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Wed May 29, 2013
Group Prenatal Care Takes Root In New Hampshire
Just off from a circle of cushioned chairs, behind a privacy screen, Jessica Densmore greets patients inside a Cheshire Medical Center conference room, in Keene.
“Let’s take a listen and see if we can hear this baby today,” she says, positioning a fetal heart monitor.
Today’s mothers, ten in total, are all between 22 and 29 weeks pregnant. They come once a month, and then every two weeks as due dates approach, for their Centering Pregnancy appointment: basically a group check-up.
When they arrive, there’s no waiting room or doctors running behind schedule. Instead, mothers-to-be including Courtney Howe meet with Densmore for a five minute private appointment, and then take their own blood pressure and weight while mingling with the group.
“It is 138 over 86, which is pretty high compared to the rest of them,” says Howe. “It has been a very stressful day.”
Howe notes the results in her log, which gets entered into her medical records. One of Centering Pregnancy’s goals is to get women to play a more active role in their care, and to reinforce how important diet, exercise and stress management are to a healthy pregnancy.
The traditional system of prenatal care, with private 15 minute check-ups in a sterile environment touches on this information, too. But Densmore says the Centering Pregnancy model, with its regular series of 2 hour appointments, always with the same women, allows the conversation to go deeper.
“This group setting allows us to provide that basic information, and then run with the topics that are so interesting and so important.”
And Densmore says group prenatal care creates shared experience: women of different backgrounds learn from each other during the discussion session.
“The more diverse the group, the better. What I’ve found is that it is really important to have people who have had babies before, people who haven’t had babies before, people who are on the older side of becoming a parent, people who are on the younger side, people of all socio-economic statuses. This is a place where all of those factors melt away.”
Kevin and Carrie Sullivan fall into that category of people who have had babies before. They went through Centering Pregnancy for their first child, and are back again.
“I like how each session has a topic, so we learn about a lot of different things you may not think about, and you hear other people’s stories and questions, things you wouldn’t even think to ask, so it is really, really helpful,” says Carrie.
There are the topics couples may not think to ask about. There are also the topics some could be reluctant to bring up in a one-on-one setting.
In the circle, nothing is taboo.
“Pushing a baby out feels a lot like having a bowel movement,” Densmore says, as the circle enjoys a laugh.
"Clueing into those sensations is actually the best way to prepare for pushing your body uses those same receptors, those same things that tell you when…”
But while today's topic may seem light, Centering Pregnancy does get results.
The program was first developed 20 years ago in a clinic in Connecticut by Sharon Schindler Rising.
Compared to traditional care, Rising says researchers found higher rates of breastfeeding, and a 33% reduction in premature births.
“Well, that was surprising for us. We knew the model was working, that women really liked it, but we didn’t know that there was going to be an effect on pre-term birth,” says Rising, who now runs the Centering Health Care Institute.
With neonatal intensive care a huge cost burden, Rising says Centering can lower health care spending.
But even with these benefits, only 135 facilities around the country now offer the program as an option, and only four hospitals in New Hampshire: Cheshire Medical Center, Dartmouth’s main facility in Lebanon, Alice Peck Day, and Concord Hospital.
Jessica Densmore says the new trainings, new materials, and space concerns cause mangers to think twice before adopting the program.
“I think it is daunting for practices to change the way they do things.”
But compared to the traditional model, she believes Centering Pregnancy in the long-term eases strain on staff, and expecting mothers.
Labor, she says, will be hard enough on them.