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Centered prenatal care: Will it work?

Bellies
(photo - sarah gilbert)

I guess it should not surprise me at all that so much has changed in the last four years. You see, four years is about how long it’s been since my last “first visit” to the Midwifery group at OHSU. Some things stay the same, but some things have definitely changed. During my medical history review, the nurse asked me the same questions as the last two times (the same questions I had just filled out on the piece of paper, no less).  And the same blood draw and urine catch (thank GOODNESS they’ve opted out of doing that each visit.  It’s impossible to do that around a big belly!).  But then, the nurse brought up “Centered Prenatal care”, which is currently being re-termed and she doesn’t have a flyer for, just yet.

Centered?  Apparently this is the name for prenatal care in a group format.  The schedule is set from the beginning of care.  There are 10 sessions, 2 hours each.  No waiting in the waiting room.  There will be the usual external exams, weight checks, blood pressure and measurements.  It will just all be done… communally.  The group will be comprised of women who are all due the same month as I am.

So how can I decide if this is for me?  My partner said he was already ok with this type of care and that it was up to me.  I’m trying to weight the pros and cons.  Set schedule, no waiting is a good thing.  Having others to sympathize and commiserate with, also a good thing.  But traditional appointments are about 20 minutes long, and there are 10 of those, too, generally.  So the time difference of 20 hours vs nearly 4 is quite a difference, waiting time aside.  Then there’s the fact that this is my third time at this.  I guess it could be naïve of me to say there’s nothing for me to learn, but it’s sort of how I feel.  What other benefits can a group setting for this care offer? (besides the obvious of reducing the number of times the midwife has to say the same thing to 6-10 different women).

Maybe, in the end, it’s not all about me?  Maybe it’s about what I can share with others?   I’m sensing the practice is generally new here in Portland but the nurse said they’ve never had any issues getting “critical mass” for their groups, since the program’s inception.  So, have any of you mamas tried group prenatal care?  Did you love it?  Hate it?  Want it to be a little different?  I’m sure it’s a very personal choice but I’m hoping someone has some insider information for me.

Comments

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Sorry, I don't have an opinion, just wanted to say congrats on being pregnant! :)

Shetha, I've never heard of such a thing either! Interesting.

Here's my take, fwiw. I think that for the first pregnancy this would be terrific. I even think that it might be nice to do for a few times on a third pregnancy. But--committing to 10 2-hour sessions--to me, that seems like a lot more than I at least would need or want. It's undoubtedly true that a woman pregnant for the first time has way more questions and [potentially] more need for support than one on her third time. Indeed, it's nice to be the one "in the know" in these situations, but after a while I do think that for me it would get tedious. I'm not the most patient person (is it showing?)...but I think that I'd personally prefer to wait 30 minutes in the waiting room and read a book (and then have an extra hour with kids # 1 and 2?) than do 2 hours once a month...

Apologies, anyway, for the not-very-community minded sentiment! Just my 2 cents...

This is interesting - I am also a patient of the midwives at the OHSU Center for Women's Health and pregnant with my second child. This option was not offered to me, although it is the midwife I see the most of that is running/most involved with this program. In fact, when I went to schedule my next months appointment I wasn't able to see her anymore because the front desk said she would be focusing on the group prenatal. So I scheduled with someone else, which is fine. I'm not sure i would be so into the group format - maybe if I was a first time Mom. I don't have a tremendous amount of time as it is, and I like individual attention. Maybe that's why they didn't offer it to me? Either way, good luck and congrats on your pregnancy!

I've been pregnant 5 times and I was in a different mood each time. I say try it! If you like it, do it. If you're not in the mood, that's ok too :D Congrats!

I recently moved to Arizona and was so happy to just find a midwife in the area! We're expecting #2 in September and opted into the Centering program. I have to say I wish I had this option as a first-time mom. Our group really eliminates the need for any extra birthing classes, nursing classes, and baby-care classes.

Since we're new to the area, my husband and I have enjoyed the opportunity to meet other couples that will have kiddos around our daughter's age. It's fun to socialize and talk about things we're all experiencing. However, if we were going to have a third, I don't think I'd do it again. I don't think I'd have enough time on my hands!

This sounds perfect for someone with endless patience for listening stranger's stories and complaints. I can't think of a more torturous way to spend 2 hours. But it would probably be awesome for a first timer.

I wonder if I would feel like the attention from the staff still felt like 20 minutes? I'm fine talking to other moms, first timers or not, but I'm paying for this and would want to feel like I'm getting care not just 2 hours of social prego time. Good Luck, I'd give it a try!

I don't understand how this doesn't violate HIPAA and impinge upon people's privacy. It sounds moderately useful for a 1st time mom, especially if it's *cheaper* than traditional visits. However, a room of fellow moms-to-be don't need to know that I'm the one with the elevated blood pressure, how much weight I gained, and so on.

Also, my OB/GYN doesn't make you wait more than 20 minutes (barring some emergency the doctor has to tend to)...I guess I figured most practices were like that.

Just to address the confidentiality issue-
The really personal stuff is only discussed with you and the midwife, behind closed doors. Each mom gets as much time as she needs behind closed doors- "tummy time." That's when we check the heart beat, take measurements and chat privately. Anything you don't want discussed with the group, won't be. Also, every member signs a confidentiality agreement stating that what is discussed in the group, stays in the group.

And following up on Doreen's comment, HIPAA doesn't apply when you voluntarily disclose medical information. So the only issue in that regard would be whether you were comfortable with the amount of privacy this setting provides.

Although I generally like this idea and would have seriously considered it had it been offered when I was pregnant, 2 hours is a really long time to block out for every prenatal visit. Then again, if it negates the need for the breastfeeding, birthing, and "don't kill the baby classes" we had to take separately, it probably works out, time-wise. However, I don't think I'd opt for it the second (or third) time around, simply because of the time commitment.

They do this in MN and I know alot of people that really enjoy the visits. I work with moms that are teens/high risk so the sense of support with their group is great. Word of mouth of this program is great and I have young moms that ask for this program.

I would HATE this idea but welcome to socialized health care.

Anon--
Is that a joke? I don't understand the connection you're drawing between this "group therapy" approach to prenatal care and socialized medicine. Ummm . . . is it a pun because the group approach is more social?

I would also not choose this type of prenatal care. If you're doing the actual medical check up stuff in private, and asking personal questions in private, what actually takes place during the group sessions? But I can understand that the chance to meet and learn from other moms is attractive.

I considered doing this through OHSU. This is my second pregnancy and I thought it would be nice to do something different. Plus I'm new to Portland and would love to meet some more moms.

Alas, I was told I could not bring my daughter with me. I'm a WAHM and the schedule they offered me didn't coincide with my daughter's nursery school schedule. Because of that, and other reasons, I opted to go elsewhere.

I think it would be cool for first-time moms, however.

Anon-Group approaches to medical care have been around for quite a long time (think diabetes care) and have nothing to do with the perceived "socialized healthcare" everyone is afraid of these days thanks to uninformed comments like that.

I think from a practical stand point, you wouldn't be able to schedule your visits. You would have to schedule your life around the dr. appointments and that totally wouldn't work for me. Who has two hours after work? I guess if you don't work outside the home it may be ok.

I spend on hour with my midwives every appointment and I love it. I can't imagine being in a group setting for 20 minutes. How would they ever get to know you? How would you ever get to know them? I want people around me that I'm comfortable with while giving birth. My midwives make me feel pampered and cared for and safe. What you're describing would make me feel like cattle. The only benefit I see is meeting other moms who will have baby when you do. But there are other ways to make those connections.

I had my daughter at a birthcenter in Gainesville, FL. We had sort of a hybrid version of prenatal care. We met with 1 of 3 midwives ( and sometimes one in training added) each time we went to a prenatal visit. Here we did the basic blood if needed talk over results and listened to the heart. We could ask any questions and bring up concerns if there were any. We also had 8 group meetings. These meetings were parent type meetings. Partners came together (whichever partner you thought would be present at the birth.) Here we talked about the actual stages of giving birth. We watched movies looked at diagrams and hands on replicas of the pelvis and pelvic floor. These meetings were great! We met people from many different walks of lives and thus perspectives. Questions and suggestions arose that I or my partner never thought of.

I agree that this might have been attractive to me for my first pregnancy, when I was dying to meet other moms and talk endlessly about pregnancy. But for baby number two, no thanks. So, as long as it's elective, I guess it's a nice option for women who are looking for that kind of thing.

Also, I've experienced the typical hospital 15-minute sessions where you pee in a cup, wait around for half an hour, and then get just a few minutes with the midwife/doctor to make sure nothing's terribly wrong. I much preferred the prenatal care offered my most home birth or birth center midwives. You get a whole hour of attentive care with your midwives with plenty of time to discus anything that's on your mind and get advice from everything from diet to planning for the baby, etc. They even bring you tea and rub your back or feet! Like Robin, I think it's really important to have the time to build a relationship of trust and understanding with the people who will attend your birth!

I was part of the first Centering group and thoroughly enjoyed it. I am a first time mom and was new to the Portland area, I wanted to go to a place where I felt that I was being monitored, but not feeling like I had a doctors appointment, it felt more like a social hour with those who were experiencing the same issues as I. It was quite nice to meet other couples and it was even greater to experience my journey through my pregnancy with other great women. I can't imagine my experience being any different and I have to say I was very satisfied - I had the birth experience I wanted due to the support and strength I felt from my group! I highly recommend it and I would do it again with another pregnancy.

I am going to my first OHSU centering class tomorrow. Even though this is my second pregnancy I feel I have much to learn and share, will benefit from the "social prego time," won't have to worry about scheduling each session (appointments are pre-scheduled), and can go back to regular 1-on-1 appointments at any time if I wish.
The only downfall I see so far is that we only get to work with one midwife rather than getting time (20 min. at least) with each of them.

I was an emotional mess at both births. I try not to feel bad about it. When I am stressed, I am analytical and solution oriented. Usually works great, but not for birthing. The way that I yam, I guess.

I am a soon to be "graduate" of the OHSU centering program I have thoroughly enjoyed it. There are different groups so there is some flexibility scheduling wise. The beginning of each session is when you are individually doted upon by your midwife as long as you need. What I have liked most about the centering program is that it really is what you make of it. If you are quieter and prefer to simply listen, great. If you are an experienced mom and have lots to share, great. If you are in the middle, that's cool too. Centering is not for everyone but if you enjoy group discussions led by a midwife in addition to your usual prenatal care it is very rewarding.

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