March 12, 2010

Prenatal care program’s group approach gaining popularity

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Bensonnetta Baker, left, asks a question during a recent Centering Pregnancy meeting at Vanderbilt Health One Hundred Oaks. (photo by Anne Rayner)

Prenatal care program’s group approach gaining popularity

Traditional prenatal care focuses heavily on individual visits with a provider — measurements are taken, the baby's heartbeat is checked, and in the last few minutes of the visit expectant parents have the opportunity to ask questions.

The Department of Obstetrics and Gynecology, at their Vanderbilt Health One Hundred Oaks clinic, is offering an alternative to the provider-driven visit. In the Centering Pregnancy program, expectant mothers are paired in small groups of eight to 10 women with similar due dates. Each woman's husband or significant other may attend.

The program is not new to Vanderbilt — it's been offered for several years by Vanderbilt University School of Nursing's midwifery practices, which have had grant support from the March of Dimes to provide Centering care to their patients. But it is becoming more widely used by Ob/Gyn departments at academic medical centers, like Vanderbilt.

“It's a huge shift in the way we do things,” said Deborah Wage, F.N.P., C.N.M., assistant professor of Obstetrics and Gynecology. “Providers actually devote more attention to core competencies — like nutrition, diet, exercise, preparing for labor, delivery, breastfeeding and newborn care — in the group setting than they do in traditional individual appointments,” she said.

“In traditional care, the provider has about five to 10 minutes to cover all those things. Women in our groups will tell you that they get a lot of education and empower each other as well. For our patients, we know the impact is lasting.”

The women meet, in 10 two-hour sessions, throughout their pregnancy, beginning between the 12th and 16th week of pregnancy. They meet once a month for four months, then twice a month until they deliver.

Prior to the first Centering group, each woman has a complete initial visit, which includes a full physical, pap smear, labs and ultrasound if indicated.

Each session begins with the expectant mothers taking their own blood pressure, weighing, and recording their data on medical charts, all overseen by a nurse or patient care technician.

Then each woman gets a few minutes of private time with the provider, who listens to the baby's heartbeat, measures her uterus, and reviews her chart.

Vanderbilt Ob/Gyn residents facilitate the group meetings under the supervision of an attending provider — a physician in the Department of Obstetrics and Gynecology or a certified nurse-midwife.

Resident Charles Webb, M.D., examines Bensonnetta Baker, who is taking part in Vanderbilt’s Centering Pregnancy program at Vanderbilt Health One Hundred Oaks. (photo by Anne Rayner)

Resident Charles Webb, M.D., examines Bensonnetta Baker, who is taking part in Vanderbilt’s Centering Pregnancy program at Vanderbilt Health One Hundred Oaks. (photo by Anne Rayner)

Ob/Gyn residents rotate through the Centering groups as they would normally rotate through the OB clinic. “They are learning core competencies of prenatal care through a whole different model,” Wage said.

The program is funded by a three-year, $1 million grant from the State of Tennessee — money earmarked to help Tennessee deal with poor perinatal outcome statistics — too many small-for-gestational-age babies, pre-term deliveries, etc. Several institutions across the state are implementing the model, and Wage is the state's liaison for the program, helping other programs get started and educating their providers.

“The grant is two-pronged,” Wage said. “First, it helps us implement a new model of care we know will contribute to improving some of these poor perinatal outcomes; and secondly, it's about the residents and how they learn, that through this model they may have a deeper and broader competency about what they are here to accomplish.”

Georgia Ferrell, M.D., a Vanderbilt Ob/Gyn resident, was trained in the Centering concept as a third-year medical student at the Medical College of Virginia. She's a firm believer in the benefits of group prenatal care.

“Getting two hours with your care provider with each visit allows questions to be answered, and topics to be discussed,” Ferrell said.

“The social aspect of Centering is also so important, knowing that other women are going through the same experiences, same discomforts, and having the same questions. As a physician, I wish that all prenatal care was administered in a group setting. Being able to sit down with your patients, talk to them in depth about nutrition — that just doesn't happen in a 15-minute appointment.”

The program is also a good model of providing health care efficiently, Wage said. “It's far more satisfying for me to be a provider in this model. It's an hour and a half of your time. It's efficient. You only have to say things one time. You don't have to answer the same questions, sometimes inadequately, mind you, room after room after room.”

Wage said all expectant patients are encouraged to receive their prenatal care through a Centering group.

“It's not presented in an opt-in, opt-out kind of way. “We don't say, 'choose A or choose B.' We embrace the model in this department as a model open to all women who are cared for in our system, although they do ultimately have a choice as there are other constraints like children. We currently cannot accommodate children in group sessions, and it just doesn't work for some women for various reasons. We have very diverse groups, from all socioeconomic demographics.”

Many of the groups also form close bonds, Ferrell said. A woman in one of her groups developed high blood pressure and was sent to the hospital to rule out preeclampsia.

“This encouraged a talk about preeclampsia, which educated the group,” Ferrell said. “This patient went on to deliver early, and the group was able to visit her and hear about her delivery experience. She needed that kind of support, and to be able to voice her delivery story.”

More than 170 women have either gone through or are currently in Vanderbilt's Department of Obstetrics and Gynecology Centering program.

The goal is to provide group prenatal care to a minimum of 350 women by the end of the grant's three years, and to be a permanent model of care in the Department of Obstetrics and Gynecology.