'Centering' has benefits for women

Prenatal care visits often mean waiting an hour or more for 10 minutes with a health-care provider. Pregnant women are irritated by that. And many caregivers grow weary of going room to room answering the same questions again and again.

A national movement, which includes clinics in Durham and Chapel Hill, is changing all that.

Instead of one-on-one medical visits, pregnant women who are due about the same time get care in groups. The participants share health-care providers but get the providers' undivided attention during sessions lasting up to two hours.

And there is no waiting. After women check in, they head right to the meeting room.

Over talk of cravings, aching backs and whether to circumcise boys, women forge a community of support. Veteran mothers share war stories with first-timers. Tips for easing nausea or soothing itchy bellies are traded.

"It's just a sigh of relief that you're not going through it alone," said Ch-Hara Davis, 20, a first-time mother who is expecting a daughter any day now. She attends group prenatal care every two weeks at Lincoln Community Health Center in Durham.

But "Centering," as the group approach is known, isn't just a way to make prenatal care more enjoyable. Research indicates it has clinical benefits. Women in group prenatal care who delivered prematurely had larger babies than women who got such care on their own, a 2003 study found. Heavier infants are far more likely to live.

The findings suggest that group care might be another strategy for reducing infant mortality -- a problem in North Carolina, where infant death rates consistently rank among the nation's highest.

The state's infant mortality rates have fallen in recent years but edged up in 2004, with 8.8 babies per 1,000 live births dying before their first birthday. The rates were nearly twice as high, 15.6 deaths per 1,000 births, among racial minorities. Studies have found that women who participate in group care make fewer visits to emergency rooms and miss far fewer prenatal appointments than women getting one-on-one care.

Many health centers that offer group prenatal care target high risk groups such as low-income women, racial minorities and teens. But the doctors and nurse midwives who lead the groups have found that the sessions appeal to women of all backgrounds.

The UNC Family Practice Center in Chapel Hill offers a Centering option to all patients beginning prenatal care. About half accept, said Dr. Cristy Page, a family physician who helps lead the groups. She said it is not uncommon to have low-income teenagers on Medicaid in the same group with high-powered professionals with generous private insurance. Centering costs the patient no more than individualized care.

"You might look at this collection of women and say, 'How can this group bond?' " Page said. "But they come together every time. It's just really magical what happens."

Taking ownership

Centering, created by a nurse midwife and former faculty member at Yale University's nursing school, is built on the notion that women should take ownership of their pregnancies. Sessions begin with each woman checking her baby's heart rate, taking her own blood pressure and weight and measuring her belly to assess fetal growth and development. Results are recorded on the patient's medical chart and in a workbook that each woman takes home.

"It's empowering when you write it down," said Kathryn Trotter, a nurse midwife who helped establish the Centering program at the UNC Family Practice Center. She is now an assistant clinical professor at the Duke University School of Nursing.

"You ask, 'What does this mean?' It sparks a discussion about [pregnancy-related high blood pressure], and women get the idea that blood pressure is something they should pay attention to," she said.

That kind of knowledge is powerful.

Davis, a student at N.C. Central University, recognized the symptoms of dangerous pregnancy-related high blood pressure, called preeclampsia, in a classmate. The woman had mentioned her swollen hands and face and complained of blurred vision. On Davis' advice, the woman sought medical attention. Doctors ended up performing an emergency cesarean section to save her baby.

"She had no idea -- she just thought it was normal," Davis said. "If I hadn't been in the Centering group, I wouldn't have known either."

Meetings cover a surprising amount of ground.

During a recent group session at Lincoln, nurse midwife Amy MacDonald guided women through topics such as sudden infant death syndrome, the dangers of suffocating a baby who sleeps in the parent's bed, the health benefits of breast-feeding, how to bathe a newborn and whether to circumcise boys.

At one point, MacDonald dropped to the floor to demonstrate how women in the late stages of pregnancy can get in and out of bed more comfortably.

"It's definitely more intimate than lying on a table being measured," Jamila Thornton, 28, said of the group. Her daughter is due this week. "I'd recommend it to anyone who is having a baby."