Combining individual care with group support
A woman with a new pregnancy has so many questions. Health care providers can answer some. Practical advice from fellow expectant parents can address others. Using an innovative model of prenatal care called "Centering Pregnancy," the midwifery practices at Bellevue, Wash. and Tacoma, Wash. Group Health Medical Centers are helping mothers and their partners share knowledge and experiences while getting the individualized care they need.
"I learned things I never would have thought to ask at a regular doctor visit," says Nanveet Verma, an Eastside mom whose daughter Jayna was born last summer. "We had some second-time moms in the group who told us what to expect, offered great advice, and answered our questions."
Take me to the pilot
The Centering Pregnancy pilot brings together soon-to-be moms for 11 group visits scheduled throughout their pregnancies. Each group begins with 8 to 12 women at the same stage of pregnancy. Often their partners attend too. A nurse midwife and a medical assistant co-facilitate the sessions, which start out monthly, then move to twice-monthly as due dates get closer. About a month after the babies are born, the group reunites to coo over them.
The two-hour sessions cover pregnancy, childbirth, self-care, family planning, diet, exercise, and more. Each session includes a self-assessment, supervised by nursing staff, and an individual health and physical assessment by a nurse midwife.
"It's not like a traditional childbirth education class, where a teacher would be lecturing," said Karen McConnell, CNM, a certified nurse midwife who urged adoption of Centering Pregnancy and leads groups in Bellevue. "We have facilitated discussions. We encourage women to take responsibility for making healthy nutrition and lifestyle choices and to be in charge of their own care. They learn to check their own blood pressure and weight and embrace the idea of shared decision-making."
A history of success
Previous research on the Centering Pregnancy model found:
- mothers had fewer pre-term births,
- were more likely to initiate breastfeeding, and
- had better prenatal knowledge than those receiving usual care.
- patient satisfaction,
- rates of vaginal versus cesarean deliveries,
- use of epidurals,
- the babies' gestational age and birthweight, and
- rates of breastfeeding.
They also determine whether mothers return for their six-week post-partum exam and how much additional care they request via phone, urgent care, and other clinic visits.
"Centering Pregnancy is a model that fits well with Group Health's philosophy of prevention, shared decision-making, and health care literacy," Ms. McConnell said.
Active dads
She's delighted with the way many dads take to the group. "The guys are the ones setting up Facebook connections, keeping the group informed when their partners are in labor, and posting baby photos. They also seem very engaged with their babies at the reunions."
She also likes spending two hours a week with families instead of a typical 15-minute appointment. "It's very rewarding because I feel a much closer connection with these patients."
A preliminary evaluation found high satisfaction among participants as well. New mom Nanveet Verma said, "I'm so glad I went!"
