When babies are born too soon or too small, they're more likely to be sick, have developmental problems and to die. In the U.S., one out of 12 newborns weighs less than 2500 grams. But a group care model, called Centering Pregnancy, is improving those numbers.
Nurse-midwife Sharon Rising developed the concept of group health care a decade ago, bringing together patients with shared health concerns and offering them care, education and support.
"Centering Pregnancy is a model that brings women out of exam rooms and into the group for their care," she explained.
An empowering community for moms-to-be
The Centering Pregnancy model is now used in more than 300 clinics nationwide and in several countries around the world. Studies indicate that it's popular with both moms-to-be and medical staff. What's more, it reduces the rate of low-birth weight babies.
Rising says a community of support builds as pregnant women attend 1.5 hour group sessions. She points to those regular sessions as a major reason for improved outcomes. "That can happen when you're in a group, over time, 20 hours, throughout your pregnancy, with a group of women who are due during the same time period," she said.
At Clinica Family Health Services in Denver, Colorado, only one in 30 babies has a less-than-healthy birth weight, thanks to the Centering Pregnancy program. Blanca, one of the 10 moms-to-be attending a recent group meeting, said she enjoys getting together with the other women and learns valuable information.
For instance, Blanca said the women take their own vital signs. "Every month we measure our weight and our blood pressure," she said. Blanca and two pregnant friends demonstrated their ability to use a blood pressure monitor. Instead of waiting for a nurse, the women helped each other adjust Velcro cuffs, push buttons and write results on their medical charts.
A paradigm shift away from short, private checkups with obstetricians
In another departure from typical doctor visits, prenatal checkups don't happen behind closed doors. Instead, an exam table is located in a corner of the group meeting room. At the recent session, one by one, expectant moms greeted Misae Vela Brol, the attending Nurse Practitioner. After each lies down, she lifts her shirt halfway to reveal a melon-sized belly.
Using a tape measure, Vela Brol calculates the unborn baby's growth. Then, with a high-tech stethoscope, she shares with the group a wonderful sound of a baby's heartbeat.
Participant Vela Brol said she prefers this approach to private checkups. "[I love] group care. Hands down. I could do groups all day. I'd be perfectly happy. Women here probably get a lot more out of the education, out of the talks, out of what we talk about, out of our conversation," she said.
Lupe Tellez is a Clinica caseworker who leads many of the conversations, which can last an hour or more. She says the women discuss everything from healthy food to birth control to dealing with depression.
"It's women empowering women," Tellez explained.
A need to change the current trend
Lynn Scheidenhelm, Clinica's Behavioral Health Clinical Manager, says too many babies in the United States are born too small, putting them at risk for a lifetime of health problems. "Colorado's low birth weight rate is 9 percent," she pointed out, adding that it's one of the highest in the country.
By contrast, she expressed pride that Clinica clients in the Centering Pregnancy groups, have better outcomes with their babies. "The low birth weight rate was 3.13 percent. It's dramatic," she said.
As for being born too early, one out of every 8 babies in the U.S. is premature. But that's not what has happened at Clinica. Every one of the 200 babies born last year to members of Centering Pregnancy groups was born healthy - and full term.
A promising model for change
Ciaran Phibbs, a Stanford University Health Economist, calls those results intriguing, but notes there is not enough data to make firm conclusions about Centering Pregnancy's value.
"Compared to [traditional] prenatal care," he said, "if this model is a model to provide what appears to be a significant enhancement of the amount of services, and you get some effects in terms of preventing preterm deliveries, it's going to pay for itself." Phibbs said he'd like to see larger studies.
Clinica's Lynn Scheidenhelm says the program costs the same as standard prenatal care but, "the difference is, our outcome measures are better. Our staffare happier. Our patients are happier," she said.
That's why Scheidenhelm says Clinica is expanding the number of its Centering Pregnancy groups.
Sharon Rising added that the model for their program is now used in some European countries, as well as in Canada and Australia. And, Rising is adapting the model for care delivery in Africa and Latin America.