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Centering on healthy pregnancies
ALTERNATIVE PRENATAL CARE STEMS EARLY BIRTHS
By Sarah VosSVOS@HERALD-LEADER.COM
As they arrive, the women step on a scale and then take their own blood pressure.
Some of them can still hide the baby growing inside; others have the full-figure looks that prompt unspoken questions.
The women take turns going behind a screen to hear the wha-wha-wha of the fetal doppler and, after a moment of searching, the fast pah-pah-pah of heartbeats. Then they sit down to talk.
This is their prenatal care: an innovative program where women meet as a group with their health care providers.
The program, called Centering Pregnancy Smiles, has had remarkable results. During the first two years that Trover Health System, in partnership with the University of Kentucky, has offered group prenatal care, only 5.6 percent of women in the program have had a preterm birth, defined as delivering a baby before 37 weeks. A normal pregnancy is 40 weeks.
That compares to a weighted average of 17 percent for women in the seven-county area in Western Kentucky that Trover serves.
With more than 8,500 preterm births a year, Kentucky has the fifth highest preterm rate in the nation, according to the Centers for Disease Control and Prevention.
Those births are expensive. UK estimates that Centering Pregnancy Smiles saved $1.9 million in medical bills in 2006 and 2007 by preventing 37 preterm births.
Fewer preterm births also means better outcomes for children: Babies born early are more likely to have health problems later in life, to have developmental problems and to die within their first year.
'Bad gas'
On this April morning, the Centering Pregnancy Smiles session is about discomfort in pregnancy and ways to avoid it, ranging from eating small, frequent meals to sitting up straight.
The atmosphere is cozy, with the nurses and nurse midwives who lead the group chiming in about their own pregnancies and the patients openly talking about their concerns.
Danielle Rollins, 26, of Princeton, is pregnant with her fourth child. She works long hours in a factory, standing on her feet. Her youngest is 7 months, and this pregnancy was unplanned. When she first found out she was pregnant, she thought about an abortion because she worried what people would think, but she decided against it. "Nobody takes care of my kids but me," she said.
Aubrianne Scott, 21, of Hopkinsville, is pregnant for the second time. She had a miscarriage last fall. Her mother's pregnancies always ended early, and her grandmother miscarried several times, so she's worried.
Deandra Arnett, 18, of Madisonville, has crazy dreams when she sleeps on her side. She's a senior in high school, and she's tiny. This is her first pregnancy, and she's scared she won't be able to push a baby out.
"What I don't like about being pregnant is the gas," she said, as the women around her laughed. "I got some bad gas," Rollins added.
Using cross-sectional charts, Bonita Katz, a nurse midwife in training, shows the women how their bodies will change as their babies grow. Constipation, a common problem, occurs because the large intestine gets compressed. Bladders get squashed.
Arnett asks about the placenta, the organ that develops inside the uterus to connect the fetus to its mother. The placenta is a filter and comes out after the baby is born, Katz explained.
In women who smoke, as 25 percent of pregnant Kentuckians do, or use illegal drugs, the placenta looks diseased when it is delivered, said LeAnn Langston, a nurse and director of the Center for Women's Health at Trover.
"Unfortunately, if you're putting bad things in your body, it's going to filter through to the baby," she told the women.
Patient in charge
Centering Pregnancy Smiles is a variation of the Centering Pregnancy program that was started in 1995 by a nurse midwife in Connecticut. It combines medical appointments with education and puts the women in charge, giving them the responsibility of checking their weight and blood pressure and recording them in their charts.
A 2007 study of the program, conducted at hospitals affiliated with Yale and Emory universities, found that the likelihood of preterm births was 33 percent less for women who had group prenatal care, compared to those who had traditional prenatal care.
The women in group care spent more time with practitioners: 10 two-hour visits compared to the 10 15-minute visits of traditional care. And since they avoid the waiting room and time spent waiting inside the office, the overall time is about the same, say advocates.
At Trover Clinic, practitioners say the program has had more benefits than just a reduced rate of preterm births and low birth-weight babies. The women who participate make fewer emergency room visits during their pregnancies. They are more likely to initiate breast feeding, and they maintain healthier weights throughout their pregnancies.
Proponents of Centering Pregnancy say they don't know why the group setting works so well, but they suspect that women bond over their babies, that peer pressure builds and instead of "my baby," the pregnancy becomes a community concern.
"What we see in many groups is, there's a shift in the behavioral norm," said Sharon Schindler Rising, the nurse midwife who started Centering Pregnancy. "Where the group may have started out with many women in the group drinking a lot of soda, smoking, people decide, hey, that isn't cool to do."
Looking to expand
Most of the women who come to Trover's midwifery practice for prenatal care participate in Centering Pregnancy Smiles. The program doesn't cost more than traditional care, and it's billable to insurance.
Before the clinic adopted the program, Langston and other staffers wondered how it would work -- whether women would feel comfortable talking about personal issues in front of other patients and how they would handle it if one of the women miscarried.
But those issues haven't been problems. The nurse midwives like how much time they spend with their patients, getting to know them better than they would in the clinical setting. They are able to ensure that patients who need prenatal education the most get it.
The Trover program, which was started with the help of a $1.5 million earmark from Senate Minority Leader Mitch McConnell, is not the only Centering Pregnancy program in the state. Using the same money, UK started one for Hispanic women at Bluegrass High Risk Obstetrics in Lexington. UK recently added a group for teenage moms at the Polk-Dalton Clinic, formerly known as Kentucky Clinic North in Lexington.
UK might expand its Centering Pregnancy programs in the future, said Dr. Jef Ferguson, an obstetrician at Bluegrass High Risk, but they are moving slowly.
Statewide, several community health care providers are considering adopting the program. UK has another earmark from McConnell, this time for almost $500,000, to start the programs.
Centering Pregnancy might not be for every woman, Ferguson said. Some women prefer to take prenatal education classes on their own or read books instead of having longer prenatal appointments.
But for Yashira Rodriguez, 27, meeting other expectant mothers in the Centering Pregnancy program in Madisonville last summer was comforting. Her daughter, Leila Baker, was born in September. It was her third pregnancy, but her first time with Centering.
"I actually enjoyed my pregnancy more this time," Rodriguez said. "I didn't feel like I was going through it by myself."