December 9, 2005

Nursing School clinic makes prenatal care a group effort

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Sara Ross, a patient at West End Women's Health Center and a member of the Centering Pregnancy class, is examined by Margaret Buxton, a certified nurse midwife.
photo by Dana Johnson

Nursing School clinic makes prenatal care a group effort

Margaret Buxton, a certified nurse midwife at the Vanderbilt University School of Nursing's West End Women's Health Center is helping to bring a new approach in prenatal care to Middle Tennessee.

Buxton is the only nurse midwife in the state trained in an innovative prenatal approach called “centering pregnancy.”

“The nine months leading up to birth can be a lonely and isolating experience for many mothers,” said Buxton. “Centering pregnancy replaces the traditional one-on-one visits in an examination room with a health care practitioner. Instead, we hold group meetings where moms-to-be and their partners receive care, and education and form a sense of community with other group members. It's been an amazing process to be a part of.”

Centering Pregnancy maintains all the elements of high-quality prenatal care, blending them into a supportive and empowering experience for expectant mothers. Buxton formed her first group this fall after meeting with each pregnant woman for her initial prenatal visit, which included taking a complete medical history and physical. Her current group includes eight expectant mothers with similar due dates. The group started meeting when members were between 12 and 16 weeks along. They met monthly for the first four months, and now bi-weekly as their due dates approach.

Each class starts with the expectant mothers taking their own blood pressure, monitoring weight gain, checking urine samples and recording data on medical charts under Buxton's guidance. For some members, the self-care portion is the most enjoyable part of the class because it makes them feel all the more involved and aware of their baby's progress.

“I like being in more control and really enjoy getting to do most of my own measurements,” said Lucky King, 23, a first-time mother. “My husband attends class with me and it's gotten him much more involved in how things are progressing than he would be at a traditional prenatal appointment.”

Next, Buxton leads the group and provides expertise. Discussion topics include nutrition, common pregnancy complaints, selecting pediatric care, sibling concerns, baby care, exercise, postpartum care, sexuality, birth control, childbirth preparation and parenting issues. For one class, group members decided to each bring in their favorite pregnancy book to share with the group. Many of the first-timers moms found that activity particularly helpful.

Buxton doesn't lecture; instead, she facilitates discussion by asking open-ended questions framed in a variety of ways. Some members quickly chime in while others are reserved. Two members already have young children and their input is particularly helpful when discussing the different approaches to feeding a newborn, the topic of a recent class. Members cite different personal experiences, concerns and humorous anecdotes, which contribute to a lively discussion that involves everyone. By the end of the meeting, Buxton becomes more listener than leader.

“We're the first set of our friends to have a baby, so it really helps that there are other people in the class who we can talk to who are in the same situation,” said John King, 26, (Lucky's husband). “We can bounce ideas off people who have been through this before. It's really helpful that we're not just talking with one person.”

In addition to their self-care, each expectant mother gets “mat time” or one-on-one time, where Buxton listens to the baby's heartbeat, checks uterine growth and discusses individual concerns.

The meetings last about an hour and a half and members are invited to stay if there is a concern that wasn't answered during group time.

“I already have two children and wanted to do something differently for the third,” said Sara Ross, 36. “I've had a positive experience with centering pregnancy. We all have a very strong connection with Margaret and feel great about the continuity of care through the nurse midwives at West End Women's Health.”

Two members have recently delivered their babies, and the other members are expected to deliver by mid-January.

“Each person brings richness to the group and to the prenatal experience,” said Buxton. “It's been a very rewarding experience for me, too, as a health care provider.”

“It's a different philosophy of care, and I love it. I hope it takes off all over Nashville,” said Ross.

Centering Pregnancy was started 10 years ago and today there are more than 50 programs in the country.