- Ickovics J, Kershaw T, Westdahl C, Rising SS, Klima C, Reynolds H, Magriples U. (2003) Group Prenatal Care and Preterm Birth Weight: Results from a matched cohort study at public clinics. Obstetrics & Gynecology, 102 (5, part 1): 1051-57.