Centering: A Prenatal Care Alternative

Pregnant women often enjoy the advice and support of others who are expecting; that may be why an alternative prenatal approach called Centering is growing in popularity. Certified nurse midwife Michele Burtner answers some questions about this group-based care program.

Health Matters: What is Centering?

Burtner: Centering is an approach to prenatal care designed to give women more time for instruction, health checks, and discussion with their providers and other patients. The Boston-based Centering Healthcare Institute developed the Centering practice model more than two decades ago and has been working to share it with practices around the country. The goal is to improve health care for pregnant women and their babies, and to reduce the cost of health care caused by premature birth and other unwanted outcomes.

Health Matters: How is this different from traditional prenatal care?

Burtner: In traditional prenatal care, a woman has 10 one-on-one scheduled visits with her provider for health assessments and care; these typically take 15 minutes or less. In Centering, patients participate in group sessions with a small number of other pregnant women who are at the same stage of pregnancy. Centering provides patients with the recommended 10 prenatal wellness visits, but each visit is 90 minutes to two hours long. So rather than spending approximately three hours of prenatal care with the typical approach, women who participate in Centering Pregnancy normally receive approximately 23 hours of prenatal care. The group facilitators—a midwife and nurse—help to guide the group’s discussion around pregnancy and postpartum topics, covering everything from normal pregnancy symptoms to labor and delivery and newborn care. It’s not only an efficient way to deliver information, it’s an environment where expectant parents can learn from and support each other. We’ve seen women form lasting friendships at these sessions, and they get to see their babies grow up together!

Health Matters: What happens in a Centering visit?

Burtner: Sessions begin with an individualized health assessment that involves each woman (and her partner) and a midwife. Each woman learns how to take her own weight and blood pressure, and record her own health data in a personal Centering Pregnancy book. They will also meet with a midwife to have private time with her. Once health assessments are complete, the group comes together to discuss a wide range of pregnancy and postpartum topics. Midwives lead the discussion and interactive learning activities.

Health Matters: What are the benefits of Centering?

Burtner: Numerous studies have shown that the Centering approach improves outcomes for pregnant women and their babies:

• It reduces the number of preterm births, which affect 11.4 percent of all U.S. births and are the leading cause of death in the first year of life.
• Centering also has been found to decrease the rate of low-weight babies, increase breastfeeding success rates, improve adolescent pregnancy health and improve postpartum health visit attendance and immunization rates.
• Centering’s focus on interactive, group learning helps parents feel more engaged and empowered in their pregnancy, allowing families to feel empowered and supported.

Health Matters: How common is Centering?

Burtner: There are more than 470 certified Centering Pregnancy practices in 45 states; they cared for more than 50,000 patients in 2015 or roughly 1 percent of all births. As word about the benefits grows, so do the number of patients who choose this approach to their prenatal care.

Health Matters:  What is covered over the course of the sessions?

Burtner: The classes cover all the topics a woman and her family need for prenatal health: nutrition, common health concerns, stress management, labor and delivery, breastfeeding, infant care, the postpartum period, and options for contraception.

Health Matters:  What happens if a woman has a medical issue during her pregnancy that requires additional/individual attention?

Burtner: If a woman has a medical issue during her pregnancy that cannot be safely or appropriately addressed within the group setting, she would be encouraged to have a one-on-one office visit with a midwife.

Michele Burtner, CNM, MS, IBCLC, is director of the UR Medicine Midwifery Group and has been a midwife for 14 years. She specializes in normal pregnancy, birth, gynecology care and has a special interest in breastfeeding.