Prenatal Group Program Improves Pregnancy Outcomes

The most recent data from the Centers for Disease Control and Prevention indicate that approximately 10% of infants in the United States are born preterm annually1 and approximately 83% of mothers start breastfeeding after delivery.2 In 2019, outcomes for mothers in Cleveland Clinic’s CenteringPregnancy program were much better: a 4% rate of preterm birth and 92% breastfeeding at discharge.

Those numbers tell the story of the significant impact that “centering”—a unique form of supportive prenatal care that involves group appointments—can have on both mothers and their babies.

“Centering involves a totally different level of patient education and connections with nurse-midwives and facilitators,” says program manager Rasheeda Larkin, MPA. “For mothers to be, the other women in the group are like pregnancy BFFs.”

Centering has a demonstrated track record of providing improved outcomes among those choosing to participate. It also reduces healthcare costs and patients report higher levels of satisfaction, according to Edward Chien, MD, MBA, Chair of the Department of Obstetrics and Gynecology and a maternal-fetal medicine specialist with Cleveland Clinic.

“These factors are some of the reasons we are looking to grow and expand our programs. Our community partners have been enthusiastic about our continued expansion into the community,” Dr. Chien says.

An alternate model of prenatal care

Mothers-to-be who participate in the CenteringPregnancy program have shared medical appointments with a set group of as many as 10 other expectant women in similar stages of pregnancy. These sessions take the place of the 10 regular well-check visits in a low-risk pregnancy, and each is approximately 2 hours. (Insurance providers reimburse for Centering sessions the same as regular visits.)

Currently, CenteringPregnancy is “opt-out,” meaning that at the first prenatal visit, every woman is offered the option of participating—but can decline. Some women are initially reluctant because they think it may be difficult to fit the long sessions into their schedules. Others may hesitate because of the group dynamic.

Says Ms. Larkin, “The data show that this is a great way to deliver prenatal care. But we realize that some moms are just not comfortable with the setting, and it’s important to give them a choice. We talk about more than just fetal growth. We get into very intimate topics—their work, communities, partner and sex life.”

For women who make it to the first session, however, any fears they had usually disappear quickly. “It’s like the anxiety about the first day at a new school,” according to Ms. Larkin. “Once we get the women in a room together, they don’t want to not come to the group.”

Reducing stress and building support systems

During the CenteringPregnancy program, the moms-to-be learn about many aspects of pregnancy, delivery and infant care from specially trained nurse-midwives and from each other. Guest speakers provide information on lactation and how to care for newborns. Each woman also receives a private check-in with her midwife at each session.

“The number one factor that leads to preterm birth is stress and the facilitators and nurse-midwives build relationships with the moms that allow them to get to know what’s going on in the women’s lives,” says Ms. Larkin. “We do whatever we can to support them, whether that’s connecting them to social support, a health worker, doula, or appropriate resources in their community.”

There is also a special focus on normalizing breastfeeding, because of what Ms. Larkin describes as the approximately 30% lower rate of initiating breastfeeding among Black women than among white mothers-to-be. “In the Black community, there is a lack of education about breastfeeding and a stigma around it,” she says. “The group allows us more time to talk to women and normalize the practice so they can be successful with breastfeeding.”

By the end of 2020, CenteringPregnancy program groups will be available in six locations: Cleveland Clinic’s Akron General, Lakewood Family Health Center, Lorain Family Health & Surgery Center, South Pointe Hospital, Stephanie Tubbs Jones Health Center and Westlake Family Health Center. The expansion from the initial pilot was made possible, in part, by a grant from the March of Dimes as part of Cleveland Clinic’s efforts to reduce infant mortality in the community.

During 2019, 23 groups were held across the four locations. Of the 168 participants, 42% were African-American and 39% were on Medicaid. Year-to-date through September, 10 groups have been initiated, with 61 participants, despite the unique challenges posed by the COVID-19 pandemic.

“The pandemic created new challenges, but has not stopped us from continuing to pursue this model of care,” notes Dr. Chien.

“A lot of women are having virtual prenatal appointments and we’ve given them the opportunity to do the groups that way, too,” says Ms. Larkin. “In some cases, we have one or two moms in the room with us and the rest are online in their homes or together in a safe space in the community.”

Plans are in the works to continue to expand the number of CenteringPregnancy groups offered and outreach to additional underserved populations, such as women who are members of the Latinx community or immigrants.

“One provider/one woman has been the traditional way of providing prenatal care for so long, but this program is very different,” says Ms. Larkin. “Being connected to other pregnant women and seeing a provider for more than 15 minutes really improves patient satisfaction.”

References

1. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Division of Vital Statistics. Births: final data for 2018. National vital statistics reports. 2019 Nov;68(13). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_13-508.pdf. Accessed September 29, 2020.
2. Centers for Disease Control and Prevention. Key statistics from the national survey of family growth – B listing. National survey of family growth. Retrieved from https://www.cdc.gov/nchs/nsfg/key_statistics/b_2015-2017.htm#initiation. Accessed September 29, 2020.