CenteringPregnancy and the Current State of Prenatal Care

Gina Novick, CNM, MSN

Disclosures

J Midwifery Womens Health. 2004;49(5) 

In This Article

Abstract and Introduction

Prenatal care is often credited with improving pregnancy outcomes. Yet rates of low birthweight (LBW) and prematurity have risen in recent decades, calling into question the efficacy of traditional prenatal routines. Proposals have included broadening the objectives of prenatal care beyond prevention of LBW and enriching care to provide education and support for pregnant women. CenteringPregnancy, an innovative model of prenatal care that integrates extensive health education and group support with the standard prenatal exam, incorporates many of these elements. Impediments to wider implementation of CenteringPregnancy are explored, as well as proposals for addressing these challenges.

Expressions of despair and anger over inadequacies in our health care system can be heard everywhere in the last decade, from consumers of care and providers alike. A recent report from the Institute of Medicine, Crossing the Quality Chasm, succinctly summarizes this state of affairs:

The American health care delivery system is in need of fundamental change. Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive. … The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain (p. 1).[1]

Despite the widespread sense of the shortcomings of care, there has been little progress in restructuring outmoded health care systems. Prenatal care, one of the most widely used preventive health services in the United States,[2] is beleaguered by problems of fragmentation, lack of evidence of effectiveness, and barriers to innovation. The prevailing approach to care of women during pregnancy is based largely on a century of tradition.[2,3,4] Questions regarding the efficacy and purpose of prenatal care have been raised and debated in the literature for decades. Although important investigations examining the content and practice of care have been published, few of their recommendations for change have been implemented.[5] CenteringPregnancy (Centering) is an innovative group prenatal care model that seeks to address the concerns of consumers and professionals about the shortcomings of traditional prenatal care. This approach has recently been implemented in a number of settings throughout the United States[6,7] but is not yet widely disseminated or used. This article reviews the existing recommendations for redesigning prenatal care and proposes Centering as one model that meets the recommendations of a body of research on the effectiveness of prenatal care as well as the Institute of Medicine report. Impediments to the use of Centering and some strategies for advancing this model are also reviewed.

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