Get Centered: Break Out of the Exam Room for Better Birth Outcomes

When the home pregnancy test turns blue and blood test results are confirmed, it’s time to schedule prenatal visits. Typically, moms-to-be schedule monthly 20-minute appointments with a health care provider to ask all the serious, quirky and confounding questions that have occurred to them. In the tiny exam room, they receive the usual urine test, blood pressure check, weight check, uterus measurement, and the provider listens for a heartbeat.  

Although pregnancy feels new to every woman, many women experience similar things. Yale-educated nurse midwife Sharon Schindler Rising observed that many expectant mothers asked her the same questions, which consistently knocked her off schedule. Rising figured there had to be a better way for women to navigate the bewildering gantlet of prenatal care while gaining knowledge and confidence about what was to come. So, in 1993, she developed Centering-Pregnancy and later became executive director of the Centering Healthcare Institute.

The method has caught on with providers and families, and been championed by local midwifery groups for years. Doctors are on board, now, too: This year, the first Centering pregnancy residency clinic in Washington state is being held at Swedish Family Medicine – Cherry Hill.

What is Centering?

Centering prenatal care is a method in which 10 women or couples with similar due dates meet together, learn care skills, participate in a facilitated discussion and develop a support network, which includes a doctor or midwife who completes the monthly standard physical assessments. Centering participants attend 10 two-hour sessions for a total of 20 contact hours throughout pregnancy and early postpartum, versus the standard 3.5 total hours.

Centering has been proven to improve outcomes, increase satisfaction with the experience for both mothers and providers, and lower health care costs. These findings were documented in a 2007 National Institutes of Health study, illustrating how impactful Centering can be. Specifically:

• Women in Centering/group care were only 9.8 percent likely to have preterm births, notably less than the 13.8 percent in standard care.

• Women in group care possessed significantly better prenatal knowledge, felt more ready for labor and delivery, and experienced greater satisfaction with their care.

• Breastfeeding initiation was higher in group care at 66.5 percent, compared to 54.6 percent in standard care.

• The study’s authors concluded that the group prenatal care model resulted in equal or improved perinatal outcomes at no added cost.

For my one-on-one prenatal doctor visits years ago, I did my best to write down all the questions beforehand, but inevitably I forgot something or didn’t know exactly what to ask. With Centering, a substantial benefit is the “group wisdom,” as Rising calls it, when a Centering facilitator encourages all observations, intuition and insights.

“Having a group discussion led to better conversations overall. Oftentimes, someone would ask something and I would think to myself, I’m glad they asked that. I was wondering that as well,” says Shannon Testa, Swedish Ballard Centering participant and mother of a son, age 5.

Perhaps the only downside of Centering is that this method requires a greater time commitment from the participants. If there are older children at home or conflicts in scheduling, that could be an issue. But Centering can serve a broad population of women, from low- income families with limited access to prenatal care to high-risk pregnancies needing extra visits for closer follow-up. 

Long-term connections

Centering was initially championed by midwives. Because of the positive impact on birth outcomes, it quickly caught the attention of physicians, including those of Swedish Family Medicine – Cherry Hill in Seattle. Their first cohort of babies will arrive in December/January, and the clinic hopes to serve 80–100 women annually.

“When it comes to prenatal care, our role is to help a woman take control of her health and guide her in building a healthy life for herself and family,” says Jeremia Bernhardt, M.D., the clinical operations director at Swedish Family Medicine – Cherry Hill. The main challenge Bernhardt sees to delivering this method of care is changing old patterns and assumptions. “Centering is a different way to approach medical care. Though it is clear [from the research] that this model is better, most physicians have been trained in, and have practiced in a traditional model of office-based care,” he says.

Centering isn’t new to Seattle. Local midwifery groups, including Swedish Midwifery and Women’s Health in Ballard — the area’s longest-running Centering program — have offered it for almost a decade. “The group support continues even after they all have their babies,” says Fra Na Ready, ARNP, CNM, a nurse practitioner and midwife at Swedish Midwifery Ballard. “I ran into a couple at Green Lake one day with their 5-year-old. They said their group still gets together for potlucks every couple of months.”