Centering Groups Support the Prenatal Experience

Medical expertise and the wisdom of the hive help during pregnancy


Even in a world full of advanced medical technology, there’s a place for the tradition of peers sharing knowledge and experiences with each other about pregnancy and childbirth. That’s the basis on which Cleveland Clinic’s group prenatal care program is built.


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Introduced at Cleveland Clinic in 2016, CenteringPregnancy® is prenatal care that combines brief, private meetings with a healthcare provider and a facilitated group gathering. Groups of around eight to 10 pregnant people and their partners is optimal. Group members share information on topics of common interest – everything from backaches to breastfeeding to post-natal birth control options and more.

This process, called Centering, allows information to be shared while supportive peer bonds are being built – a factor that has a documented role in reducing infant mortality. Centering typically begins when the patient is between 16 and 20 weeks pregnant. The meetings take place once a month for four sessions, then every two weeks for six sessions.

How Centering care works

Sessions replace the 10 regular well-check visits typical for a low-risk pregnancy, and each lasts about two hours. Visits are devoted predominantly to group discussion, says Toni McDougald, MSN, WHNP-BC, CenteringPregnancy Coordinator.

Patients arrive as they would for a traditional prenatal visit, check and record their vital signs, and meet individually with a provider to cover private information and to listen to the baby.

“Those one-on-one visits are quick, because we want most of the questions and conversations to come back to group,” McDougald says.

The group gathers in a circle with the facilitator, shares an ice-breaker activity, and moves on to discussion, which is largely driven by the participants. McDougald emphasizes that Centering isn’t a class or a lecture, but a place for mutual support. Each group develops its own dynamic as participants take time out from daily life to focus on their pregnancies.

“We’ve done 106 Centering groups, and I’ve probably participated in 90% of them,” she says. “Every group is different, and it’s about the pregnant people. We want them to feel comfortable and safe to learn from each other. We create a peer-to-peer learning environment, and we are there to help them build support and to assure that they are sharing correct information.”

Centering has a track record of providing improved outcomes such as reducing prematurity, low birth weight and increasing breastfeeding. Those improvements help to decrease healthcare disparities and healthcare costs. Patients also report higher levels of satisfaction, according to Edward Chien, MD, MBA, Chair of Cleveland Clinic’s Department of Obstetrics and Gynecology and a maternal-fetal medicine specialist.

“These factors are some of the reasons we are looking to grow and expand our programs,” Dr. Chien says.

That said, the decision to participate in Centering is up to the patient, McDougald adds. “We love to get people signed up by the third month of pregnancy, but we never force anyone. Sometimes scheduling or childcare may be an obstacle. Or they may just have personal reasons for not wanting to participate. It doesn’t always work for everyone.”


The power of the group

Those who do take part report high satisfaction rates for their care. It can hard to fully understand the Centering dynamic unless one has been part of it, says McDougald.

“On day one, they don’t know each other and it’s very awkward,” she says. “By the 10th session, they are all excited for each other and for those who have already delivered. It’s impossible to get that kind of support in individual care.”

Two-week and six-week postpartum visits also are part of the program, so Centering group members also have an opportunity for reuniting after delivery, McDougald says. “They get to meet up again, show off their babies and tell their birth stories,” she says. “It’s pretty amazing.”

And they will continue to have each other to lean on, she adds.

“When they’re up at 3 a.m. breastfeeding and having struggles, I’m not up. But now they have a support group of others who are right there with them,” McDougald says. “Aside from imparting all the information and care that we have, that’s the best thing I can give them.”

The non-profit Centering Healthcare Institute, which helps healthcare facilities implement Centering programs, also tracks outcomes and shares research through an online annotated bibliography. McDougald recommends that healthcare professionals at other institutions start there for guidance on setting up a program.

“I want people to know that it’s available and to be excited about it,” she says. “It becomes part of these women’s birth stories for the rest of their life. I’m honored to be a part of that.”


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