Centering Pregnancy: The Group Prenatal Care Model

As a medical student in an obstetrics clinic on my 3^rd 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

• https://www.centeringhealthcare.org/what-we-do/centering-pregnancy
• https://www.ucsfhealth.org/programs/centering_pregnancy_program/
• “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.