Journal of Nurse-Midwifery
DepartmentsCentering Pregnancy: An Interdisciplinary Model of Empowerment
Section snippets
Prenatal Care and The Literature
Prenatal care refers to pregnancy-related services that monitor the health status of the woman; provide information to foster optimal health, including good diet and hygiene practices; and provide appropriate psychological and social support [1]. Although the content of the prenatal care may vary, usual initiation is in early pregnancy, with an increasing number of visits as pregnancy progresses. “Women who have early and regular prenatal care have healthier babies” [2]. Defining an accurate
Development of the Centering Pregnancy Model
Centering Pregnancy is a group model of prenatal care delivery that places all three components of prenatal care—risk assessment, education, and support—into the group setting. There is considerable literature available that describes and evaluates childbirth and parenting education programs. There are also articles describing support groups and their effect on health and healing. The literature detailing more comprehensive group programs is scarce.
In the 1970s, the Maternity Center Association
Evaluation of the Program
Within 3 months of beginning the pilot program, a decision was made by the clinic staff (which included registered nurses, nursing assistants, a nurse-midwife, nurse practitioner, and an obstetrician) to continue the model. The staff believed that the women were responding very positively to the group approach and that the nurses were finding personal satisfaction in their own participation. Early concerns about having women with high-risk pregnancies in the groups were discussed among the care
Why a Centering Pregnancy Program?
Centering Pregnancy is a new way of delivering prenatal care. It abolishes most examination room visits and moves women within a group setting for their care. There are several reasons to consider configuring care in this way.
1) Pregnancy is a time of affiliation for most women. Although medical and obstetric problems may be present or arise during the pregnancy, usually, this is a time of health for a woman. Indeed, her most pressing concerns often revolve around general health and
What are the Problems with Centering?
1) Some of the strengths of the program are also the problems. Many providers, midwives included, are not comfortable with group facilitation. This program is not an education class with set objectives. Although there is guidance for the content for each session, the format is one of discussion, building on comments and concerns voiced by group members. The program can be led by a team: a practitioner for the assessments and a skilled group leader for the discussion. For the first groups, it
Evaluation
As with any model of health care delivery, it is important to have an evaluative process. The outcome objectives selected will evolve from the major purposes of the model. In this case, it is important to evaluate mother and infant birth outcomes, as well as the effectiveness of the model in enhancing empowerment of the mother.
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What are the major health outcomes for the mother and infant? Are they at least comparable to those of the larger community being served? Some specific outcomes could
Summary
Centering Pregnancy is an approach to the care of pregnant women that alters the traditional model by bringing women out of examination rooms for the majority of their care. The woman’s involvement in self-care activities, the discussion and education format, the worksheets and handouts, and the sharing among the women all lead to her enhanced sense of empowerment. This, in turn, results in a sharing of power between the provider and the consumer. Although this initially can be unbalancing for
Acknowledgements
The author thanks Denise Pratt, APRN, Joan Seabury, RN, and the Chase Clinic nurses for their help in developing and implementing the Centering Pregnancy program in Waterbury. The focus group research was conducted by Marjorie J. Smith, CNM, PhD, Winona State University, Rochester, Minnesota. Vera Keane, CNM, MA and Jane Tokunow, student nurse-midwife also provided invaluable assistance.
Sharon Schindler Rising practices midwifery in a community health center and in a private practice in Waterbury, Connecticut, and at a large hospital ambulatory center in Hartford. She leads Centering Pregnancy groups at each site. She received her nurse-midwifery educational preparation at Yale University School of Nursing, where she taught on the faculty and then developed the graduate nurse-midwifery program and the Childbearing Childrearing Center at the University of Minnesota. She is the
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2023, Preventive Medicine ReportsUsing Shared Medical Appointments in Your Practice
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2023, Obstetrics and Gynecology Clinics of North America
Sharon Schindler Rising practices midwifery in a community health center and in a private practice in Waterbury, Connecticut, and at a large hospital ambulatory center in Hartford. She leads Centering Pregnancy groups at each site. She received her nurse-midwifery educational preparation at Yale University School of Nursing, where she taught on the faculty and then developed the graduate nurse-midwifery program and the Childbearing Childrearing Center at the University of Minnesota. She is the author of Centering Pregnancy: A Model for Group Prenatal Care, published in 1995.