Could group care be the new model for pregnancy?
JUST ABOUT a year ago, women around Boston were mourning the loss of Isis Parenting, a private chain of maternity and parenting centers, catering to middle- and upper-middle-class women, that suddenly went bankrupt. Some scoffed — it’s hard to drum up pity for a business that also sold $700 strollers — but Isis graduates understood what was disappearing. When it comes to having babies, there’s untold value in sharing the experience with a group.
This happens to be the experience many low-income patients are getting at Boston Medical Center, through a program called CenteringPregnancy that’s growing nationwide. Instead of meeting individually with obstetricians or midwives, about a fifth of eligible BMC patients get their care in group visits, built around discussion.
In some ways, this feels like a radical way to deliver medicine. It can be a hard sell for clinicians, who view one-on-one time as the gold standard of care. It can be a hard sell for patients, too, who worry they’re being shortchanged. But the leaders of the Centering Healthcare Institute, a Boston-based nonprofit, have an ambitious goal: to make this the national model for pregnancy care.
It’s definitely a departure from the typical experience. If you’re fortunate enough to have a routine pregnancy, a standard doctor’s visit is surprisingly brief: A quick blood pressure check, a little pee in a cup, the brief thrill of hearing a fetal heartbeat, any questions? In BMC’s Centering groups, patients meet for about two hours at a time. They start each visit by checking their own weight and blood pressure and take turns listening to that fetal heartbeat.
And then they sit in a circle, led by a midwife, and talk. There’s a structured curriculum, with information about pregnancy, safety, and food. But the discussion veers into how to manage siblings, where to get a car seat, stress, relationships, fears. The patients get to know one another. They get help finding resources for housing, education, and child care. They also get the midwife’s phone number, so they can text her with questions between meetings.
I recently visited a group that had been together for months; a couple of the members had recently given birth, and a diagram of the body in labor was lying on the floor. Midwife Beth Monahan was leading a discussion about delivery and managing that post-delivery time: What kind of help will you need when you bring the baby home?
In this group, fathers were welcome; Carmela Pradieu brought her husband, Yves, and their toddler son. Justine Gonzalez, a first-time mother, came with her partner, William Sanchez.
Pradieu, 43, garrulous and cheerful, said she was skeptical when a doctor recommended Centering. But soon she grew to love the discussions, even the presence of quieter members. It was “therapeutic, because you just got to express yourself,” she said.
Gonzalez, 23, shy and nervous about giving birth, said she’d learned to take better care of herself. She has gestational diabetes, and an extra challenge: She’s living in a shelter, with limited control over her diet. With encouragement from the group, she’s been testing herself with a glucometer, carrying around healthy snacks, eating more fruits and vegetables. Sanchez, armed with information, has been coaching her along.
“It’s not like a guy can just walk up to pregnant women and hear their stories,” he said. The group has helped him prepare for fatherhood.
Those stories have power, Monahan said. Sometimes advice given during a brief doctor’s visit goes in and out of mind; advice reinforced by your peers can stick. The presence of other women can counter mistrust of the health care system. It can bridge the gap between Western medicine and home-country traditions.
And it can counter a disturbing disparity in outcomes between white women and minority women, who are more likely to deliver premature and low-birth-weight babies. Preliminary data from BMC show a 30 percent reduction in preterm births among CenteringPregnancy patients, compared to the general hospital population. About 90 percent of women in Centering groups try breastfeeding — 60 percent more than the patient pool at large.
Those numbers are echoed nationwide, said Colleen Senterfitt, chief operating officer of the Centering Healthcare Institute. And they’re helping to fuel a growth in the program, which is now used in about 400 sites around the country — mostly in community health centers or hospital clinics with large Medicaid populations.
Consultation and training to set up a program costs about $35,000 for the first couple years, Senterfitt said. But the savings to insurers and Medicaid can be dramatic, she said. Eliminating one pre-term birth saves about $55,000. The Institute for Healthcare Improvement estimates that if all pregnant women used Centering programs, the health care system could save $9 billion.
Given our desperate need to cut health care costs, that number is too compelling to ignore. But the experience of Centering is worth selling, too — to patients, who talk about strong bonds and lasting friendships; to health care providers, who have a chance to offer a different kind of care.
“I was a midwife for more than 25 years, and I loved what I did, but I can tell you that I never used the word ‘fun’ at work,” Senterfitt said. Among Centering providers, “we hear people say that all the time now: That it’s fun.”