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 support group.
“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 their experience.
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, visit http://www.centeringhealthcare.org/
Stay tuned. ss