CenteringPregnancy: an innovative approach to prenatal care delivery.

From an initial narrow focus on preventing eclampsia, prenatal care has evolved to become a prime example of preventive care. It has been expanded from a temporal focus on occurrences during late pregnancy to encompass preconception preparation for pregnancy and to include goals for the mother and infant that stretch well beyond the peripartum period. The scope has broadened from an original emphasis on preventing maternal and neonatal mortality to include an in depth concern with short- and longer-term morbidities for the mother, child, and family. Similarly, the goals of prenatal care have grown beyond the purely biological to include the psychosocial influences on pregnancy outcome. In the United States, these goals were most recently outlined by the US Public Health Service Expert Panel on the Content of Prenatal Care in 1989 (Table). 1 They are admirable goals, yet prenatal care as commonly practiced in the United States and elsewhere remains largely unchanged over the last century. Certainly new and improved tests and interventions have been added to the armamentarium of prenatal care providers, such as ultrasound, screening for chromosomal aneuploidies and genetic disorders, etc, that have improved pregnancy outcomes. Still, it is hard to imagine how the increasingly comprehensive goals for prenatal care can be achieved with the current model for prenatal care delivery. Recognition of the failure to achieve the goals for prenatal care as outlined by the Public Health Service Expert Panel was among the reasons that led the Centering Healthcare Institute to develop the CenteringPregnancy model of group prenatal care. 2 It represents a major change in the delivery of prenatal care, allowing enough time for the provider to focus on antenatal education while integrating family members, peer support, and self reliance. CenteringPregnancy replaces individual care with a group model that starts after the initial prenatal visit for obstetrically low-risk women. Groups of 10-12 participants with similar gestational ages are brought together for the remainder of the pregnancy following the traditional schedule of prenatal visits. Each group visit lasts 90-120 minutes during which time pregnant women participate in discussions about a range of health education topics in addition to the usual physical assessments. This model of care allows for approximately 20 hours of prenatal care over the course of the pregnancy as compared with approximately 2 hours in total that is typical with the individual visit model. This is accomplished without affecting provider productivity and creates an economy of scale that allows more time for a wide range of pregnancy-related topics. Basic tenets of the group care model include health promotion, peer support, and self-management of care facilitated through discussions among participants during each session. Relationships are built among the participants and with the provider. There are educational objectives including topics such as health and nutrition, childbirth preparation, stress reduction, family planning, and parenting. 3 Data are now starting to appear in the literature to support the benefits of the group model of care. These include improved compliance with prenatal care, higher rates of breastfeeding, and greater patient satisfaction and readiness for childbirth and parenting. 4 Even more promising is the 33% reduction in preterm birth reported in a trial of more than 1000 inner-city women aged 14-25 years (9.8% vs 14.8%) among women randomized to Centering groups, compared with those who received traditional individual care. 5 That same study found fewer repeat pregnancies within 6 months of delivery, increased use of condoms, and less unprotected sexual intercourse among Centering participants. 5 This group later reported that patients who attended Centering groups that adhered to the model most faithfully