Grady program helps pregnant women get 'centered'

By Alicia Sands Lurry

When it comes to having a child, expectant mothers have plenty to worry about. There are concerns about eating properly, having a healthy baby, even the numerous practitioner visits. At Grady Hospital, expectant mothers can rest assured, knowing all their worries will be addressed, while also being encouraged to take responsibility for themselves, thanks to the Centering Pregnancy Program headed by Claire Westdahl, director of nurse-midwifery in the School of Medicine.

Also known as “Group Prenatal Care,” the program is an innovative model for providing complete prenatal care within a group setting. Its overriding mission is to empower pregnant women by encouraging them to take responsibility for themselves and to interact positively with the health care system, while meeting their health and educational needs. Other motivating factors are to help women have healthier babies and decrease the rates of low birth weight and premature births.

“We know we’re increasing patient satisfaction within the Grady Health System,” said Westdahl, who leads groups at Grady Hospital and the DeKalb/Grady Neighborhood Health Center. “That is the driving intention, as well as to attract people to Grady. As nurse-midwives, we spend more time with women and take more time to foster and support normal childbirth. We also honor pregnancy—because it’s not a state of disease.”

The program essentially frees women from the confines of the traditional exam room for the majority of their care by providing the three components of prenatal care—assessment, support and education—within a group setting, under the leadership of a skilled practitioner.

Groups of eight to 12 women of similar gestational age meet at regular intervals throughout their pregnancies, beginning at approximately 14 weeks of pregnancy and ending one-month postpartum.

During the 90- to 120-minute sessions, the women receive basic prenatal physical assessments and engage in self-care activities related to this process, socialize and get support from other women and couples, and gain knowledge and skills related to pregnancy, childbirth and parenting.
Issues addressed during the sessions include nutrition, common discomforts, relationships, labor and delivery, infant care, and postpartum. The women are responsible for taking their own blood pressure, weighing themselves and completing self-assessment forms.

The program began at Grady in 1999 from a concept developed by Sharon Schindler Rising, a Connecticut nurse-midwife and consultant who conducted the first centering pilot groups in 1993.

The philosophy, quite simply, is that pregnancy is a process of wellness and a time when many women can be encouraged to take responsibility for their own health and learn to participate in self-care.

According to the handbook Centering Pregnancy: A Model for Group Prenatal Care, the program is built on the premise that “prenatal care is most effectively and efficiently provided to women in groups; that learning and support are enhanced by group resources, including the guidance of the professional care provider and an atmosphere that facilitates learning, encourages free exchange and develops mutual support; and that this high quality of care can be difficult to achieve within the traditional structure of individual examination room visits.”

Group prenatal care consists of 10 two-hour sessions with a nurse and midwife. The group assembles in a circle to discuss common pregnancy issues: physical and psychosocial changes of pregnancy, and the behavioral changes that may be required to maintain a healthy pregnancy. The “risk assessment,” or routine exam of the fetal size, position and fetal heart, is performed in the group space. (If a pelvic exam is required, arrangements are made for the client to be seen in an individual exam room.)

The program has been particularly successful. More than 200 women, ages 16 and older, have completed it, with more than 96 percent “highly satisfied” with this form of prenatal care. Participants are given pregnancy calendars and notebooks and are encouraged to discuss the barriers and benefits of breastfeeding.

“What I really like about the program is that we talk about all good and bad problems and compare them,” one woman said.

“It helped me to see that others go through the same mood swings and have the same worries,” another said.

Westdahl said she couldn’t be happier with the program, and the progress many of the mothers-to-be have made. “The women are empowered, and they’re really proud of themselves,” she said.