A new model for prenatal care is taking expectant moms out of exam rooms and putting them in groups of pregnant couples - with satisfying results for patients and practitioners. Centering Pregnancy is a group approach that combines three essential elements every pregnant woman needs: health assessment, education and support.

Sharon Rising, MSN, CNM, FACNM, a Yale University School of Nursing graduate and former faculty member there, developed the model in 1994 and began sharing it with doctors and midwives around the country.

One of those was Claire Westdahl, CNM, MPH, FACNM, assistant professor in the department of gynecology and obstetrics and director of nurse-midwifery at Emory University School of Medicine. With a $1,000 Newton Long Fund grant, Westdahl started a Centering Pregnancy program with pregnant women who would deliver at Grady Health System in 1999. She wanted to address the disparities in prenatal care and birth outcomes among African-American women.

"If we were going to change outcomes, like lower birth weights and higher prematurity, we had to change the way we delivered prenatal care," she said.

The results of the program have startled Westdahl.

"I am humbled by what happens to women in these groups. It's magical," she said. "Compared to the women you see in clinic waiting rooms, these women are glowing and just radiate energy. Their self-esteem is higher because their own knowledge about their bodies and pregnancy is validated."

In March, Westdahl will end a five-year study in partnership with Yale that compared outcomes of women in the groups vs. those receiving individual prenatal care.

"We wanted good science to back up what we were seeing," she said. "The results aren't published yet, but we're seeing significantly higher numbers in patient satisfaction and participation, greater initiation of breastfeeding and reduced prematurity rates among the women in groups."

"It's empowering and creates a community of pregnant couples," said Maureen Kelley, clinical associate professor and chair of family and community nursing in the Nell Hodgson Woodruff School of Nursing at Emory University and director of the nurse-midwifery program at Emory Crawford Long Hospital.

Kelley started offering optional group prenatal care to her patients at Emory Crawford Long Hospital 18 months ago.

Groups of up to 10 women with similar due dates and their partners begin meeting monthly with a nurse-midwife at the 16-week mark. The women take responsibility for checking their own weight, blood pressure and lab results and recording them in their notebooks. They meet briefly with the nurse-practitioner for tummy checks and private questions, but most of the two-hour meetings consist of group education and discussion of topics like pregnancy, birth, nursing, postpartum depression
and parenting.

"My role is to facilitate as the group learns to use each other as resources. If someone asks about birth, I'll ask the mothers who have already had babies to share their experiences," Kelley said.

Women bring different knowledge to the group and can share their solutions to common concerns, such as backaches or childbirth.

"It's wonderful to watch the relationships and their feelings of confidence grow, and the dads are a riot. You never know what they'll ask," Kelley said.

"I wanted my husband to see what I do [as a midwife] and to talk about issues like parenting. We're both busy, and this gave us a great place to discuss topics we may not have thought to bring up ourselves," said Kate Woeber, CNM, MPH, who has experienced Centering Pregnancy both as a facilitator and as a patient.

"Guys often feel out of place at the OB/GYN office and the hospital. They want to know how they can be helpful, and this gives them a place to ask those questions."

Kelley calls it "enhanced pre-natal care," because the couples get so much more education than they would at a 15-minute office visit. Sometimes group members support one another in the hospital and often meet for reunions after their babies are born.

Midwives and doctors have resisted group care, believing that it can't replace one-on-one patient relationships, but Kelley said she forms deeper relationships with her patients in groups.

"I love being a midwife, and I love this way of delivering prenatal care. It's satisfying to me because I can see how satisfying
it is to them," she said.

"It's not just for first moms, teen moms or poor moms," Westdahl said. "All women need to talk things over, to process things. It reduces their stress."

Sessions are strengthened by self-assessment surveys the women fill out on various topics before meetings.

"They have time to reflect and answer questions beforehand, which makes the group discussion powerful and fabulous," Westdahl said.

"Group sessions also reduce my stress as a midwife, because I get to know my patients better and we have so much fun
together," she said. "I think it's transforming for women to have that kind of relationship with a health care provider."