I’ve been in Washington DC where I co-presented a workshop at CenteringHealthcare
Institute’s fourth national conference. I was drawn to this organization the first time
I read their motto: Transforming care through disruptive design.
CenteringPregnancy (CP) is a rapidly spreading model of group prenatal care. Eight to
12 women with similar due dates have their prenatal visits together. Each has the usual
individual health assessment with an obstetrician or midwife in the group space. Meanwhile
the rest of the group engages in “self-care”; they weigh themselves, take their own blood
pressures and chart the data. They can read their own lab results and ultrasound reports.
The rest of their 1.5 -2 hour appointment is dedicated to education and support through
facilitated group discussion and activities.
Reimbursement levels and processes are the same as for conventional individual prenatal
care. The schedule of visits and core content follow ACOG* guidelines.
Process trumps content
CenteringPregnancy’s founder and CEO, midwife Sharon Rising, emphasizes, “Content
should not get in the way of process.” The women talk about what they want to talk about.
There are games, activities and multiple ways of learning. Women test out what they've
heard; they explore their cultural beliefs and share sensitive issues like violence that are
only rarely discussed in traditional prenatal care. They build community and function as a
“March of Dimes wants all mothers to get prenatal care in CenteringPregnancy,” says
Judy Gooding, MOD’s Vice President for Signature Programs. No wonder.
She describes CP as an evidence-based program to prevent preterm birth and disparities
in infant health outcomes. MOD’s 2012 Preterm Birth Report card shows the US rate at
11.7% of all births. Among women in CP the rate is 5.5%. The national low-birth-weight
rate is 8.1% compared to CP’s 6.3%
CP meets the Institute of Medicine’s goals to make healthcare services safe, patient
centered, equitable, timely and efficient. Participating mothers seem to agree. There is
no waiting time, no need to retell their story to strangers. They build a relationship with
the provider. What they like best is being with other women.
Sharon Rising says, “Facilitation is the secret sauce.” Clinician facilitators are trained
not to answer questions or instruct the group, but rather to elicit the group wisdom and
listen to what drives behavior. They come to understand and appreciate the needs, beliefs,
and struggles of the women and the complexity of their live. Throughout the conference
there were reports of clinicians coming out of CP sessions where they completed the
equivalent of 10-12 prenatal visits in 2 hours beaming and talking in superlatives about
All this makes group prenatal care the ultimate environment for promoting maternal health
literacy. I’ve been working for a year with WellPoint, the health insurance giant, to design
a pilot to test the hypothesis that CP promotes MHL as a side effect, and with facilitator
awareness, tools and strategies it can be very effective.More on that next time. Meanwhile,
Stay tuned. ss