Feature Archive

Centering Yourself for a Healthy Pregnancy

Frustrated by short prenatal visits that leave you with more questions than answers? You might be a candidate for the latest trend in prenatal care.

By Colette Bouchez
WebMD Feature

Reviewed By Brunilda Nazario

Bundling. It's a term you probably associate more with your phone/cable/ Internet provider than your health care provider.

But that could soon change, thanks to a new model of prenatal care called "centering pregnancy." According to Yale researcher Jeannette Ickovics, PhD, the program "bundles" together essential health assessment and education services in a very special social setting. Much like the best Internet plans, Ickovics says the program is chock full of value-added premiums for mother and baby.

"This is not one-stop prenatal care shopping; there is a synergistic effect to what we are doing so you get a set of value-added services, where the whole is greater than the sum of its parts. It's bundling for the mother-to-be!" says Ickovics, who's studying this new form of prenatal care and comparing it with traditional care.

The real goal of centering pregnancy: to do away with those frustratingly short and frequently impersonal prenatal visits and replace them with longer, more meaningful, and more productive sessions lasting up to three hours in length.

The catch: Each visit involves an obstetrician or midwife -- and 10 women, all with similar due dates.

"It is the group model of care. It has worked in many areas of medicine, and we believe it can not only work in, but exceed the current model of, prenatal care," says Sharon Rising, RNM, a midwife and creator and executive director of Centering Pregnancy.

Currently group care is being utilized in health settings ranging from the treatment of diabetes and heart disease to a variety of geriatric concerns. And there are now more than 60 centering pregnancy group care programs in place nationwide, many of them initially funded by contributions from the March of Dimes.

Much like regular prenatal care, each centering pregnancy program begins with a lengthy, private visit and thorough exam with an obstetrician or midwife. But this is where the similarity to standard care ends.

Indeed, what follows is approximately 10, two- to three-hour prenatal group visits featuring 10 women and their health care provider.

Now, if you're thinking adult education -- or even childbirth classes -- guess again. While each meeting is semi-structured in terms of topics -- such as nutrition, common pregnancy complaints, labor and delivery concerns, even sex -- the atmosphere is far from a classroom setting.

"The doctor or midwife orchestrates each session, but it's really the women themselves who take charge and play an integral role in not only their own care, but the care of each other," says Peter S. Bernstein, MD, MPH, medical director of obstetrics and gynecology at the Comprehensive Family Care Center of Montefiore Medical Center and a pioneer in orchestrating hospital-based centering pregnancy programs.

At the start of each meeting every woman gets a few minutes alone with the provider. Here the doctor or midwife listens to the baby's heartbeat and gives a general "belly check," while the mom gets to ask any deeply personal questions or discuss any troubling symptoms, privately.

"If there is any indication of a serious problem, [the patient] is seen privately for a full exam, either directly following the meeting or the next day," says Bernstein. In this respect, no benefits of private care are sacrificed.

While each mom is being checked, the others are busy taking their blood pressure and weighing in -- either on their own or with the help of a

nurse -- and then writing the results in their own charts.

"We encourage them to participate in their care as much as possible, even down to keeping their own charts. They take charge of their pregnancy, they own that chart, and it's a very empowering feeling," says Rising.

The next step: The women form their chairs in a warming circle of life, where in a comforting and safe environment, each patient is encouraged to share her personal pregnancy concerns. Providers and group members give advice and provide caring together.

"It is like nothing I've ever experienced as a doctor; the compassion and the nurturing that emerges is phenomenal," says Bernstein. Other doctors have witnessed similar results.

"I think the whole group concept really engages women in their care in a way that might be otherwise difficult with provider influence alone," says Urania Magriples, MD, a Yale professor of obstetrics who was the first in the nation to train other doctors in the centering care philosophy.