By Colette Bouchez
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.
While the women frequently quiet each others pregnancy fears -- exploring symptoms and solutions together -- still, that's only a small part of what each group tackles.
"I've had group talks about mother-in-laws, about sex, about fears of raising a baby, fears of giving birth -- you name it, we've discussed it, which is something I probably would never get to do with a patient in a private setting," says Bernstein.
Magriples says the sense of entitlement that follows carries these women clear into labor and delivery.
"Even the nurses comment that they can always tell the patients who have gone through group; they are calmer, more prepared, have all the answers instead of asking all the questions, and they just seem to come through the experience with a lot more confidence," Magriples tells WebMD.
Additionally Rising says the groups are also instrumental in helping the women change important health habits, the benefits of which can carry far beyond pregnancy.
"They find themselves exchanging junk food for a healthy diet, quitting smoking, stopping drinking, and in some instances turning away from substance abuse -- something that is very difficult to accomplish with provider influence alone," says Rising.
In the first study of Centering Pregnancy -- published in the journal Obstetrics and Gynecology in 2003 -- researchers found that the group model resulted in delivery of infants with higher birth weight, especially infants born prematurely.
Another plus: More than 90% of the women in group go on to breastfeed, which Magriples says is a "phenomenal success story in the clinic setting."
For babies, studies have suggested that breastfeeding can reduce the risk and severity of many infections and may cut risk of sudden infant death syndrome. It reduces the rates of obesity, diabetes, asthma, and other health problems later in life.
According to the CDC, 14 states in the U.S. have achieved the national Healthy People 2010 objective of 75% of mothers initiating breastfeeding; whereas only six states have achieved the objective of having 50% of mothers breastfeeding their children at 6 months of age and merely eight states have 25% of mothers breastfeeding their children at 12 months of age.
But if you think this program is only valid in low socioeconomic and medically underserved communities, guess again. Rising reports that a number of upscale practices are having great success with centering pregnancy, including one New England chapter.
"This program addresses needs that cross all demographic lines and has something to offer even those who believe they have the best private health care," says Rising.
More recently, the same group of researchers tackled the first randomized study trial comparing centering pregnancy to traditional provider care. It involves patients from Yale and from Emory University in Atlanta. About 650 women followed the model of group care, while 350 were given traditional prenatal care. Although the last woman in the study delivered this month, doctors say follow-up will extend for another year, necessary to garner the full impact of the program.
"We want to see if the habits learned in prenatal care influence how well they care for themselves and their baby in the year that follows," Magriples tells WebMD.
That said, the preliminary data available right now shows the women in the Centering Pregnancy program are the clear winners -- and so are their babies.
The data from the study show that various aspects of the group model for prenatal care improve and favor treatment with this type of model, says Ickovics.
In a special segment of the program known as centering pregnancy plus, some groups also had meetings on sexually transmitted diseases and birth control, and researchers say the impact here is already obvious.
"We are seeing a reduction in short-term repeat pregnancy and a reduction in STD infection among the highest-risk groups," says Ickovics.
Perhaps most important: Patient satisfaction with centering pregnancy is high.
"In a survey I conducted among my own patients, those in group were ecstatic about this model of care -- in some instances, strong friendships have been forged and the women continue to influence each other's lives in a positive and healthful way," says Bernstein.
More 'Centering' on the Horizon
Indeed, the bonds fostered in these groups are so strong that Rising is now developing "centering parenting," a program that would allow the groups to go forward together into the first year of their baby's lives, with the focus on well-baby and well-mommy care.
Still, even with all the success, Bernstein concedes that it's not the right approach for every pregnant woman.
"Some don't have more than 10 minutes once a month to devote to prenatal care; others are too private for a group situation and just don't feel comfortable," he says. And for these women, he tells WebMD that totally private care should remain an option.
The good news: So far, not a single insurance company has refused payment for Centering Pregnancy, with many now on board supporting and encouraging these programs.
To find a Centering Pregnancy group in your area, visit the web site at www.CenteringPregnancy.org. Or talk to your health care provider.
Colette Bouchez is the author of Your Perfectly Pampered Pregnancy: Health, Beauty and Lifestyle Advice for the Modern Mother-to-Be.
Published May 9, 2005.
SOURCES: Jeannette Ickovics, PhD, associate professor, Yale School of Public Health, director, social behavioral sciences program, Yale University, New Haven, Conn. Sharon Rising, RNM, creator and executive director, Centering Pregnancy, Cheshire, Conn. Peter S. Bernstein, MD, MPH, medical director, obstetrics and gynecology, Comprehensive Family Care Center of Montefiore Medical Center, Bronx, New York; and associate professor, clinical obstetrics & gynecology and women's health, Albert Einstein College of Medicine. Urania Magriples, MD, associate professor, obstetrics and gynecology, Yale University School of Medicine. Obstetrics and Gynecology, Nov. 2003, vol 102. CDC. WebMD Medical News: "Surprises in New Breastfeeding Guidelines."
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