Redesigning Prenatal Care Through CenteringPregnancy

Sharon Schindler Rising, CNM, MSN; Holly Powell Kennedy, CNM, PhD; Carrie S. Klima, CNM, PhD

Disclosures

J Midwifery Womens Health. 2004;49(5) 

In This Article

Abstract and Introduction

CenteringPregnancy is a model of group prenatal care that provides more than 20 hours of contact time between the childbearing care provider and a cohort of pregnant women with similar due dates. During this time, each woman has the opportunity to build community with other pregnant women, learn self-care skills, get assurance about the progression of her pregnancy, and gain knowledge about pregnancy, birth, and parenting. Ten essential elements have been defined, which contribute to the success of this model of prenatal care delivery. These elements correspond with the Institute of Medicine's 2001 challenge to improve the quality of health care in the United States. Foundational perspectives provide potential explanations for the model's growing influence and success. Implications for clinical practice and further research to link it with perinatal health outcomes are suggested.

The health care system is struggling. An expert panel for the Institute of Medicine published "Crossing the Quality Chasm: A New Health System for the 21st Century" in 2001, which concludes that current delivery systems are poorly organized to meet today's health care challenges.[1] This report proposes six fundamental aims central to health services outcomes. Care must be 1) safe, 2) effective, 3) patient-centered, 4) timely, 5) efficient, and 6) equitable. To the uninitiated, these aims may seem obvious; however, those providing frontline prenatal care know that a major redesign of delivery systems is needed to accomplish these basic goals. This article presents a discussion of one such emerging model of health care.

CenteringPregnancy was created when it became apparent that the regular prenatal care system was no longer effective to meet the needs of women.[2] Since its inception more than 10 years ago, Centering has gained momentum and is emerging as a potentially "disruptive redesign" of US prenatal care.[3,4] The elements of the CenteringPregnancy model are described with a discussion of its concordance with the Institute of Medicine's goals for quality health care. Relevant foundational theories are also discussed to provide guidance for understanding the model and its growing influence and for future research.

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