Clinical:Group Prenatal Care

Group pregnancy care for non-high risk patients

Centering Pregnancy (CP) is a model of group care devised by Connecticut midwife Sharon Rising.
The idea behind group care is to normalize, rather than medicalize, pregnancy. Instead of single patients seeing a physician for 15-minute appointments, patients of similar gestational age are grouped together for two-hour sessions with a physician in an open space such as a community or conference room.
During that time, patients weigh themselves and monitor their blood pressure. The physician does a belly-check on each woman. The rest of the time is spent talking about common pregnancy issues such as back pain, nutrition, and fears about delivery as well as parenting and baby care.
The Centering Pregnancy approach increases productivity, reduces backlog, improves patient access and delivers health information efficiently. It costs no more than traditional care and has the added advantage of patients supporting one another. ^[1]
Benefits of bundling prenatal care include:
--more time for the patient and one-stop shopping of lab tests, labor preparation and social support
-- an alternative to the traditional brief model of care
--for physicians it offers continuity of care, a comprehensive model, reduces time pressures and improves patient flow. Also frees up examining rooms for procedures

Centering Pregnancy Plus groups consisted of eight to 12 women with the same estimated date of delivery. They met for 10, two-hour sessions from 16 to 40 weeks gestational age. The difference between CP and CP + is that CP + bundles HIV and STD prevention prenatal care.

BACKGROUND

At Yale, the prenatal clinic ran Centering Pregnancy groups for five years. We took part in a study from the National Institute of Mental Health from 2001 to 2006. The study aimed to implement unique group prenatal care for young women that would: --reduce adverse birth outcomes --increase healthy behaviors during and after pregnancy --increase psychological well-being during and after pregnancy --reduce rates of STI, HIV and repeat pregnancy

HYPOTHESES

Women enrolled in the CP or CP+ program will have better birth outcomes and psychosocial function than those who get standard individual care. Those patients participating in CP+ will have better biological, behavioral, and sex-related outcomes than those who get CP or standard individual care.

METHODS

We randomized women to: --standard individual prenatal care (control) --Centering Pregnancy (CP) --Enhanced Centering Pregnancy (CP+) bundled with HIV/STI prevention

The data were collected at 16 to 20 weeks gestational age, 34 to 38 weeks gestational age and six and 12 months post-partum. The study sample, (N=1,047), included patients in public clinics in Atlanta and New Haven, aged 14 to 25 years, HIV-negative, who spoke English or Spanish. Patients were randomized for differences in race, preterm birth and prenatal stress. About 80 percent of patients were African-American.

RESULTS

Centering Pregnancy reduced the prematurity rate, especially for African American women. This randomized trial controlled for smoking, prior preterm birth and and prior miscarriages. For the total sample of almost 1,000 women, the adjusted odds ratio for preterm delivery was .67(95 percent CI 0.44-0.99). Among almost 800 African American women in the study, the adjusted odds ratio for preterm birth in the Centering Pregnancy group was 0.59 (95 percent CI 0.31-0.92). The study also showed that the women in the CP group had more knowledge about pregnancy, were more prepared for birth and baby care and reported less parenting stress. The women assigned to the HIV-prevention group were significantly less likely to have a repeat pregnancy at six months post-partum than the women in the standard individual prenatal care (control) group or the Centering Pregnancy group. The women in the HIV prevention group were more likely to insist that their partners use condoms and less likely to have unprotected intercourse than the other two groups. Rapid repeat pregnancy was less common in the Centering Pregnancy groups. Chlamydia and gonorrhea were less common in the adolescents in the study, one year post-partum. That effect did not appear in the women age 20 to 25 who had a low incidence of STI. Women in the CP group were more likely to meet benchmarks for “adequate prenatal care.” They also reported greater satisfaction with their overall prenatal care than women in the individual care group.

CONCLUSION

Centering Pregnancy costs no more than conventional medical care and may benefit mothers and children in the long and short term because patients are active participants in their own care. A similar translational study is ongoing at hospitals in New York City and overseen by Yale University public health researchers.