Centering Pregnancy™
An innovative care model for expectant and new mothers Few life transitions are as thrilling and challenging as pregnancy, birth, and caring for a newborn. While there are certainly commonalities in each pregnancy, every mother-to-be navigates motherhood differently, and is sure to encounter moments of doubt and fear. Many women have questions about physical and behavioral changes during pregnancy, birth planning, and the best newborn care practices. The uncertainty of these changes can prompt many women to question their parenting skills.
Pregnant women and new mothers need substantial educational and psychosocial support, a need that has been confirmed by multiple organizations, including the March of Dimes and Boston’s Centering Healthcare Institute (CHI). Over the past 20 years, the CHI has pioneered research in CenteringPregnancy™ groups, and created an expansive, highly-successful curriculum that has been replicated in hospitals across the nation. The Institute also maintains curriculum and approve program sites.
CenteringPregnancy™, a maternal wellness curriculum created by Boston’s Centering Healthcare Institute, offers a new prenatal care model. This model focuses on extended group sessions, as opposed to the traditional series of short, one-on-one doctor visits, which last 15 minutes on average. CenteringPregnancy™ originated in the early 1990s as the brainchild of Yale University Certified Nurse Midwife Sharon Rising. Its name is reminiscent of a popular meditation concept that calling for calm breathing to center mind and body. Rising’s program has grown exponentially over the past decades.
The CHI has developed three central components to serve new and expecting mothers: routine health assessments, newborn education and best practices for healthy development, and emotional support for inexperienced (and exhausted) new mothers. During the group session, women lead discussion, ensuring their real concerns are addressed. The program is efficient, flexible, and custom-built for its patients’ needs.
The CenteringPregnancy™ program consists of ten discussion- and activity-based group sessions leading up to birth. Women are grouped by due date, and sessions are held in a safe environment. In these group sessions, women exchange helpful information, learn from one another, and benefit from the direction of an on-site medical supervisor. The positive relationships cultivated between patients during these sessions often continue even after the women gives birth. In addition to the patient advantages, CenteringPregnancy™ provides a more relaxed experience for caregivers as well.
Angel Medical Center in Franklin, NC plans to soon offer CenteringPregnancy™, which dovetails nicely with the significant expansion of their Women’s Unit. This expansion project, part of Mission Health’s Future Ready initiative, includes construction of Asheville’s Hospital for Advanced Medicine and the Angel Medical Center Women’s Unit, among others. The $4.3 million expansion and the CenteringPregnancy™ program are necessary responses to the region’s growing birthrate: during the period from 2013-2015, the Angel Medical Center has witnessed a doubling in birthrates. CenteringPregnancy’s addition to the Angel menu of patient services will serve as a fitting complement to the new Labor, Delivery and Postpartum rooms, the new nursery for babies needing special care, and other features designed specifically with new families in mind.
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“Government and payer investments in CenteringPregnancy™ pay tremendous dividends in healthier babies and moms, as well as substantial savings.” Specifically, CenteringPregnancy™ provides: • Emotional support from peers in a safe environment with professional guidance • Training for mothers on how to assess and record their own vital signs (consistent monitoring of pregnant women’s blood pressure, weight, and other factors that can contribute to the development of gestational diabetes is a central theme, as well as provision of effective stress management strategies) • Nutritional counseling • Practical educational information on typical problems that arise when caring for one’s infant (comforting techniques, sleep issues, breastfeeding tips, etc.) • Parenting education that aligns with developmental stages • Information on family issues and relationships Overwhelmingly positive program results were registered by participants in the pilot and ensuing programs. CenteringPregnancy™ participants experienced: • Significant reduction in preterm births • Lower percentage of preterm labor by as much as 30-50%, depending on population • Lower rates of preventable illness, and less need for longer post-birth hospitalizations • Reduction in maternal mortality and morbidity • Reduction in fetal loss • Reduction in C-section births • Reduction in low birthweight babies • Fewer unnecessary pregnancy interventions • Reduced health risks for subsequent pregnancies • Reduced instances of failure to thrive • Lower maternal smoking rates • Diminished racial disparity in preterm birth rates
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CenteringPregnancy™ has also been shown to contribute to better parent-newborn relationships, help identify child neglect and family violence risk factors, and is linked to a reduction in unintended pregnancy. The March of Dimes was one of the first investors in the CenteringPregnancy™ program, and has become one of the program’s most generous long-term funders, giving over $4 million for the program’s expansion since 2005. This and other investments have paid off; 11 years later, the Journal of Maternal and Child Health reported in their March, 2016 issue that a University of South Carolina-led study found that CenteringPregnancy™ participants experienced: • A 36% reduction of preterm birth risk • A 28% reduced risk for NICU stay • An average cost savings of $22,667 per birth
Despite advances in pregnancy care and American births, preterm birth remains a critical problem. Over 543,000 babies are born prematurely each year in the United States. In fact, over the past 30 years, the premature birth rate has risen by 36 percent, and attendant costs amount to $26 million.
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Providing powerful physical and emotional benefits and risk reduction The enormous success CenteringPregnancy™ programs have enjoyed across the country has garnered increased federal funding from the Center for Medicare and Medicaid Innovation. Centering Healthcare Institute CEO Angie Truesdale proudly promotes the program’s benefits coupled with the study’s findings: “This newest research from South Carolina confirms that government and payer investments in CenteringPregnancy™ pay tremendous dividends in healthier babies and moms, as well as substantial savings.” And, from a cost standpoint, CenteringPregnancy™ receives high marks. Costs are modest for curriculum materials and supplies, making CenteringPregnancy™ a program whose return on investment is significant: when compared with other programs, CenteringPregnancy™ gives health systems a lot of “bang for their buck.” For detailed information on these costs, see Appendix A. CenteringPregnancy™ offers the true patient-centered care that embodies Mission Health’s primary goal: patients are more accountable to themselves and their babies due to the program’s participatory philosophy. Participants also experience improved confidence as they gain expertise regarding their own health.
The program accommodates participants’ diverse learning styles and personalities: verbal patients can ask questions and interact with others, while quieter members can learn through listening. Information shared at CenteringPregnancy™ meetings ranges from evidence-based information to tips on issues such as morning sickness, nutrition, labor, breastfeeding, infant care, and the development of good parenting skills. Mission Health already offers a CenteringPregnancy™ program in Asheville, which meets at the Mountain Area Health Education Center; Angel Medical Center is slated as the next targeted member hospital program site. While 12 percent of North Carolina’s births are preterm, patients who have participated in the CenteringPregnancy™ program at MAHEC average only 7.2 percent preterm births. In terms of potential cost saving for North Carolina, the Centering Healthcare Institute reported that, out of 126,845 births in 2009, program participants experienced an 8.6 percent (10,909) preterm birth rate, while the rest of the state averaged a 13 percent preterm birth rate, or 16,494 births, with a potential cost savings of as much as $288 million dollars. It is evident that as the national healthcare system changes, health systems across the country must follow suit. New methods must be developed for patient care and for caregiver delivery. CenteringPregnancy™ is a prime example of a creative solution that eliminates the inefficiencies of traditional prenatal care. It is incumbent upon Mission Health and the community to implement programs that strive for the best practices in prenatal healthcare.
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Mission Health’s faith in the CenteringPregnancy™ program is strengthened by the fact that the Centering Healthcare Institute provides approval for all participating sites, thus ensuring individual program quality. CHI also provides ongoing support to get the program up and running smoothly with essential tools such as: • Thorough meeting facilitation training • Extensive curricular materials and advisory literature any practice or hospital needs to start a CenteringPregnancy™ program, from planning through evaluative stages • Solid knowledge and information on the measurable benefits and reimbursement of the program • Advocacy and advice on how to present the model • All supplies necessary for holding group sessions • Marketing materials Given the tremendous success of CenteringPregnancy™, other programs with the same care model are in the works to address health problems such as cardiovascular disease, diabetes, and obesity. Though implementing the Centering Pregnancy program will require a strong core of supporters who care deeply about infant and maternal health, a substantial commitment to prenatal care improvements by Mission Health administration and staff is necessary. Mission Health believes the substantial value to the community from Centering Pregnancy justifies its startup costs. CenteringPregnancy™ programs across the Mission Health system will provide an equal level of care to all women, regardless of race, socioeconomic status, or location. Committed partners in the CenteringPregnancy™ program will not only support Mission Health and Angel Medical Center, they will strengthen the community at large (including some of its most vulnerable and forgotten members). Investment in the CenteringPregnancy™ program shows our community the value we place on holistically-oriented self-care. The program enables mothers to learn how to provide for their infants by providing for themselves. It is, in the truest sense of the word, “self-care” for new mothers in western North Carolina.
Optimal and holistic self-care for mothers in western North Carolina
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Appendix A CenteringPregnancy™ Startup Costs First year $850 a person x 7 Training Site license One year of remote consultation Start-up materials Kickoff day Notebooks for 22 patients Centering Leader kit Posters Guidelines
$5,950 $250 $4,250 $1,500 $5,000
$410 (ongoing cost) $300 $12 per piece
Second year Consultation fee Site license Site Approval
$2,750 $250 $6,500
Ongoing costs Notebooks Snacks
$500 $400 $250
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