Birth plans. Laboring in warm water. Lamaze. Pain management. Midwifery and Doula services. Just when you thought we’ve reached the ultimate when it comes to the birthing experience, the Hubbard Center for Women’s Health at Cheshire Medical Center/Dartmouth-Hitchcock Keene (CMC/DHK) introduces a new concept for expectant mothers. It’s called Centering Pregnancy, and it offers a new approach to prenatal care.
Centering Pregnancy, or Centering, is an innovative prenatal care program that emphasizes self-awareness, education and support within a group setting. Created by a nurse midwife, the program is a model of empowerment that encourages women to take control of their pregnancies, their bodies, their families and their situations.
At CMC/DHK, the program includes seven months of group visits (about 20 hours in all) led by a women’s health professional, either an obstetrician or a nurse midwife. “In our practice providers will rotate through the Centering group so women have an opportunity to meet each provider, though the main group sessions are run by a certified nurse midwife,” explains nurse midwife Jessica Densmore, CNM.
A Group Effort
The group consists of expectant mothers who are due to deliver around a similar date. Participants come to each visit prepared with results from self-care activities like weight and blood pressure checks recorded on their charts. Following the medical segment, the direction of the meeting can go wherever the group decides to take it through their discussions, which could cover topics ranging from physical changes during pregnancy to parenting philosophies, from diapers to diets.
Another benefit is scheduling. While a baby’s arrival time can be unpredictable, there is a set timeframe of group meetings, which begin and end on time. This structure enables women to better plan their schedule if work or childcare issues are a concern.
A NEW PUSH
How does this format alter the role of the healthcare provider? Actually, each healthcare provider is more involved in each woman’s prenatal care because they run the group session, which lasts for approximately two hours. During that session, many more issues can be discussed than in a traditional 15-minute private appointment. And the medical responses sought by one woman will undoubtedly benefit the others.
OB/GYN Department Chair Tim Fisher, M.D., says, “Centering builds upon the already strong foundation of midwifery care at DHK/CMC. And by midwifery care, I mean a philosophically different approach to the care of an otherwise well-woman who is traveling down the road toward motherhood. Centering is an extension of this philosophy that also incorporates an emphasis on personal involvement in, and accountability for, pregnancy care on the part of women, as well as a totally new dynamic of group care and support. And while this is a somewhat revolutionary concept in our traditional thinking about healthcare, I think it gets back to a much more basic and important aspect of care and support of a woman during pregnancy that involves a larger community and extended support network often missing for women in today’s complex society. Imagine a group of women of various ages and stages of life being able to share their knowledge and experience about pregnancy in an environment of safety and support, with facilitation by a midwife and behavioral health expert.”
Amanda Houle, behavioral consultant at CMC/DHK, explains that joining together to share experience is a beneficial opportunity for women as they prepare for the arrival of their babies. Her role in the process is to offer counsel concerning the mind/body connection and provide support for the expectant mother’s whole being.
Rikki Bolewski, a participant in the Centering Program says, “I love it! Because I’m taking my own blood pressure and weight and keeping my own chart, I’m really aware of what’s happening during my pregnancy and what I’m doing to be as healthy as possible.” She adds, “During each visit, we share personal experiences, physical and emotional, that really help each other. The interaction with the other women has shed light on topics I might not have otherwise considered.”
Dr. Fisher says, “As doctors, our training tends to focus on a disease model of pregnancy rather than a wellness model. Instead of focusing on how to maximize health, physicians are trained to think about what could go wrong and how to then manage those problems when they arise. Our practice embraces the best of both worlds in providing pregnant women with the health and wellness emphasis of midwifery care, as well as the problem management aspect, as appropriate, by the physicians.”
“Centering would be appropriate for any pregnant woman interested in learning more about her body, her baby, and her pregnancy,” Densmore says. “Self-care responsibilities encourage members to recognize their role in making healthy choices for their bodies, their babies, and their families.”