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Innovations : Centering Pregnancy

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Clinical Innovations

Title: Centering Pregnancy

Organization: University of Maryland School of Medicine Department of Obstetrics, Gynecology and Reproductive Health Sciences 

Innovation type: Group Medical Care 

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What They’re Doing: Group prenatal care that uses a facilitated discussion model to engage women in having healthy pregnancies. 

Clinical Innovation: With support from Amerigroup and March of Dimes, the Certified Nurse-Midwives (CNM’s) at University of Maryland School of Medicine have started the first Centering Pregnancy program in the State of Maryland. Centering Pregnancy is a model of group prenatal care that integrates the three major components of care: health assessment, education and support. Eight to twelve women of similar gestational ages are grouped together to receive this integrated prenatal care. The groups meet starting at approximately 16-18 weeks estimated gestational age for a total of 10 two-hour sessions in which they receive their prenatal physical assessments, learn self-care skills, participate in facilitated discussion (facilitated by CNM’s trained in this model of care and in leading facilitated discussion) and develop a support network with other group members

Benefits of this model of care include: ​

  • Increased contact/interaction with providers - a total of 20 hours of direct contact with prenatal care provider in Centering model vs. approximately 3.5 hours in traditional model of care. Women have hours rather than a few minutes at each session to ask questions and learn about their pregnancies and their babies from their providers and from each other.
  • Focus on self-care – women are encouraged to participate in the assessment of their weight, fetal growth, blood pressure measurements as well as other components of self-care
  • Integrated pregnancy and childbirth education as part of prenatal care
  • Continuity of care - same provider facilitates all the 10 sessions with the same group (save one or two sessions that may be led by another midwife if lead midwife for the group is ill or on vacation). In our program we also have the same co-facilitator (a nurse) for a group.
  • Creates a support network among the women – women share their experiences around pregnancy. Positive peer pressure from the group also helps reinforce good habits and choices such as breastfeeding, smoking cessation or safe sleep measures.
  • Short or no wait time and decreased no-show rate – sessions are prescheduled on same day and same time (e.g. Fridays from 9 to 11). Sessions start and end on time and the women know the schedule of their visits for their entire pregnancy.
  • Teaching is focused on needs of women – while each session has pre-selected topics that are addressed (e.g. fetal development, preterm labor, nutrition, contraception, breastfeeding, childbirth preparation, infant care) the facilitated discussion model allows women to determine the focus of the discussion around these topics, which helps ensure that what is being discussed is relevant to their pregnancy/situation.

In other places where this model has been implemented this model of care has led to measurable improvements in patient satisfaction with care, prenatal care attendance, and decreased preterm birth rate – particularly among African-American women. This decrease in preterm birth rate has been replicated in a randomized control trial on the model.

This model of care is also associated with improved provider satisfaction. . 

Evaluation Type: Quasi-Experimental.  

Evaluation Plan: University of Maryland is submitting an IRB proposal to study the outcomes of its Centering Pregnancy program. The University proposes to compare women in the Centering model of care with women (of similar pregnancy risk, parity and age) in traditional care. Ideally, each Centering “case” will be matched with two control “cases” – one concurrent control (women who are offered Centering but decline) and two historical clients (women who would have been eligible for Centering prior to the study’s local initiation).

Patient Outcomes :

  • Gestational age at birth
  • Birthweight
  • Route of delivery
  • NICU admission
  • Adequacy of care (measured ad total # of prenatal care visits)
  • Breastfeeding initiation and breastfeeding rates at postpartum visit.

The first round of outcomes data is expected to be available in October 2012. 

Cost outcomes:

  • Session productivity (patients seen by midwives in 2 hour Centering session vs. average two-hour session in same center in traditional model
  • Cost of care in this model of care vs. traditional model of care (prenatal and birth).
  •  No show-rates  

Other results of interest:

  • Patient satisfaction
  • Provider satisfaction

Initial Phase:

In the Fall of last year (2011), Maryland Women’s Center at Penn Street began offering Centering Pregnancy to clients. The first group started in October (with due dates in March) and all the women in that group delivered their infants (full-term). UM has started a new group each month since October. The 7thth group of 8-12 women started in April 2012 so approximately 60 women have started receiving prenatal care in this model. UM is seeking out new space and staff to offer Centering Pregnancy to more women in its care both at Penn Street and at Edmondson village. Both these sites provide care primarily to women who are African- American and are publicly insured and at high risk for poor birth outcomes including preterm birth. In addition to expanding the program to serve more women, it wants to expand the program to include more providers, including physician providers and to include women with higher risk conditions such as gestational diabetes or gestational hypertension.

Publications: The journal article on the study referenced above: Ickovics J, Kershaw T, Westdahl C, Magriples U, Massey Z, Reynolds H, Rising S. (2007) Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics and Gynecology, 110(2), part 1: 330-39.   

Target Population: Pregnant women receiving prenatal care at Maryland Women’s Center at Penn Street or Edmondson Village. Women who receive care at these two sites are predominantly African-American and on public insurance (>90%).

Date of Implementation: October 2011 - ongoing

Contact:  

Jenifer O. Fahey, CNM, MSN, MPH                                                                                                                                          Assistant Professor                                                                                                                                                           Organization: University of Maryland, School of Medicine                                                                                                                 Phone number: 410-328-7671                                                                                                                                                       Email: jfahey@fpi.umaryland.edu  ​

Multimedia:

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Wher​e to learn more: www.centeringhealthcare.org 

 

 

 

 

 

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