Group Prenatal Care: Strength In Numbers In a growing trend called centering, a group of women meet for collective medical visits throughout their pregnancies, getting advice from professionals and each other on things like nutrition, postpartum depression and breast-feeding. The goal: putting health care in the patients' hands.
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Group Prenatal Care: Finding Strength In Numbers

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Group Prenatal Care: Finding Strength In Numbers

Group Prenatal Care: Finding Strength In Numbers

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From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.


And I'm Michele Norris.

For our series on childbirth, we're looking at issues surrounding maternity all over the world. However, our next story happened to be right in our backyard.

I'm in Columbia Heights. It's a neighborhood in Washington, D.C., that's not very far from downtown. It's an area where there's been a lot of recent building. There are shiny new condominiums up and down the street. There's a lot of new retail establishments. There's a lot of diversity here: socioeconomic diversity and racial diversity.

All the recent gentrification almost swallows up some of the pockets of poverty, and the building I came to visit sits in one of those pockets. It's a health center run by Unity Health Care. The majority of patients here are uninsured or receive Medicare, and over 90 percent live below the poverty line.

I'm here to learn more about a growing trend in prenatal care. It's called centering, and inside this building, I'm going to find out how it works.

A group of women have collective two-hour-long medical visits throughout their pregnancies. It's a model that combines traditional prenatal care with something much like a coffee klatch.

(Soundbite of music)

NORRIS: In this group at Unity, all six patients are Hispanic and all in the same late stage of pregnancy. They're in a tight, windowless cinder block room, a circle of bulging bellies. There's not idle time spent thumbing through waiting room magazines. The women get down to business as soon as they arrive. As music plays in one corner, they check their own vital signs at a table behind the door.

Ms. ANA LUISA RALSTON (Nurse-Midwife): It's awesome to see them take their blood pressure and say, this is my blood pressure and it's normal. Or my urine dip is a little bit off. Like, wow, you know, that's pretty cool that they know that.

NORRIS: That's Ana Luisa Ralston, a nurse-midwife at Unity. Through the course of the visit, the mothers-to-be take turns on a low metal cot and have their bellies measured by her. She also listens for fetal heartbeats.

(Soundbite of fetal heartbeats)

NORRIS: After all the vitals are checked, next, a discussion. The women settle into comfortable chairs, most with hands resting on their belly bump. This, too, is part of that centering model. Women get advice from nurses and from each other on things like nutrition, postpartum depression and breastfeeding.

To help the women understand how to position a newborn at their breast, Ralston talks about how far a newborn can see.

Ms. RALSTON: (Through Translator) It's the distance between the baby and its mommy's breast. Wow, look. The hair on my arms is raised. A little baby has limited vision. They're able to see about as far as the distance between the mother's breast and her face. They can't see any further because the only thing that matters for that baby when it leaves its mom's belly is seeing its mom.

NORRIS: And since the women spend so much time together, they build enough trust to tackle sensitive subjects like domestic violence or family tension, things that doctors can't easily address in a quick office visit.

The goal is to provide a place where women who often live far away from immediate family can find support.

Ms. RUTH LOPEZ: When you don't know about this or you don't have, like, other pregnant ladies going through the same thing, you freak out. You don't know if what's happening to you is normal or if something's wrong. And then you come here and everybody is like, oh, yes, I'm tired, I can't eat this, I can't smell that, all sorts of stuff, and you're like, oh, then I guess it's normal.

NORRIS: That's Ruth Lopez. She's 34 weeks pregnant. Her black hair hangs straight and long. And, yes, she does seem tired. Like most of the other women in the program, she was referred by a doctor who thought she might benefit from a circle of support.

The centering model offers benefits for health care workers as well by maximizing the time they spend with patients. There are more opportunities to eavesdrop, to give advice and to help women become advocates for themselves and for their children.

That last thing will potentially have a lasting impact, says Dr. Andrea Anderson. She's worked as a family physician at Unity for seven years.

Dr. ANDREA ANDERSON (Assistant Medical Director, Unity Health Care): It's important to us to encourage our patients, to help them take ownership over their own bodies, their own pregnancies, be able to plan their pregnancies, be able to have healthy babies, and to really feel like they're a player at the table in their own health care.

NORRIS: Putting health care in patients' hands. That's one of the main goals behind centering. The model was created in 1993 by nurse-midwife Sharon Schindler Rising. Rising said she got tired of answering the same questions over and over again.

Ms. SHARON SCHINDLER RISING (Founder and Executive Director, Centering Healthcare Institute): I just thought women have so much wisdom inside but not a lot of opportunity to test it out with the health care system.

The big challenge for the provider is to be quiet and not answer questions. Because the minute you answer a question, you won't know the group wisdom. So what happened to me, as I was listening to women talking in the groups, is I started having a real appreciation for cultural beliefs and values that I just didn't understand. And I would be thinking to myself, well, that's why that strategy never worked, because I didn't really understand.

NORRIS: What role does peer pressure play in the centering model?

Ms. RISING: I think that one of things that we see is the support for behavior change. In one of the groups, I heard one woman look at another woman and say: I don't know how you can continue to keep smoking, putting that horrible stuff in your body. You know where it goes. And I stopped when I got pregnant, and I'll just tell you that if I can stop, you can stop. And I'm here to help you with that.

Well, that isn't anything I could ever say. So it's - there's tremendous power in the group, and that doesn't happen in individual care.

NORRIS: In reading about this - and forgive me if I'm wrong - but I'm reading about this, it seems like a lot of these programs are most often offered to low-income women, even though everything suggests that women at all income levels and all socioeconomic levels might benefit from this.

Ms. RISING: The vulnerable population is - has the most to gain in terms of outcomes. And the providers and agencies that are providing care to this population are the most open to change.

Unidentified Woman #1: (Foreign language spoken)

NORRIS: Back at Unity, the team says the centering model has improved birth outcomes for the 98 women who've completed the program over the past two years.

(Soundbite of laughter)

NORRIS: They hope it will be available to more pregnant women in the future, and they hope it eventually might also become a model for pediatric visits once children are born.

(Soundbite of music)

NORRIS: Our series continues Friday with a piece about SIDS, sudden infant death syndrome. For years, little was known about what causes babies to die suddenly and unexpectedly in their sleep. Their deaths were mysteries. It was thought little could be done to prevent them.

Now, though, it's believed many so-called SIDS deaths are the result of accidental suffocation caused by unsafe sleep practices.

Unidentified Woman #2: There are some deaths we cannot prevent. These are not those deaths. The vast majority of these are preventable deaths.

NORRIS: And that has people wondering how relevant the term SIDS is and whether even more focus should be placed on safe sleep.

Unidentified Woman #3: Oh, yeah. I can imagine the time when we just talk about safe sleep, and I think we're starting to get there. I think it is - we do have to talk more about safe sleep. Because, I think, if people know that something is preventable, then - and they can visualize it happening, then they're more likely to take steps to try to prevent it.

NORRIS: Rethinking SIDS, that's the next installment of our series Beginnings. You can hear that story this Friday on ALL THINGS CONSIDERED.

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