The Duke Endowment: Innovative Care for Mothers-to-Be

She credits the program with helping her feel more confident during her second pregnancy and more prepared for a safe and healthy delivery.

“I was skeptical at first, but I don’t think I ever missed a meeting,” says the Blythewood, S.C., school teacher who’s now the mother of two sons. “I tell everyone what a difference it made for me.”

For more than two decades, CenteringPregnancy has offered mothers-to-be an alternative way to receive prenatal medical care. Rather than individual office visits, it features two-hour-long group sessions for women who are due around the same time. It’s based on the principle that when people are engaged in their own care, they are more likely to make good lifestyle changes.

In more than 100 published studies and peer reviewed articles, CenteringPregnancy demonstrates improved outcomes – including lower risk of preterm births, flattening the disparity gap in preterm birth between African American and white women, increased breastfeeding rates, and improved attendance at postpartum visits. The model is also linked to significant health care savings, and greater patient and provider satisfaction.

The Duke Endowment is supporting expansion efforts in South Carolina through the University of South Carolina School of Medicine in Columbia.

“CenteringPregnancy is an outcome-driven, cost-effective, patient-centered model that produces positive results for mothers and babies,” says Lin Hollowell, director of the Endowment’s Health Care program area. “It’s important for more women, especially in underserved areas, to be able to benefit from this approach to prenatal care.”

A New Approach

Sharon Schindler Rising, a certified nurse midwife in Waterbury, Conn., created the CenteringPregnancy model in the mid-1970s believing that she could improve outcomes for patients if she had more time during visits. She invited the 12 women she would normally see in two hours, reserved a room, brought in food, and launched the first CenteringPregnancy group.

Centering care is now offered at more than 550 practice sites nationwide. Using funding from the Valhalla Charitable Foundation, the Centering Healthcare Institute has launched plans to expand to 130 new sites, focusing on low-income communities with poor health outcomes.

Centering follows the recommended schedule of 10 prenatal appointments, but each visit is up to two hours long, giving women much more time with their provider. It has three parts:

• A health check, when patients receive one-on-one time with their provider and learn to take their own assessments such as weight and blood pressure. This engages them in their care.
• Interactive learning, with activities and facilitated discussions that help mothers become more informed and empowered to make healthier choices.
• Community building to decrease isolation and stress while creating friendships and support.

Beverly Huegel, CenteringPregnancy manager with Palmetto Health USC Medical Group in Columbia, S.C., says the model fosters positive health behaviors.

“It sounds very empowering and it is,” Huegel says. “That’s one of the reasons patient satisfaction rates are 94 to 98 percent nationwide.”

One in Ten Babies

The first published randomized controlled trial of more than 1,000 mothers found that CenteringPregnancy participants were 33 percent less likely to have a premature birth than women in traditional prenatal care. For African American women, the figure was 41 percent.

The study also found that health care systems using the CenteringPregnancy model reduced the cost of prenatal care by $2,000 per patient. Each preterm birth prevented saved about $53,000 in medical expenses.

CenteringPregnancy women also breastfed more, reported more satisfaction with their care, and felt better prepared.

Those are important statistics in the United States, where preterm birth (before 37 weeks of pregnancy) and its complications are the leading cause of neonatal death.

According to the March of Dimes. the country’s preterm birth rate is nearly 10 percent, which means 1 in 10 babies is born too early. The associated costs – medical and health care for the baby, labor and delivery for the mother and special education services – top $26 billion each year.

In South Carolina, where the pre-term birth rate is the fifth highest in the country, Palmetto Health has offered CenteringPregnancy since 2013. Now, with the $270,000 grant from The Duke Endowment, more women are able to participate in groups, which include one for teens and one for Spanish-speaking women.

On a recent morning, ten expectant moms gather in Palmetto Health’s cheerful-looking CenteringPregnancy room. They step on the scale, take their own blood pressure and get checked by their nurse practitioner. As the women snack on cheese and fruit, a trained facilitator helps them discuss lower back pain and what early labor feels like.

Huegel says early results are surpassing expectations:

• The new programs have served 162 women, exceeding the first year goal of 120.
• Among the new participants, no one had delivered at less than 35 weeks, and there were no NICU admissions.
• For all CenteringPregnancy participants at Palmetto Health (not just women in the new programs), the preterm birth rate was 8 percent, compared with a county rate of nearly 13 percent.
• 30 percent of participants who were overweight when they began the program had weight gain within guidelines, and 60 percent were within 5 pounds of the recommendations. Among women who were obese, 67 percent gained weight within guidelines. National data show that 61 percent of women who are overweight when they begin pregnancy – and 55 percent of obese women – gain above recommendations.
• Nationally, only 53 percent of women return for their six-week postpartum visit. In the Palmetto Health group, 99 percent returned. 

“Some of our outcomes have been pleasantly shocking,” Huegel says. “We are clearly seeing a positive impact on mothers and children.”