Journal of Midwifery & Women’s Health
www.jmwh.org
Honoring US Midwife Researchers
Part II: The CenteringPregnancy Model of Group Prenatal Care Mary Barger, CNM, PhD, MPH, Mary Ann Faucher, CNM, PhD, MPH, Patricia Aikins Murphy, CNM, DrPH
This column highlights the research contributions of midwives to prenatal care and focuses on the CenteringPregnancy model of group prenatal care, which has a strong evidence base and is now being recognized by both the Agency for Healthcare Research and Quality and Centers for Medicare and Medicaid Services as an innovative care model. Sharon Schindler Rising, CNM, MSN, is responsible for conceiving the CenteringPregnancy model and promoting it through the Centering Healthcare Institute. The CenteringPregnancy model seeks to actively engage women in their health and health care through group interaction facilitated by prenatal care providers. Women of a similar gestational age meet in groups of 6 to 10 women for 1.5 to 2 hours for a total of 10 visits during pregnancy and postpartum. Each session includes an individual assessment with usual procedures, such as checking weight and blood pressure, and peer interaction around appropriate topics for gestational age with the flexibility to include topics important to the group. The highlighted articles in this column include research studies about the CenteringPregnancy model of care where certified nurse-midwives/certified midwives are the first, second, or last author. These were published from 2004 to the present and are listed in alphabetical order. Many other studies about CenteringPregnancy exist in the literature. A complete list is available from the Centering Healthcare Institute. Baldwin KA. Comparison of Selected Outcomes of CenteringPregnancy Versus Traditional Prenatal Care. J Midwifery Womens Health. 2006;51(4):266–272.
This quasi-experimental study was conducted at 3 geographically diverse prenatal care sites where all care was managed by nurse-midwives. Women self-selected to traditional care (n = 48) or CenteringPregnancy care (n = 50). The 2 groups were similar on baseline socio-demographics. Women in the CenteringPregnancy group had a greater posttest knowledge on common pregnancy topics. However, there were no differences between groups in perceived social support, fetal health locus of control, or satisfaction. Limitations of the study were differences in gestational age and completion of posttest assessments in the control group compared to the CenteringPregnancy group as well as a possible ceiling effect due to high pretest scores.
examined the midwives’ thoughts, feelings, and perceptions as they first contemplated attempting the CenteringPregnancy model of care, continued with attendance at educational training workshops, and completed work with their first CenteringPregnancy group. The findings mirrored the transtheoretical health education model of Prochaska and DiClemente.1 The stages of change from precontemplation through contemplation, active participation, action, and maintenance provide an appropriate framework for expressing how the midwives felt as they contemplated changing from a traditional model of prenatal care and then implementing CenteringPregnancy. Grady MA, Bloom KC. Pregnancy Outcomes of Adolescents Enrolled in a CenteringPregnancy Program. J Midwifery Womens Health. 2004;49(5):412–420.
This quasi-experimental study examined the effects of CenteringPregnancy among pregnant adolescents from an inner city in the Midwest compared to historical and contemporaneous control groups. The premise was that the social support and education inherent in the CenteringPregnancy model would be particularly important among adolescents. Thirteen groups of teens (N = 124) completed the CenteringPregnancy model of care. They were very comfortable with the group model and highly satisfied with the group support and interaction. Compared to the contemporary and historical control groups, the CenteringPregnancy group had less than half the preterm birth rate (10.5% vs 25.7% and 23.2%, respectively; P ⬍ .05) and low-birth-weight rate (8.9% vs 22.9% and 18.3%, respectively; P ⬍ .05). In addition, women in the CenteringPregnancy group were more likely than women in the historical control group to identify a pediatric provider (79% vs 52%) and be breastfeeding (46% vs 28%) at hospital discharge. Hackley B, Applebaum J, Wilcox WC, Arevalo S. Impact of Two Scheduling Systems on Early Enrollment in a Group Prenatal Care Program. J Midwifery Womens Health. 2009;54(3):168–175.
This phenomenologic study assessed 6 midwives’ experiences implementing CenteringPregnancy. The study
Although there is strong evidence for the CenteringPregnancy model of care, the logistics of scheduling women with similar gestational ages to a group can be difficult. This study explored 2 methods of scheduling: first group available compared to estimated date of birth. Using 14 CenteringPregnancy groups evenly divided by scheduling method, they found that women assigned by estimated date of birth entered groups at an earlier gestational age and were able to attend more group sessions. Women in both groups had similar attendance rates.
1526-9523/09/$36.00 doi:10.1111/jmwh.12307
c 2015 by the American College of Nurse-Midwives
Baldwin K, Phillips G. Voices along the Journey: Midwives’ Perceptions of Implementing the CenteringPregnancy Model of Prenatal Care. J Perinatal Educ. 2011;20(4):210–217.
211
This information may be helpful for the logistics of scheduling women into the group model. Ickovics JR, Reed E, Magriples R, et al. Effects of Group Prenatal Care on Psychosocial Risk in Pregnancy: Results from a Randomized Controlled Trial. Psychol Health. 2011;26(2):235–250.
A randomized controlled trial was conducted with 1047 healthy pregnant women aged 25 years or younger, who were assigned to 1 of 3 groups that varied by the type of prenatal care: standard individual care, CenteringPregnancy, or CenteringPregnancy Plus. CenteringPregnancy Plus is the group prenatal care model with the addition of specific skill building in the area of sexually transmitted infection prevention. The aim was to assess whether the CenteringPregnancy Plus program was significantly better at improving psychosocial outcomes. In this intention-to-treat analysis, no significant difference in psychosocial measures was observed between the individual care group and CenteringPregnancy Plus group. However, when level of stress at study entry was analyzed, women in the CenteringPregnancy Plus group showed significantly better psychosocial outcomes in the third trimester when compared to women in the individual care group. At the one-year postpartum assessment, significant reduction in rates of social conflict and depression also were observed in the CenteringPregnancy Plus group compared to individual care. Ickovics JR, Kershaw TS, Westdahl C, et al. Group Prenatal Care and Perinatal Outcomes: a Randomized Controlled Trial. Obstet Gynecol. 2007;110(2 Pt 1):330–339.
This multisite randomized clinical trial recruited more than 1,000 pregnant women who were primarily African American (80%). Participants were randomly assigned to either standard care or CenteringPregnancy group prenatal care. There were no differences in baseline characteristics between groups. The intention-to-treat analysis showed that women in the CenteringPregnancy group had a 33% lower preterm birth rate (9.8% vs 13.8%, P = .045), and this result was stronger among African American women (10.0% vs 15.8%, P = .02). In addition, women in the CenteringPregnancy group were more satisfied with care, had better pregnancy knowledge and preparation for labor and birth, and higher breastfeeding initiation rates than women receiving standard care. No differences in cost or birth weight were documented. Kennedy HP, Farrell T, Paden R, et al. “I wasn’t Alone”–a Study of Group Prenatal Care in the Military. J Midwifery Womens Health. 2009;54(3):176–183.
This is a qualitative study of women’s experiences with the CenteringPregnancy model of care as compared to traditional care in 2 military health settings. Data were collected in a semi-structured telephone interview at 3 months postpartum from 234 of 322 women enrolled. Compared to women in traditional care, women in CenteringPregnancy spent most of their time discussing their prenatal care experience. The 212
2 themes from the CenteringPregnancy group were “I wasn’t alone” and “I liked it but . . . ” Women expressed the support they received from the group, especially related to military issues, frequent moves, and their partners being deployed. Women’s suggestions to improve CenteringPregnancy care included more individual time with the provider. The third theme, “They really need to listen,” was voiced by both groups of women but more by those in traditional care. Women expressed frustration with lack of continuity of care, choice of provider, and difficulties getting an appointment. Novick G, Reid AE, Lewis J, et al. Group Prenatal Care: Model Fidelity and Outcomes. Am J Obstet Gynecol. 2013;209(2):112e1–6.
This secondary analysis of a large randomized trial of group prenatal care evaluated the fidelity of the CenteringPregnancy model, both process and content. Scores on group facilitation and participant involvement measured process fidelity. Content fidelity was assessed with a checklist of topics recommended in CenteringPregnancy. Fidelity was assessed through observation by a trained researcher. Fidelity to the model was associated with the outcomes of preterm birth, adequacy of prenatal care, and breastfeeding initiation, which were all previously reported as improved with CenteringPregnancy. Higher scores on process fidelity were associated with lower odds of preterm birth. Both process and content fidelity were associated with lower odds of intensive utilization of prenatal care. Novick G, Sadler LS, Knafl KA, Groce NE, Kennedy HP. In a Hard Spot: Providing Group Prenatal Care in Two Urban Clinics. Midwifery. 2013;29(6):690–697.
The challenges faced by clinicians when providing group prenatal care, specifically CenteringPregnancy, are described in this article. The study design was qualitative using interpretative description and situational mapping. Data were collected from 2 urban clinics and included 23 pregnant women with their significant others and 2 nurse-midwife group leaders. The main finding was that clinics did not always provide the resources needed to implement CenteringPregnancy. Results describe how the clinician adapts to these challenges and the effects these adaptations have on fidelity of the CenteringPregnancy model of care. Having administrative support was noted as critical to successful implementation of CenteringPregnancy, which requires an element of time. Greater buyin was seen as translating to increased resources including staffing and provision of adequate space. Group leaders used a combination of advocacy, persistence, and compromise to make adjustments although some modifications that are described pose significant threats to receiving the full benefits of CenteringPregnancy care. Phillippi JC, Myers CR. Reasons Women in Appalachia Decline CenteringPregnancy Care. J Midwifery Womens Health. 2013;58(5):516–522.
The purpose of this study was to ascertain reasons why women attending a rural birth center in Appalachia declined Volume 60, No. 2, March/April 2015
CenteringPregnancy care. The authors interviewed 20 women who had declined to participate and used conventional content analysis to analyze the interviews. They found 3 broad reasons for declining to participate: women preferred one-toone care, they experienced logistical barriers to participation, and they did not know that group care was an option. The authors concluded that clinicians should use promotional materials that are clear about options and respectful of privacy concerns. They also noted that group care may not meet the needs of all women. Risisky D, Asghar SM, Chaffee M, DeGennaro N. Women’s Perceptions Using the CenteringPregnancy Model of Group Prenatal Care. J Perinat Educ. 2013;22(3):136–144.
This qualitative study assessed women’s perceptions of their experience in the CenteringPregnancy model. A small qualitative thematic analysis that evaluated interviews from 10 women and 3 support persons identified 3 themes in the data: women enjoyed the in-depth learning; the peer support normalized pregnancy concerns; and the participation of support people helped during pregnancy, birth, and afterward. In summary, this study found that women who engaged in the CenteringPregnancy model felt direct benefits from the in-depth nature of their care, and group prenatal care had a positive impact on womens’ pregnancy experiences. Skelton J, Mullins R, Langston LT, et al. CenteringPregnancySmiles: Implementation of a Small Group Prenatal Care Model with Oral Health. J Health Care Poor Underserved. 2009;20(2):545–253.
An enhanced CenteringPregnancy model of care with an added component on oral health was developed and titled CenteringPregnancySmiles. Pregnant women enrolled in this program receive an oral examination, diagnosis, and treatment plan by a dentist along with an education program in multiple group sessions provided by a dental hygienist. The article provides descriptive preliminary data on baseline assessments and improvement of oral health in 447 women attending the CenteringPregnancySmiles group. Many women had poor initial oral health, which improved by late pregnancy. Singleton preterm birth (6.6% vs 13.7%) and low birth weight (5.3% vs 7.3%) were lower in the women participating in CenteringPregnancySmiles compared to rates in the region prior to the program. Tandon SD, Colon L, Vega P, Murphy J, Alonso A. Birth Outcomes Associated with Receipt of Group Prenatal Care Among Low-Income Hispanic Women. J Midwifery Womens Health. 2012;57(5):476–481.
This study examined the effectiveness of the CenteringPregnancy group prenatal care model in Hispanic women. The authors enrolled pregnant Hispanic women at 20 weeks’
Journal of Midwifery & Women’s Health r www.jmwh.org
gestation or less and collected data on 150 women who attended the CenteringPregnancy program and 66 who had traditional care. All women received care in public health clinics. The rate of preterm birth was 5% in the CenteringPregnancy care group and 13% in the traditional care group (P = .04). There were no differences in the rate of low birth weight between the groups. The authors concluded that the model holds promise for improving outcomes in this group of at-risk women. Tilden EL, Hersh SR, Emeis CL, Weinstein SR, Caughey AB. Group Prenatal Care: Review of Outcomes and Recommendations for Model Implementation. Obstet Gynecol Surv. 2014;69(1):46–55.
This meta-analysis reviews the literature regarding group prenatal care, including but not exclusive to CenteringPregnancy, providing an overview of the history and structure of the model. The meta-analysis summarizes various outcomes. Preterm birth is the most consistently evaluated outcome, and all but one study reviewed found lower preterm birth rates among those in group prenatal care. There is also a consistent downward trend in low-birth-weight rates in most studies, but this finding did not reach statistical significance. In 2 of 3 studies that evaluated breastfeeding, rates were significantly improved in women attending group prenatal care. Most studies found high satisfaction and increased knowledge in group prenatal care participants. The authors of this review identify the need for future research that addresses external validity, model fidelity, impacts of stress and support, and changes in the social context of care. AUTHORS
Mary K. Barger, CNM, PhD, MPH, FACNM, is an Associate Professor at the Hahn School of Nursing, University of San Diego, San Diego, California. Mary Ann Faucher, CNM, MPH, PhD, FANCM, is an Associate Professor and Program Coordinator for NurseMidwifery at the Louise Herrington School of Nursing, Baylor University, Dallas, Texas. Patricia Aikins Murphy, CNM, DrPH, FACNM, FAAN, is a Professor at the University of Utah College of Nursing, where she holds the Annette Poulson Cumming Presidential Endowed Chair in Women’s and Reproductive Health. Dr. Murphy is Deputy Editor of the Journal of Midwifery and Women’s Health. REFERENCE 1.Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–395.
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www.jmwh.org
Honoring US Midwife Researchers
Part II: The CenteringPregnancy Model of Group Prenatal Care Mary Barger, CNM, PhD, MPH, Mary Ann Faucher, CNM, PhD, MPH, Patricia Aikins Murphy, CNM, DrPH
This column highlights the research contributions of midwives to prenatal care and focuses on the CenteringPregnancy model of group prenatal care, which has a strong evidence base and is now being recognized by both the Agency for Healthcare Research and Quality and Centers for Medicare and Medicaid Services as an innovative care model. Sharon Schindler Rising, CNM, MSN, is responsible for conceiving the CenteringPregnancy model and promoting it through the Centering Healthcare Institute. The CenteringPregnancy model seeks to actively engage women in their health and health care through group interaction facilitated by prenatal care providers. Women of a similar gestational age meet in groups of 6 to 10 women for 1.5 to 2 hours for a total of 10 visits during pregnancy and postpartum. Each session includes an individual assessment with usual procedures, such as checking weight and blood pressure, and peer interaction around appropriate topics for gestational age with the flexibility to include topics important to the group. The highlighted articles in this column include research studies about the CenteringPregnancy model of care where certified nurse-midwives/certified midwives are the first, second, or last author. These were published from 2004 to the present and are listed in alphabetical order. Many other studies about CenteringPregnancy exist in the literature. A complete list is available from the Centering Healthcare Institute. Baldwin KA. Comparison of Selected Outcomes of CenteringPregnancy Versus Traditional Prenatal Care. J Midwifery Womens Health. 2006;51(4):266–272.
This quasi-experimental study was conducted at 3 geographically diverse prenatal care sites where all care was managed by nurse-midwives. Women self-selected to traditional care (n = 48) or CenteringPregnancy care (n = 50). The 2 groups were similar on baseline socio-demographics. Women in the CenteringPregnancy group had a greater posttest knowledge on common pregnancy topics. However, there were no differences between groups in perceived social support, fetal health locus of control, or satisfaction. Limitations of the study were differences in gestational age and completion of posttest assessments in the control group compared to the CenteringPregnancy group as well as a possible ceiling effect due to high pretest scores.
examined the midwives’ thoughts, feelings, and perceptions as they first contemplated attempting the CenteringPregnancy model of care, continued with attendance at educational training workshops, and completed work with their first CenteringPregnancy group. The findings mirrored the transtheoretical health education model of Prochaska and DiClemente.1 The stages of change from precontemplation through contemplation, active participation, action, and maintenance provide an appropriate framework for expressing how the midwives felt as they contemplated changing from a traditional model of prenatal care and then implementing CenteringPregnancy. Grady MA, Bloom KC. Pregnancy Outcomes of Adolescents Enrolled in a CenteringPregnancy Program. J Midwifery Womens Health. 2004;49(5):412–420.
This quasi-experimental study examined the effects of CenteringPregnancy among pregnant adolescents from an inner city in the Midwest compared to historical and contemporaneous control groups. The premise was that the social support and education inherent in the CenteringPregnancy model would be particularly important among adolescents. Thirteen groups of teens (N = 124) completed the CenteringPregnancy model of care. They were very comfortable with the group model and highly satisfied with the group support and interaction. Compared to the contemporary and historical control groups, the CenteringPregnancy group had less than half the preterm birth rate (10.5% vs 25.7% and 23.2%, respectively; P ⬍ .05) and low-birth-weight rate (8.9% vs 22.9% and 18.3%, respectively; P ⬍ .05). In addition, women in the CenteringPregnancy group were more likely than women in the historical control group to identify a pediatric provider (79% vs 52%) and be breastfeeding (46% vs 28%) at hospital discharge. Hackley B, Applebaum J, Wilcox WC, Arevalo S. Impact of Two Scheduling Systems on Early Enrollment in a Group Prenatal Care Program. J Midwifery Womens Health. 2009;54(3):168–175.
This phenomenologic study assessed 6 midwives’ experiences implementing CenteringPregnancy. The study
Although there is strong evidence for the CenteringPregnancy model of care, the logistics of scheduling women with similar gestational ages to a group can be difficult. This study explored 2 methods of scheduling: first group available compared to estimated date of birth. Using 14 CenteringPregnancy groups evenly divided by scheduling method, they found that women assigned by estimated date of birth entered groups at an earlier gestational age and were able to attend more group sessions. Women in both groups had similar attendance rates.
1526-9523/09/$36.00 doi:10.1111/jmwh.12307
c 2015 by the American College of Nurse-Midwives
Baldwin K, Phillips G. Voices along the Journey: Midwives’ Perceptions of Implementing the CenteringPregnancy Model of Prenatal Care. J Perinatal Educ. 2011;20(4):210–217.
211
This information may be helpful for the logistics of scheduling women into the group model. Ickovics JR, Reed E, Magriples R, et al. Effects of Group Prenatal Care on Psychosocial Risk in Pregnancy: Results from a Randomized Controlled Trial. Psychol Health. 2011;26(2):235–250.
A randomized controlled trial was conducted with 1047 healthy pregnant women aged 25 years or younger, who were assigned to 1 of 3 groups that varied by the type of prenatal care: standard individual care, CenteringPregnancy, or CenteringPregnancy Plus. CenteringPregnancy Plus is the group prenatal care model with the addition of specific skill building in the area of sexually transmitted infection prevention. The aim was to assess whether the CenteringPregnancy Plus program was significantly better at improving psychosocial outcomes. In this intention-to-treat analysis, no significant difference in psychosocial measures was observed between the individual care group and CenteringPregnancy Plus group. However, when level of stress at study entry was analyzed, women in the CenteringPregnancy Plus group showed significantly better psychosocial outcomes in the third trimester when compared to women in the individual care group. At the one-year postpartum assessment, significant reduction in rates of social conflict and depression also were observed in the CenteringPregnancy Plus group compared to individual care. Ickovics JR, Kershaw TS, Westdahl C, et al. Group Prenatal Care and Perinatal Outcomes: a Randomized Controlled Trial. Obstet Gynecol. 2007;110(2 Pt 1):330–339.
This multisite randomized clinical trial recruited more than 1,000 pregnant women who were primarily African American (80%). Participants were randomly assigned to either standard care or CenteringPregnancy group prenatal care. There were no differences in baseline characteristics between groups. The intention-to-treat analysis showed that women in the CenteringPregnancy group had a 33% lower preterm birth rate (9.8% vs 13.8%, P = .045), and this result was stronger among African American women (10.0% vs 15.8%, P = .02). In addition, women in the CenteringPregnancy group were more satisfied with care, had better pregnancy knowledge and preparation for labor and birth, and higher breastfeeding initiation rates than women receiving standard care. No differences in cost or birth weight were documented. Kennedy HP, Farrell T, Paden R, et al. “I wasn’t Alone”–a Study of Group Prenatal Care in the Military. J Midwifery Womens Health. 2009;54(3):176–183.
This is a qualitative study of women’s experiences with the CenteringPregnancy model of care as compared to traditional care in 2 military health settings. Data were collected in a semi-structured telephone interview at 3 months postpartum from 234 of 322 women enrolled. Compared to women in traditional care, women in CenteringPregnancy spent most of their time discussing their prenatal care experience. The 212
2 themes from the CenteringPregnancy group were “I wasn’t alone” and “I liked it but . . . ” Women expressed the support they received from the group, especially related to military issues, frequent moves, and their partners being deployed. Women’s suggestions to improve CenteringPregnancy care included more individual time with the provider. The third theme, “They really need to listen,” was voiced by both groups of women but more by those in traditional care. Women expressed frustration with lack of continuity of care, choice of provider, and difficulties getting an appointment. Novick G, Reid AE, Lewis J, et al. Group Prenatal Care: Model Fidelity and Outcomes. Am J Obstet Gynecol. 2013;209(2):112e1–6.
This secondary analysis of a large randomized trial of group prenatal care evaluated the fidelity of the CenteringPregnancy model, both process and content. Scores on group facilitation and participant involvement measured process fidelity. Content fidelity was assessed with a checklist of topics recommended in CenteringPregnancy. Fidelity was assessed through observation by a trained researcher. Fidelity to the model was associated with the outcomes of preterm birth, adequacy of prenatal care, and breastfeeding initiation, which were all previously reported as improved with CenteringPregnancy. Higher scores on process fidelity were associated with lower odds of preterm birth. Both process and content fidelity were associated with lower odds of intensive utilization of prenatal care. Novick G, Sadler LS, Knafl KA, Groce NE, Kennedy HP. In a Hard Spot: Providing Group Prenatal Care in Two Urban Clinics. Midwifery. 2013;29(6):690–697.
The challenges faced by clinicians when providing group prenatal care, specifically CenteringPregnancy, are described in this article. The study design was qualitative using interpretative description and situational mapping. Data were collected from 2 urban clinics and included 23 pregnant women with their significant others and 2 nurse-midwife group leaders. The main finding was that clinics did not always provide the resources needed to implement CenteringPregnancy. Results describe how the clinician adapts to these challenges and the effects these adaptations have on fidelity of the CenteringPregnancy model of care. Having administrative support was noted as critical to successful implementation of CenteringPregnancy, which requires an element of time. Greater buyin was seen as translating to increased resources including staffing and provision of adequate space. Group leaders used a combination of advocacy, persistence, and compromise to make adjustments although some modifications that are described pose significant threats to receiving the full benefits of CenteringPregnancy care. Phillippi JC, Myers CR. Reasons Women in Appalachia Decline CenteringPregnancy Care. J Midwifery Womens Health. 2013;58(5):516–522.
The purpose of this study was to ascertain reasons why women attending a rural birth center in Appalachia declined Volume 60, No. 2, March/April 2015
CenteringPregnancy care. The authors interviewed 20 women who had declined to participate and used conventional content analysis to analyze the interviews. They found 3 broad reasons for declining to participate: women preferred one-toone care, they experienced logistical barriers to participation, and they did not know that group care was an option. The authors concluded that clinicians should use promotional materials that are clear about options and respectful of privacy concerns. They also noted that group care may not meet the needs of all women. Risisky D, Asghar SM, Chaffee M, DeGennaro N. Women’s Perceptions Using the CenteringPregnancy Model of Group Prenatal Care. J Perinat Educ. 2013;22(3):136–144.
This qualitative study assessed women’s perceptions of their experience in the CenteringPregnancy model. A small qualitative thematic analysis that evaluated interviews from 10 women and 3 support persons identified 3 themes in the data: women enjoyed the in-depth learning; the peer support normalized pregnancy concerns; and the participation of support people helped during pregnancy, birth, and afterward. In summary, this study found that women who engaged in the CenteringPregnancy model felt direct benefits from the in-depth nature of their care, and group prenatal care had a positive impact on womens’ pregnancy experiences. Skelton J, Mullins R, Langston LT, et al. CenteringPregnancySmiles: Implementation of a Small Group Prenatal Care Model with Oral Health. J Health Care Poor Underserved. 2009;20(2):545–253.
An enhanced CenteringPregnancy model of care with an added component on oral health was developed and titled CenteringPregnancySmiles. Pregnant women enrolled in this program receive an oral examination, diagnosis, and treatment plan by a dentist along with an education program in multiple group sessions provided by a dental hygienist. The article provides descriptive preliminary data on baseline assessments and improvement of oral health in 447 women attending the CenteringPregnancySmiles group. Many women had poor initial oral health, which improved by late pregnancy. Singleton preterm birth (6.6% vs 13.7%) and low birth weight (5.3% vs 7.3%) were lower in the women participating in CenteringPregnancySmiles compared to rates in the region prior to the program. Tandon SD, Colon L, Vega P, Murphy J, Alonso A. Birth Outcomes Associated with Receipt of Group Prenatal Care Among Low-Income Hispanic Women. J Midwifery Womens Health. 2012;57(5):476–481.
This study examined the effectiveness of the CenteringPregnancy group prenatal care model in Hispanic women. The authors enrolled pregnant Hispanic women at 20 weeks’
Journal of Midwifery & Women’s Health r www.jmwh.org
gestation or less and collected data on 150 women who attended the CenteringPregnancy program and 66 who had traditional care. All women received care in public health clinics. The rate of preterm birth was 5% in the CenteringPregnancy care group and 13% in the traditional care group (P = .04). There were no differences in the rate of low birth weight between the groups. The authors concluded that the model holds promise for improving outcomes in this group of at-risk women. Tilden EL, Hersh SR, Emeis CL, Weinstein SR, Caughey AB. Group Prenatal Care: Review of Outcomes and Recommendations for Model Implementation. Obstet Gynecol Surv. 2014;69(1):46–55.
This meta-analysis reviews the literature regarding group prenatal care, including but not exclusive to CenteringPregnancy, providing an overview of the history and structure of the model. The meta-analysis summarizes various outcomes. Preterm birth is the most consistently evaluated outcome, and all but one study reviewed found lower preterm birth rates among those in group prenatal care. There is also a consistent downward trend in low-birth-weight rates in most studies, but this finding did not reach statistical significance. In 2 of 3 studies that evaluated breastfeeding, rates were significantly improved in women attending group prenatal care. Most studies found high satisfaction and increased knowledge in group prenatal care participants. The authors of this review identify the need for future research that addresses external validity, model fidelity, impacts of stress and support, and changes in the social context of care. AUTHORS
Mary K. Barger, CNM, PhD, MPH, FACNM, is an Associate Professor at the Hahn School of Nursing, University of San Diego, San Diego, California. Mary Ann Faucher, CNM, MPH, PhD, FANCM, is an Associate Professor and Program Coordinator for NurseMidwifery at the Louise Herrington School of Nursing, Baylor University, Dallas, Texas. Patricia Aikins Murphy, CNM, DrPH, FACNM, FAAN, is a Professor at the University of Utah College of Nursing, where she holds the Annette Poulson Cumming Presidential Endowed Chair in Women’s and Reproductive Health. Dr. Murphy is Deputy Editor of the Journal of Midwifery and Women’s Health. REFERENCE 1.Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–395.
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