As a medical student in an obstetrics clinic on my 3rd
year rotation, I watched as the providers raced from room to room, rattling off
anticipatory guidelines to each of their pregnant patients of similar
gestational age. Blood pressures were checked. Labs were drawn. The visits were
abrupt and often times seemed rushed, especially given the enormity of what was
happening to the patients’ bodies and the uncertainty and hesitation written on
some of the mothers’ faces. I am not saying that the quality of care provided
was not adequate, but what I am saying is that pregnancy is a time of great
change physically, emotionally, and socially that necessitates support that
does not necessarily fit in a neat and tidy 15-minute window.
In the 1990’s, Sharon Schindler Rising, a Certified Nurse Midwife,
had the idea of restructuring the model of prenatal and postnatal care that
would allot more time with patients while still functioning within our
healthcare system of efficiency. Her idea was pregnancy centering, which brings
a group of pregnant women together for their prenatal visits. The thought was
that through group education, providers could spend significantly more time
with the patients, improving quality of education and time for anticipatory
guidance, increasing patient satisfaction, and preventing provider burnout.
The basic
structure of this model is to invite mothers-to-be to join group sessions after
initial prenatal assessment and laboratory testing. There are about 10 group
sessions that begin at 12-16 weeks of pregnancy and usually last 90 to 120
minutes, as described in the table. Furthermore, the women are empowered to take
ownership of their health as they are encouraged to take an active role in
their prenatal care as they are taught to measure their own blood pressures,
calculate their gestational age, monitor their weight gain, and check urine
dipsticks. The providers do routine physical assessments in semi-private rooms
which also allows a time for individual and private concerns to be brought to
the attention of the provider. Then, the clinicians facilitate a group
discussion addressing routine prenatal care issues appropriate for the gestational
age.
For the patients, there are numerous benefits to the group
care model from hearing the answers to questions that they did not think to ask
to simply having more time with providers to learn about their bodies and their
pregnancies. I believe that knowledge is power and that the more time spent
with mothers teaching them about their pregnancy, empowers them to make
informed choices about their care and lifestyle while pregnant. Furthermore,
women are given autonomy of their prenatal care as they are active participants
and are empowered to ask questions in a safe community of women having a shared
experience. Additionally, there is immense value in the communal support from
the group as well as in the friendships formed amongst participants.
Since the 1990’s, group prenatal care has increased in
prevalence across the country. Centering Programs cite better health outcomes
for both mothers and their newborns such as decrease rates of preterm delivery,
decrease incidence of low birth weight, decrease NICU admissions, increase
breastfeeding, and improved pregnancy spacing. However, these claims are
controversial as a recent systematic literature review and meta-analysis
found that group prenatal care was not associated with lower rates of preterm
birth, NICU admission, or breastfeeding initiation. However, the results of the
study did suggest that prenatal group care may decrease the risk of preterm
birth in African American women, which in-it-of-itself is of great value as African
American women have a greater risk of preterm delivery. Furthermore, there is
no evidence that suggest that group care is detrimental to moms or babies but
there is plenty of anecdotal information that moms were immensely happy with
their decision to participate in group care. Individual and group care models
merit further investigation with the aim of identifying populations that
benefit most from either individual or group care.
Christine Quake DUCOM 2019
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“ACOG Committee Opinion No. 731.” Obstetrics &
Gynecology, vol. 131, no. 3, 2018, doi:10.1097/aog.0000000000002529.
Rising, Sharon Schindler, et al. “Redesigning Prenatal Care
through CenteringPregnancy.” Journal of Midwifery & Womens Health, vol. 49,
no. 5, 2004, pp. 398–404., doi:10.1016/j.jmwh.2004.04.018.
Sheeder, Jeanelle, and Kim Weber Yorga. “Group Prenatal Care
Compared With Traditional Prenatal Care.” Obstetrics & Gynecology, vol.
129, no. 2, 2017, pp. 383–384., doi:10.1097/aog.0000000000001875.
Over the last few
months, I have gotten involved in volunteering with families through Ronald
McDonald House Charities. The House provides resources and shelter for families
with sick children while they remain in the hospital seeking treatment. At the
House, I volunteer with the siblings of sick children to make arts and crafts.
Recently, we have been doing Q-tip art, and the kids really seem to enjoy it.
One of the children painted a picture of her 5-month-old brother in his hospital
crib. She told me that he was getting an
organ transplant, and that she hoped he would like her painting. Her mother sat
at a table across from us, chatting with another parent and eating dinner with
her younger daughter. She seemed exhausted as she discussed central line
infections, challenges of tacrolimus, and the ups and downs throughout her
son’s hospital course. On the outside, she looked weathered as she tended to
the needs of everyone around her. Then I started to think about how tired she
must be, and I was amazed by her strength. She is staying in a strange place
with two of her young children while her infant is so sick. She is keeping
everyone occupied, fed, and happy. 