Centering Pregnancy

Clinic tries new approach to prenatal care, education

SALEM—You have maybe 20 minutes with your patient, a young woman who is 4 months pregnant. Is that enough time to do all you have to do for the prenatal visit, as well as educate her and answer questions about pregnancy and childbirth?

It’s a challenge doctors face with each patient receiving prenatal care, again and again, all day long.

Willamette Family Health Center is trying something different. The clinic in Salem is launching “Centering Pregnancy” with support from CareOregon’s Care Support and System Innovation (CSSI) program.

Studies published in The Journal of Obstetrics and Gynecology and other professional journals consistently show that across the nation, pre-term birth rates have actually increased over the past century. Pre-term birth rate is one of the benchmarks for healthy births. Increasing rates have many potential consequences such as neonatal and infant deaths, childhood neurological disability, prolonged hospitalization, increased cost and higher risk of lifelong developmental problems.

An alternative model

“We see Centering Pregnancy as an alternative to traditional models,” says Stephanie Wong, Special Projects Coordinator at Willamette Family Medical Center. “It is a method of providing excellent care through a global approach to health care with multiple components.”

The program was developed in the mid 1990s by a nurse midwife practicing in Connecticut. Rather than seeing one patient for a short visit, and repeating the same advice over and over, Sharon Rising, CNM, MSN, wanted to try a different approach.

How about bringing together a small group of women who are all at about the same stage of pregnancy for a 90-minute group visit? Use the first part of the visit for one-on-one consultation, and the rest of the time educating, answering questions and discussing issues that concern them all.

The program Rising founded is now known as Centering Pregnancy and is coordinated throughout the country by Centering Healthcare Institute, of Cheshire, Conn.

This fall, Willamette Family is recruiting patients for its first Centering Pregnancy groups. The first group started Oct. 15, and a second group session, to be conducted in Spanish, will begin in November.

“Our physicians are excited about it because group sessions increase patient education, allow for more interaction with women and families, and result in better birth outcomes,” Stephanie says.

An additional benefit is considered one of the most powerful aspects of the Centering Pregnancy model.

“In the group setting, the participants learn from the wisdom and experiences of the women in the group,” Stephanie says. “While traditional care is more didactic, Centering allows women to problem solve and address their concerns through facilitated discussions. This support group is definitely a shift in thinking, but a good one.”

“We really do want to focus on the family, and outstanding prenatal care is the fundamental building block,” Stephanie says.

Research support

Willamette Family is just getting started with its Centering Pregnancy program, but there is research that supports the concept as a model of care worth trying:

• In a comparison of Centering Pregnancy’s education element with more traditional prenatal education, The Journal of Midwifery and Women’s Health in 2006 reported statistically significant differences between the groups on knowledge of pregnancy. (Read the full report.)

• This year, the same journal published a study that concluded, “Compared to women in individual care, women in Centering Pregnancy had significantly more prenatal visits, increased weight gain, increased breast feeding rates, and higher overall satisfaction.” (Read the full report.)

• The Journal of Obstetric, Gynecologic & Neonatal Nursing reported in 2006 that physicians “who have conducted Centering Pregnancy groups have found their clinical practice transformed. Providing care in the group setting has reduced time pressure by seeing patients more efficiently and enhanced the rewards of prenatal care by adding the opportunity to provide greater depth and scope of services.” (Read the abstract; purchase the full report.)