Women who enroll in the Centering Pregnancy Program at Grady Memorial Hospital are more likely to give birth to larger babies, feel empowered about their pregnancies, and experience social support from their peers compared to those women who receive prenatal care through traditional means, thanks to a nationwide, innovative model. The program is designed to address clinical as well as psychological, social and behavioral factors to promote healthy pregnancy.
"We hope to reduce low birth weight and pre-term delivery for women who are at risk for adverse outcomes," explains Claire M. Westdahl, CNM, MPH, and Director of Nurse-Midwifery at the Emory University School of Medicine in Atlanta. "If we can do that, we believe we can help eliminate racial and ethnic disparities in pregnancy outcomes."
Data published in an article in Obstetrics and Gynecology in November 2003 compared women in Atlanta who received group care to women who received individual prenatal care and delivered at Grady Hospital. In total, 142 women participated in Centering Pregnancy at Grady and the DeKalb Grady Neighborhood medical clinic. Those who completed group prenatal care were pregnant 4.2 days longer, for at least 39.3 weeks, and gave birth to babies weighing an average of seven pounds, four ounces. In comparison, the 142 women who received individual prenatal care from a nurse-midwife were pregnant an average 38.7 weeks with babies weighing an average of six pounds, 14 ounces.
Data for the study was combined with 174 participants at Yale-New Haven Hospital in New Haven, Connecticut, for an overall total of 458 participants. At all three sites, women were matched by age, race (black, Latina, white, other) and number of previous babies. The study was specifically designed to examine the impact of centering pregnancy versus individual prenatal care on birth weight and gestational age among women receiving care at urban clinics that primarily serve economically disadvantaged and minority women at risk for adverse perinatal outcomes.
Overall, group participants in Atlanta and Connecticut were pregnant 2.2 weeks longer (34.8 versus 32.6 weeks) and their babies weighed more than babies born to women who received individual prenatal care (seven pounds, two ounces versus six pounds 15 ounces). Among those born premature (less than 37 weeks), infants of group patients were significantly larger (five pounds, four ounces versus four pounds, six ounces) than infants of individual-care patients. Infants of group patients were also less likely than those of individual-care patients to be born very early (less than 33 weeks), or to experience neonatal loss.
Westdahl says group sessions are especially beneficial because they give women the opportunity to care for themselves and share their experiences with other women.
"We have a philosophy of empowerment," says Westdahl, who co-authored the 2003 paper, entitled "Group Prenatal Care and Preterm Birth Weight: Results From a Matched Cohort Study at Public Clinics." "We believe that women need and deserve to be the masters of their own healthcare and information. We demystify the rituals, language and procedures of prenatal care."
In keeping with the philosophy of empowerment, group patients maintain their medical records, take their blood pressure, calculate their body mass index, plan individual targeted weight gain, assess fetal movement as well as swelling, and record their nutrition intake. Group sessions also allow women to share and address their feelings and experiences related to pregnancy.