Fox Valley a Leader in Group-Centered Prenatal Care

The Fox Valley Family Medicine Clinic has just begun implementing a national prenatal care program that brings women into group settings for their prenatal care, offering them comprehensive, structured education and social support.

The program, called Centering Pregnancy®, has been found to give women, especially those in underserved populations, more prenatal knowledge than they might get from traditional care based around individual medical visits between a woman and a health care practitioner. In addition, the program helps reduce women's risk of preterm delivery, and costs no more than traditional prenatal care.

Launching the Centering Pregnancy Program in Appleton

In the Fox Valley, the Centering Pregnancy program is led by Department of Family Medicine Assistant Professor Jennifer Frank, MD. Centering Pregnancy will start this fall with its first group of 8 to 10 pregnant women. Patients from the Fox Valley Family Medicine Clinic and from a local community health center that refers to the clinic were offered the program as one of their choices for prenatal care.

Participating women have their first prenatal examination in the traditional manner, with a physician, around 8 to 10 weeks into their pregnancy. Then, starting around the fourth month, women come to 10 two-hour group sessions, held every 2 to 4 weeks until delivery.

The group sessions are facilitated by a family physician, with participation from nurses, health educators, and residents. During the sessions, women check their own weight and blood pressure, calculate their gestational age, and record information in their chart. They work with a practitioner to listen to the baby's heartbeat, check uterine growth, and address any specific concerns. With other group members, they discuss topics related to pregnancy, childbirth, parenting, and personal growth.

At the end of the session, women complete a self-assessment questionnaire that serves as the basis for future group discussions.

These women remain together until delivery, after which they will be offered the opportunity to continue in a similar program called Centering Parenting®. Centering Parenting applies the group-centered model to the first year of a child's life, providing well-baby care, immunizations, developmental assessment, and maternal health screening. In fact, the Fox Valley clinic is the first in the nation to offer both of these programs back-to-back, for a total of 18 months of continuous support.

Significant Benefits for Women and Health Care

According to Dr. Frank, Centering Pregnancy is a natural way to provide prenatal care. "Pregnancy isn't a pathologic condition like diabetes or hypertension," she said. "It makes sense for patients to get information and education in a supportive environment along with their medical care."

She believes that the program offers numerous benefits, specifically:

• It expands the definition of prenatal care to include support and education as well as medical care;
• Its inclusive, supportive model can better reach vulnerable women who might otherwise face cultural, linguistic, or educational barriers to health care;
• It provides an important educational experience for residents-one that they can take with them to future practice communities after graduation; and
• It has a multidisciplinary focus, with participation by the entire clinic team.

Centering Pregnancy's clinical effectiveness was demonstrated in a recent trial, published in Obstetrics and Gynecology (pdf). The study found that, compared with women who had traditional prenatal care, Centering Pregnancy participants:

• were significantly less likely to have preterm births (9.8% compared with 13.8%), and in cases of prenatal birth, delivered an average of two weeks later (34.8 weeks compared with 32.6 weeks);
• were more likely to initiate breastfeeding (66.5% compared with 54.6%); and
• were more knowledgeable about prenatal care; more ready for labor, delivery and infant care; and more satisfied overall with their prenatal care.

In addition, the study found that group-centered prenatal care adds no additional costs to the clinic beyond that of traditional prenatal care. "This is the beauty of the program," says Frank. "And if the program helps not only reduce the risk of preterm delivery, but also helps reduce the number of follow-up calls and emergency room visits, it may result in cost savings system-wide," she added.

Program Organization and Funding

Centering Pregnancy and Centering Parenting are programs of the Centering Healthcare Institute, Inc., (CHI) a private, nonprofit corporation based in Cheshire, CT. Founded in 1994, CHI's mission is to change the paradigm of health services to a group care model in order to improve the overall health outcomes of mothers, babies, new families and all individuals across the life cycle.

Training and materials for the Fox Valley program implementation were funded through grants from the Northeastern Wisconsin Area Health Education Center and the Community Foundation for the Fox Valley Region, Inc.