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PRACTICAL APPLICATIONS OF THE CENTERING PREGNANCY
MODEL OF CARE
Charlene Ellis, MEd
Lisa Ross Birth and
Women’s Center
LEARNING OBJECTIVES
* Define the centering pregnancy model of care.
* Recognize the role of the family in weight management throughout pregnancy.
WHAT IS CENTERING? An innovative model of group care
Groups of 6-8 of similar gestation or child’s birthdate
8 sessions, 1½ hours each
3 components:
Assessment
Education
Support
•Approaches pregnancy as a process of wellness
•Values the knowledge and experience each woman brings to the circle.
WHY GROUPS?
Members learn from each other
Helps build community/Social support
No wait time for appointments
Snacks are provided!
Groups are fun!
ASSESSMENT Self Assessment
CenteringPregnancy Blood pressure Weight CenteringParenting Child’s head circumference, length and weight (parenting)
Scales and blood pressure cuffs available Record information in personal Centering Handbook
Mat Time Measure and listen Infant physical exam
EDUCATION Guided by the group!
Topics for each session, additional information in personal Centering Notebook
Discussion – system in place for anonymous questions
Speakers
Lactation Consultant
Yoga Instructor
Dietician
Activities
Videos
TOPICS COVERED IN CENTERING
Nutrition Gestational Diabetes Anemia
Common Discomforts
Preterm Labor
Oral health
Relaxation Techniques/Stress Reduction
Complications
Childbirth Preparation
Family Planning
Breastfeeding
Caring for the baby
Postpartum Depression
Doulas
And more!
SUPPORT
Power of THE GROUP
Peer support
Develop friendships
STAFFING
CNM (Certified Nurse-Midwife) as Facilitator for Centering Pregnancy
Pediatric Nurse Practitioner as Facilitator for Centering Parenting
Education Coordinator as co-Facilitator
GROUP PRENATAL CARE AND PERINATAL OUTCOMES-METHODOLOGY
A multi-site randomized controlled trial conducted at two university-affiliated hospital prenatal clinics (Emory and Yale)
1,047 pregnant women aged 14-25 years were randomly assigned to either standard or group care(centering)
Structured interviews were conducted at study entry, during the third trimester, and postpartum
Mean age 20.4, 80% African American
GROUP PRENATAL CARE AND PERINATAL OUTCOMES
Women in group sessions:
Were less likely to have suboptimal prenatal care
Had significantly better prenatal knowledge
Felt more ready for labor and delivery
Had greater satisfaction with care
Breastfeeding initiation was higher in group care
There were no differences in birth weight nor in costs associated with prenatal care or delivery
CENTERING AND WEIGHT MANAGEMENT
The main goal of Centering is to have patients become active participants in their own, and their baby’s care Centering - come to the visit with information to share with the provider Blood pressure Weight gain Weeks gestation Self-assessment Progress on goals
Traditional care - wait on the provider to tell them how they are doing.
CHARTING
• We want to empower women to understand their health information and to make behavioral changes based on that information
Each participant weighs themselves, charts their weight gain
FIRST SESSION:
Record weight from 1st prenatal visit and today’s session
1 – PRE-PREGNANT WEIGHT 2 – BMI 3 – WEIGHT GOAL
Each Session
“Mom - How do you feel today? “
Rated by filling in face
Physical Health –
“Taking care of yourself with
healthy food and staying active.
Monitoring exercise, weight, diet,
medication, drinking lots of water, etc.”
GOAL SETTING
“My goals for this pregnancy . . .”
Established at first session
Revisited at intervals
“This (pregnancy) is a time when many women can be encouraged to take responsibility for their own health.”
My Goals for Myself
This is a good time to start thinking about things that you would like to work
on. Pick one or more goals to focus on and track your progress here.
Goal 1:
Action Steps:
Goal 2:
Action Steps:
Goal 3:
Action Steps:
STARTING OFF RIGHT – SESSION 1
Group Guidelines
My Pregnancy - What’s Most Important
My Personal Goads
Prenatal Testing
Nutrition – Weight Changes & Calories, Foods to Avoid, Gestational Diabetes
Size Your Servings
Food Diary
Healthy Lifestyle Choices
MY PERSONAL GOALS
Check how you feel for each item:
Good (Smiley face)
Could be better
Exercise
Diet
Handling Stress
Weight
8 more
NUTRITION TOPICS Weight Changes and Calories
Protein
Folic Acid
Calcium
Iron
Omega 3 essential fatty acids
Vitamin and mineral supplements
Foods to Avoid
Gestational Diabetes
Size Your Servings
Food Diary
HOW THIS MIGHT LOOK IN A CENTERING SESSION:
Grab bag with items to stimulate discussion: milk carton, tofu package, vitamin bottle, lunch meat package, a boiled egg
Grab bag with “real” items to illustrate size
Ask group: What advice have you been given about what to eat and not eat during your pregnancy?
Write down two great foods for pregnant women
Give out a restaurant menu, ask groups of 2 or 3 to come up with best choice for a meal
HOW CENTERING WORKS
Groups share recipes, ideas, snack at the sessions
Sessions can be tailored to the needs of the group
Gestational Diabetes
Groups get together to exercise
Groups sympathize with and encourage each other
CENTERING PARENTING AND WEIGHT
Baby’s weight recorded every visit
Scales available for moms use (same ones they used in
CenteringPregnancy)
Topics include mom’s feelings about herself, goals, stress
relief, etc.
ANECDOTAL INFORMATION “We do not have any data on weight gain in pregnancy for women in CenteringPregnancy at this time. It is an area we would like to see studied further. We do hear from sites that they see better weight management from their Centering moms.”
Centering Healthcare Institute
(Women in Centering) likely spent substantially more time discussing the importance of adequate nutrition during pregnancy, which may have resulted in better weight gain and choice of more nutritious food.