Group prenatal care: Understanding the CenteringPregnancy approach

May 1, 2009

Dr. Carrie Klima discusses the value of educating patients in a group setting, rather than one on one.

Imagine an approach to prenatal care that is efficient for providers, well liked by patients, and can benefit your practice, while at the same time improving birth outcomes. Does this sound too good to be true? The innovation is CenteringPregnancy, a group model of prenatal care that is rapidly spreading across the country and many parts of the world. This group model of prenatal care challenges the traditional individual prenatal visit that has evolved into a 10 to 20 minute appointment that allows too little time for the questions and concerns common to all women during pregnancy.

In CenteringPregnancy, 8 to 10 women with similar gestational ages begin their group care after their initial obstetric exam, usually around 12 to 16 weeks. There are ten 2-hour sessions, following the usual prenatal visit schedule of 4-week visits until the 28th week of pregnancy and then bi-weekly visits until the last session. During the last month of pregnancy, healthy women can be seen every other week according to the Guidelines for Prenatal Care or may be seen individually, if needed.4 During each session, women complete self-care activities, including checking their blood pressure using digital wrist or arm cuffs, measuring their weight, and determining their gestational age using a standard gestational age wheel.

Experience with the group model suggests that women benefit from group care regardless of their parity. While primigravidas can be expected to have the greatest need for education regarding pregnancy, birth, and parenting, all women can benefit from the supportive relationships that develop within the groups and the empowering aspects of the self-care components of CenteringPregnancy. However, groups with special needs such as adolescents or Latinas can benefit from being in a group with peers who have similar issues or speak the same language. There have been prenatal groups formed for women with similar high-risk conditions such as HIV infections and diabetes. Groups with special needs may need to incorporate additional providers with specialized skills such as language proficiency or high-risk management expertise.

The educational component is guided by an extensive curriculum developed by the Centering Healthcare Institute (CHI) based upon the educational needs of pregnancy, current recommendations of leading health-care groups and organizations, and current research. A facilitative leadership style is used to guide the discussion of the group, and self-assessment sheets help to springboard discussions about common pregnancy topics like nutrition, contraception, labor, birth, and parenting issues. Women in the group share their concerns and develop supportive relationships with one another throughout the 10 sessions. Women often exchange contact information, thereby creating opportunities for mutual support during and after pregnancy. Snacks are provided to facilitate a supportive environment.