Group Support

You don’t feel alone. It was a great support team. I was able to share with other women and they were able to share with me,” says Yvette Cruz, of the Bronx, New York, enthusiastically describing her most recent prenatal experience. Just a week after giving birth to her third child, Cruz declares CenteringPregnancy, a group approach to prenatal care, provided her the best experience of all her pregnancies.

Because the nine months before birth can be a lonely experience, this approach to prenatal care helps expectant mothers find the support they need. Instead of the traditional one-on-one visits with a healthcare practitioner, women who participate in a CenteringPregnancy program meet as a group to receive prenatal care and education, as they form their own caring community. While a midwife, advanced practice nurse, or physician leads the group, each member learns to take her own blood pressure, monitor weight gain, check urine samples, and record the data on medical charts. “It’s an empowering experience,” says Sharon Rising, CNM, and founder of the program. “It demystifies the birth process and helps women take control of their own health.”

Rising started the first CenteringPregnancy program 10 years ago in Waterbury, Connecticut. Today there are more than 50 programs across the country. Women of all socioeconomic groups participate. “Any woman would benefit from being in this program,” explains Barbara Hackley, CNM, who along with medical assistant Amarilis Stable runs groups at the South Bronx Health Center for Children and Families, operated by Montefiore Medical Center and the Children’s Health Fund.

The quality of prenatal care is equal to the one-on-one traditional form of care, adds Hackley, “but the depth and quality of the group discussions and the support that women get from each other make it a better experience.” As Stable points out: “The bonds that the women build are amazing. They don’t feel isolated and are relieved that someone else is going through the same experience.” New mom Cruz agrees: “If you have questions and you are afraid to ask them, in the group discussions, someone else will probably ask and you learn that you’re not alone. I thought I was the only one who was worried about being swollen and overweight, but other women were, too.”

A midwife, advanced practice nurse, or physician meets with each pregnant woman for her initial prenatal visit and takes a complete medical history and physical examination. The expectant mother is then invited to join a group of six to 12 women who have similar due dates. The groups form between 12 and 16 weeks of pregnancy, and just like the traditional prenatal-visit schedule, the group meets monthly for the first four months, and then biweekly after that. Partners and other support people often come to the sessions. They continue to meet during the early postpartum period. Just a week after giving birth, Cruz already had been in touch with two friends she’d made through the program. “We all loved it and I still keep in contact.” She adds that she happily will share her experience as a veteran mom with the women in her group who are having their first children.

In addition to the self-care that each woman practices, at each session the mom-to-be meets with the practitioner to listen to her baby’s heartbeat, check uterine growth, and discuss individual problems and concerns. The group members also fill out self-assessment sheets that are used to stimulate group discussions. The topics include nutrition, common pregnancy complaints, selecting pediatric care, sibling concerns, baby care, exercise, postpartum care, sexuality, birth control, childbirth preparation, and parenting issues. The group sessions last between an hour and a half and two hours. Women are free to stay after or schedule an additional appointment if they have a question or concern that isn’t answered in the group.

A traditional prenatal visit is “practitioner driven,” explains CNM Hackley. “You have only 15 minutes and you need to cover the physical checkup, offer some education, and deal with any concerns. We drive the ship and there’s little time for listening.” In contrast, the CenteringPregnancy program offers more time to discuss subjects in greater depth, and it’s driven by the women. “We have to listen,” Hackley says.

Data from many sites around the United States indicates that 96 percent to 98 percent of all women surveyed prefer getting their care in this way. Rising adds, “We hypothesize that the strength of the community that develops throughout the 10 sessions will lead to the support and competence needed to be an effective parent. That, after all, is our long-term goal—healthy mothers, children, and families.”

*taken from “Centering Pregnancy,” by Marian Edelman Borden, Every Baby magazine, issue four.