PRACTICAL APPLICATIONS OF THE CENTERING PREGNANCY

MODEL OF CARE

Charlene Ellis, MEd

Lisa Ross Birth and

Women’s Center

LEARNING OBJECTIVES

* Define the centering pregnancy model of care.

* Recognize the role of the family in weight management throughout pregnancy.

WHAT IS CENTERING? An innovative model of group care

Groups of 6-8 of similar gestation or child’s birthdate

8 sessions, 1½ hours each

3 components:

Assessment

Education

Support

•Approaches pregnancy as a process of wellness

•Values the knowledge and experience each woman brings to the circle.

WHY GROUPS?

Members learn from each other

Helps build community/Social support

No wait time for appointments

Snacks are provided!

Groups are fun!

ASSESSMENT Self Assessment

CenteringPregnancy Blood pressure Weight CenteringParenting Child’s head circumference, length and weight (parenting)

Scales and blood pressure cuffs available Record information in personal Centering Handbook

Mat Time Measure and listen Infant physical exam

EDUCATION Guided by the group!

Topics for each session, additional information in personal Centering Notebook

Discussion – system in place for anonymous questions

Speakers

Lactation Consultant

Yoga Instructor

Dietician

Activities

Videos

TOPICS COVERED IN CENTERING

Nutrition Gestational Diabetes Anemia

Common Discomforts

Preterm Labor

Oral health

Relaxation Techniques/Stress Reduction

Complications

Childbirth Preparation

Family Planning

Breastfeeding

Caring for the baby

Postpartum Depression

Doulas

And more!

SUPPORT

Power of THE GROUP

Peer support

Develop friendships

STAFFING

CNM (Certified Nurse-Midwife) as Facilitator for Centering Pregnancy

Pediatric Nurse Practitioner as Facilitator for Centering Parenting

Education Coordinator as co-Facilitator

GROUP PRENATAL CARE AND PERINATAL OUTCOMES-METHODOLOGY

A multi-site randomized controlled trial conducted at two university-affiliated hospital prenatal clinics (Emory and Yale)

1,047 pregnant women aged 14-25 years were randomly assigned to either standard or group care(centering)

Structured interviews were conducted at study entry, during the third trimester, and postpartum

Mean age 20.4, 80% African American

GROUP PRENATAL CARE AND PERINATAL OUTCOMES

Women in group sessions:

Were less likely to have suboptimal prenatal care

Had significantly better prenatal knowledge

Felt more ready for labor and delivery

Had greater satisfaction with care

Breastfeeding initiation was higher in group care

There were no differences in birth weight nor in costs associated with prenatal care or delivery

CENTERING AND WEIGHT MANAGEMENT

The main goal of Centering is to have patients become active participants in their own, and their baby’s care Centering - come to the visit with information to share with the provider Blood pressure Weight gain Weeks gestation Self-assessment Progress on goals

Traditional care - wait on the provider to tell them how they are doing.

CHARTING

• We want to empower women to understand their health information and to make behavioral changes based on that information

Each participant weighs themselves, charts their weight gain

FIRST SESSION:

Record weight from 1st prenatal visit and today’s session

1 – PRE-PREGNANT WEIGHT 2 – BMI 3 – WEIGHT GOAL

Each Session

“Mom - How do you feel today? “

Rated by filling in face

Physical Health –

“Taking care of yourself with

healthy food and staying active.

Monitoring exercise, weight, diet,

medication, drinking lots of water, etc.”

GOAL SETTING

“My goals for this pregnancy . . .”

Established at first session

Revisited at intervals

“This (pregnancy) is a time when many women can be encouraged to take responsibility for their own health.”

My Goals for Myself

This is a good time to start thinking about things that you would like to work

on. Pick one or more goals to focus on and track your progress here.

Goal 1:

Action Steps:

Goal 2:

Action Steps:

Goal 3:

Action Steps:

STARTING OFF RIGHT – SESSION 1

Group Guidelines

My Pregnancy - What’s Most Important

My Personal Goads

Prenatal Testing

Nutrition – Weight Changes & Calories, Foods to Avoid, Gestational Diabetes

Size Your Servings

Food Diary

Healthy Lifestyle Choices

MY PERSONAL GOALS

Check how you feel for each item:

Good (Smiley face)

Could be better

Exercise

Diet

Handling Stress

Weight

8 more

NUTRITION TOPICS Weight Changes and Calories

Protein

Folic Acid

Calcium

Iron

Omega 3 essential fatty acids

Vitamin and mineral supplements

Foods to Avoid

Gestational Diabetes

Size Your Servings

Food Diary

HOW THIS MIGHT LOOK IN A CENTERING SESSION:

Grab bag with items to stimulate discussion: milk carton, tofu package, vitamin bottle, lunch meat package, a boiled egg

Grab bag with “real” items to illustrate size

Ask group: What advice have you been given about what to eat and not eat during your pregnancy?

Write down two great foods for pregnant women

Give out a restaurant menu, ask groups of 2 or 3 to come up with best choice for a meal

HOW CENTERING WORKS

Groups share recipes, ideas, snack at the sessions

Sessions can be tailored to the needs of the group

Gestational Diabetes

Groups get together to exercise

Groups sympathize with and encourage each other

CENTERING PARENTING AND WEIGHT

Baby’s weight recorded every visit

Scales available for moms use (same ones they used in

CenteringPregnancy)

Topics include mom’s feelings about herself, goals, stress

relief, etc.

ANECDOTAL INFORMATION “We do not have any data on weight gain in pregnancy for women in CenteringPregnancy at this time. It is an area we would like to see studied further. We do hear from sites that they see better weight management from their Centering moms.”

Centering Healthcare Institute

(Women in Centering) likely spent substantially more time discussing the importance of adequate nutrition during pregnancy, which may have resulted in better weight gain and choice of more nutritious food.