Groups Share Wisdom About Pregnancy and Parenting
A dozen or so baby dolls line the windowsill of a second-story room in the Paley building at Einstein Medical Center Philadelphia. It looks like it could be the waiting room of a doll hospital.
It’s not, of course. But it is the home base of a remarkable free program that can reduce premature births, cesarean sections, and the number of newborns who have to spend time in the Neonatal Intensive Care Unit (NICU).
This is the CenteringPregnancy® room. Think of it as group prenatal care, an optional program for women who choose it over traditional care.
Organized by similar due dates, pregnant women come together in small groups monthly and eventually, in the month before their due dates, weekly. As they arrive, the women weigh themselves, take their own blood pressures, record them, and then are seen in a private area by a certified nurse practitioner. A staff member makes appointments for any prenatal tests they need.
This is clearly no ordinary prenatal visit. There’s a large spread of sandwiches, salads, snacks and drinks along one wall, and the circle of chairs where the women sit isn’t for waiting. It’s where they learn everything they need to know about pregnancy and childbirth, from morning sickness to contractions, from postpartum birth control to domestic violence.
The baby dolls help with some practical instruction on diapering and bathing. But much of what they learn they learn from each other, though the 90-minute sessions are led by a trained facilitator. For this group, it’s Tish Johnson.
The day of this visit, the first-time mothers are listening raptly as the experienced mothers — one of whom is expecting her sixth child — talk frankly about contractions.
“Mine felt like gas.”
“It was like tightness and pressure.”
“It was like 10 times my period cramps.”
The wisdom underpinning the programs is that while experts can be helpful, there’s nothing like hearing from the voice of experience.
“One way the Centering model is different from the traditional is that it isn’t me standing up teaching people about something,” explains Alexis Pitcairn-Ramirez, CRNP, a nurse practitioner who participates in the program. “It’s a facilitated discussion. . .that taps into the collective knowledge the group has.”
“A lot of moms don’t have a lot of support,” she says. But someone in a Centering group “at least has a friend here who will listen to her.”
Better Birth Results
Developed in 1993 by the Centering Healthcare Institute in Boston, CenteringPregnancy® has been shown in studies to lower preterm labor rates by 33% to 47%, reduce cesarean sections and NICU admissions, and increase breastfeeding rates. Research has also shown that mothers who participate in group prenatal care are more knowledgeable about everything from childbirth to early child rearing. They’re also more satisfied with their care.
The program has been particularly successful with women of color. “Black women have higher rates of preterm birth and maternal morbidity and mortality related to pregnancy,” explains Pitcairn-Ramirez. Preterm birth (before 37 weeks of pregnancy) often leads to newborn complications requiring a stay in the NICU.
A five-year study by researchers at the University of South Carolina found that the centering model reduced the “persistent and profound racial disparities in preterm birth.” The research focused on the CenteringPregnancy® program run by Greenville Health Care System in the northwestern part of the state. South Carolina has a higher preterm birth rate than Bangladesh, Sudan and Iran, according to the American Hospital Association.
The scientists found there was a 36% reduction in premature births and a 28% drop in the risk of a NICU stay when pregnant women attended the group prenatal sessions. The reduction of even one premature birth reduced health care costs by an average of $22,667, the researchers estimated.
From Pregnancy to Parenting
The birth of a baby doesn’t end a new parent’s involvement in Centering at Einstein Philadelphia. When their babies are born, the women can join a CenteringParenting® group. This program, which started at Einstein in 2013, is the group version of the well-baby visit.
The babies in each group have been born within two weeks of one another, which allows parents to see the wide variation of normal development. It also serves as a learning experience for the pediatric residents who cycle through the program.
The program offers patient navigators who can help new parents with everything from day care to lactation support to food assistance. And there are books and developmental toys for the babies and toddlers to take home.
During a visit with the 1-year-old group — their milestone birthday was celebrated with cake — there are babies crawling, babies standing, and babies walking, most of them clinging to their mothers’ hands.
“And it’s all normal,” says resident Brittany Rouchou, MD.
Checkups and Discussions
Meghan Defranco, MSW, is the social worker who facilitates the CenteringParenting® groups. Each week the group discusses a new topic, which can range from breastfeeding issues to when to introduce the sippy cup.
Various pediatricians participate in the program, including Susan Leib, MD, who loves her stints in the group setting. “From the providers’ perspective, I love not having to be worried about how many people are waiting to see me,” she says. “Everyone I need to see is here.”
And, she says, they’re more likely to share their most important and most intimate concerns in this setting. “It’s not a hierarchical position where I’m the physician and I’m telling them.”
While some parents are getting their babies ready for their exams, others are in a corner of the room with Leib, a resident, or a nurse practitioner who is checking weight, vital signs, and other health indicators. When she’s not examining babies, Leib is right there in the circle with the parents—or playing on the mat with their kids.
“In adult learning theory, people learn better when they’re involved in the process,” Dr. Leib explains. “Here they can become experts about their own children and they’re able to share what they know with other parents.”
The conversations that fly across the room as the children are getting their exams often dictate what’s discussed in the circle. Today, it is milk versus juice (what kind, how much, bottle or cup), and what to do for a fever. Oh, and how to keep a diaper on a child who has learned to take it off.
Benefits for Children and Families
But this informal setting also allows practitioners to elicit information about more than how much baby weighs, how to get baby to sleep through the night, and whether she should be drinking her milk from a cup. The sessions also focus on the parents — their relationship, how much support they get, what kind of parents they want to be, any postpartum or other health issues the mom may be having.
“So much that needs to be talked about but is hard to fit into a 20-minute well-child visit,” says Dr. Leib.
Like CenteringPregnancy® sessions, the group visits for new parents have multiple benefits for children and their families. Studies have found that CenteringParenting® families are more likely to show up for postpartum visits. That leads mothers to breastfeed longer and provides more opportunities for health care professionals to screen new mothers for postpartum mental health.
“We also see better immunization rates,” says Dr. Leib. “Our parents are more likely to fully vaccinate on time.”
In fact, a study Leib conducted with two colleagues found that children seen in the CenteringParenting® program were more likely than children treated in a traditional setting to be fully immunized by ages 7 months and 25 months. The study looked at 883 children. By the time they were 2 years old, 97% of the CenteringParenting® children had received all their immunizations on time, compared with 83% of the children in traditional pediatrician practices.
The statistics are impressive, but so is the comfort and reassurance both these Centering programs offer parents, whether they’re new to parenthood or old hands.
Stay-at-home mom Josephite Brown is expecting her fourth baby. Her oldest is 12. (Her youngest, Skylar, was born shortly after this interview.)
While Brown is one of the mothers who is most likely to impart her own wisdom born of experience during the circle discussion, she says she gets as much out of the group as she gives.
“It still makes me feel relieved because I know that what they’re going through is what I’m going through,” she says.
In the CenteringParenting® room, Yahaira Rodriguez keeps her eye on her 1-year-old son, Jaxson, who can’t walk yet but has managed to motor around the room, crawling in between feet, chairs, and over anything in his way.
“I really love it,” says the first-time mom of her experience. “I get so much more information and more time with the provider. I now have a better understanding of what’s going on with him. It’s been great to hear from other parents to find out if I’m doing this right.”
She laughs. “The program is over when he’s 2, but I want it to go on forever!”
Photo by Denise Foley
Alexis Pitcairn-Rodriguez, CRNP (far left), takes part in a CenteringPregnancy® group with (left to right) Janelle Rice, Kerra Cade, Josephite Brown and Tracey Cobb.