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CenteringPregnancy

Health Factors: Access to Care
Decision Makers: Grantmakers Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 1-9% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

CenteringPregnancy is a multifaceted model of group maternity care that incorporates health assessment, education, and support. Eight to ten women with similar gestational ages meet to learn care skills, participate in a facilitated discussion, and develop a support network with other group members. Each pregnancy group follows the recommended schedule of 10 prenatal visits; visits range from 90 minutes to 2 hours long. Participants take their own weight and blood pressure, record their health data, and have private time with their provider for belly checks before group discussion and activities (CHI).

Expected Beneficial Outcomes

Improved prenatal care
Improved birth outcomes
Increased patient satisfaction

Evidence of Effectiveness

There is strong evidence that CenteringPregnancy improves birth outcomes, particularly among disadvantaged populations such as low income black and Hispanic women (Gareau 2016, Tanner-Smith 2014a, Picklesimer 2012, Tandon 2012, Ickovics 2007, Grady 2004, Ickovics 2003). Participants in CenteringPregnancy are more likely to receive adequate prenatal care than non-participating peers (Ickovics 2007, Kennedy 2011, Tandon 2013, Trudnak 2013).

CenteringPregnancy improves infant birth weight (Gareau 2016, Tanner-Smith 2014a, Grady 2004, Ickovics 2003) and reduces the likelihood of preterm delivery (Gareau 2016, Picklesimer 2012, Tandon 2012, Ickovics 2007, Grady 2004) in disadvantaged groups. CenteringPregnancy may also reduce the risk of a NICU stay (Gareau 2016) and fetal demise (Tanner-Smith 2014a). CenteringPregnancy participants may engage in healthier behaviors (Trotman 2015, Hale 2014, Grady 2004) and have more appropriate gestational weight gain than non-participants (Trotman 2015, Tanner-Smith 2014). CenteringPregnancy participants also appear to be more likely to engage in breastfeeding (Brumley 2016, Schellinger 2016, Trotman 2015, Zielinksi 2014, Tanner-Smith 2013a, Klima 2009, Ickovics 2007). 

CenteringPregnancy may also improve mental health for some participants (Trotman 2015, Heberlein 2016, Benediktsson 2013). Women in the program learn more about healthy pregnancy (Heberlein 2016a, Ickovics 2007) and report feeling better prepared for delivery (Ickovics 2007) and more satisfied with their prenatal care than non-participating women (Lathrop 2013, Tandon 2013, Kennedy 2011, Ickovics 2003). Greater fidelity to the model appears to lower the odds of intensive utilization of care (Novick 2013).

Preparing clinics and staff to implement CenteringPregnancy costs approximately $20,000 over the first 2 years, with an ongoing annual membership cost of $500 per year (Rowley 2016); the program does not appear to differ in cost from traditional care once established (Ickovics 2007). Cost-benefit modeling for group prenatal care in a practice serving disadvantaged patients suggests that the CenteringPregnancy staffing model would be cost neutral with only 5 patients per group (Rowley 2016).

Centering Pregnancy Plus, an intervention with an additional focus on reducing risky sexual behavior, has been shown to reduce unprotected sex, sexually transmitted infections, and repeat pregnancies (Ickovics 2016, Kershaw 2009). The program can also increase self-esteem and decrease depression during and after pregnancy (Ickovics 2011).

Implementation

United States

As of 2016, CenteringPregnancy and CenteringParenting programs have been implemented at over 400 sites in the United States and abroad, serving over 48,000 patents in 2015 (CHI).

Wisconsin

The University of Wisconsin Health System (UW Health) is an example of a provider that offers CenteringPregnancy (UW-CenteringPregnancy).

Implementation Resources

CHI - Centering Healthcare Institute (CHI). CenteringPregnancy overview. Accessed on August 18, 2016

Citations - Description

CHI - Centering Healthcare Institute (CHI). CenteringPregnancy overview. Accessed on August 18, 2016

Citations - Evidence

Benediktsson 2013 - Benediktsson I, McDonald SW, Vekved M, et al. Comparing CenteringPregnancy® to standard prenatal care plus prenatal education. BMC Pregnancy & Childbirth. 2013;13(Suppl 1):S5. Accessed on September 15, 2016
Brumley 2016* - Brumley J, Cain MA, Stern M, Louis JM. Gestational weight gain and breastfeeding outcomes in group prenatal care. Journal of Midwifery & Women’s Health. 2016;00:1–6. Accessed on September 15, 2016
Gareau 2016* - Gareau S, Lòpez-De Fede A, Loudermilk BL, et al. Group prenatal care results in Medicaid savings with better outcomes: A propensity score analysis of CenteringPregnancy participation in South Carolina. Maternal and Child Health Journal, 2016;20(7):1384–1393. Accessed on September 15, 2016
Grady 2004* - Grady MA, Bloom KC. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. Journal of Midwifery and Women’s Health. 2004;49(5):412-20. Accessed on August 18, 2016
Hale 2014* - Hale N, Picklesimer AH, Billings DL, Covington-Kolb S. The impact of Centering Pregnancy group prenatal care on postpartum family planning. American Journal of Obstetrics and Gynecology. 2014;210(1):50.e1-50.e7. Accessed on September 15, 2016
Heberlein 2016* - Heberlein EC, Picklesimer AH, Billings DL, et al. The comparative effects of group prenatal care on psychosocial outcomes. Archives of Women’s Mental Health. 2016;19(2):259–269. Accessed on September 15, 2016
Heberlein 2016a* - Heberlein EC, Picklesimer AH, Billings DL, et al. Qualitative comparison of women’s perspectives on the functions and benefits of group and individual prenatal care. Journal of Midwifery & Women’s Health. 2016;61(2):224–234. Accessed on September 15, 2016
Ickovics 2003 - Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and preterm birth weight: Results from a matched cohort study at public clinics. Obstetrics & Gynecology. 2003;102(5 Pt 1):1051-7. Accessed on August 18, 2016
Ickovics 2007 - Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and perinatal outcomes: A randomized controlled trial. Obstetrics & Gynecology. 2007;110(2 Pt 1):330-9. Accessed on August 18, 2016
Ickovics 2011* - Ickovics JR, Reed E, Magriples U, et al. Effects of group prenatal care on psychosocial risk in pregnancy: Results from a randomised controlled trial. Psychology & Health. 2011;26(2):235-50. Accessed on August 18, 2016
Ickovics 2016* - Ickovics JR, Earnshaw V, Lewis JB, et al. Cluster randomized controlled trial of group prenatal care: Perinatal outcomes among adolescents in New York City health centers. American Journal of Public Health. 2016;106(2):359–365. Accessed on September 15, 2016
Kennedy 2011* - Kennedy HP, Farrell T, Paden R, et al. A randomized clinical trial of group prenatal care in two military settings. Military Medicine. 2011;176(10):1169-77. Accessed on August 18, 2016
Kershaw 2009 - Kershaw TS, Magriples U, Westdahl C, Rising SS, Ickovics J. Pregnancy as a window of opportunity for HIV prevention: Effects of an HIV intervention delivered within prenatal care. American Journal of Public Health. 2009;99(11):2079-2086. Accessed on September 15, 2016
Klima 2009 - Klima C, Norr K, Vonderheid S, Handler A. Introduction of CenteringPregnancy in public health clinic. Journal of Midwifery & Women’s Health. 2009;54(1):27-34. Accessed on August 18, 2016
Lathrop 2013* - Lathrop B. A systematic review comparing group prenatal care to traditional prenatal care. Nursing for Women’s Health. 2013;17(2):118–130. Accessed on September 15, 2016
Novick 2013 - Novick G, Reid AE, Lewis J, et al. Group prenatal care: Model fidelity and outcomes. American Journal of Obstetrics and Gynecology. 2013;209(2):112.e1-112.e6. Accessed on September 15, 2016
Picklesimer 2012* - Picklesimer A, Billings D, Hale N, Covington-Kolb S. The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population. American Journal of Obstetrics and Gynecology. 2012;206(5):415.e1-415.e7. Accessed on August 18, 2016
Rowley 2016* - Rowley RA, Phillips LE, O’Dell L, et al. Group prenatal care: A financial perspective. Maternal and Child Health Journal. 2016;20(1):1–10. Accessed on September 15, 2016
Schellinger 2016* - Schellinger MM, Abernathy MP, Amerman B, et al. Improved outcomes for Hispanic women with gestational diabetes using the Centering Pregnancy© group prenatal care model. Maternal and Child Health Journal. 2016:1–9. Accessed on September 15, 2016
Tandon 2012* - Tandon S. D, Colon L, Vega P, Murphy J, Alonso A. Birth outcomes associated with receipt of group prenatal care among low-income Hispanic women. Journal of Midwifery & Women’s Health. 2012;57(5):476–81. Accessed on August 18, 2016
Tandon 2013* - Tandon SD, Cluxton-Keller F, Colon L, Vega P, Alonso A. Improved adequacy of prenatal care and healthcare utilization among low-income Latinas receiving group prenatal care. Journal of Women’s Health. 2013;22(12):1056–1061. Accessed on September 15, 2016
Tanner-Smith 2013a* - Tanner-Smith EE, Steinka-Fry KT, Lipsey MW. Effects of CenteringPregnancy group prenatal care on breastfeeding outcomes. Journal of Midwifery & Women’s Health. 2013;58(4):389–395. Accessed on September 15, 2016
Tanner-Smith 2014 - Tanner-Smith EE, Steinka-Fry KT, Gesell SB. Comparative effectiveness of group and individual prenatal care on gestational weight gain. Maternal and Child Health Journal. 2014;18(7):1711–1720. Accessed on September 15, 2016
Tanner-Smith 2014a* - Tanner-Smith EE, Steinka-Fry KT, Lipsey MW. The effects of CenteringPregnancy group prenatal care on gestational age, birth weight, and fetal demise. Maternal and Child Health Journal. 2014;18(4):801–809. Accessed on September 15, 2016
Trotman 2015* - Trotman G, Chhatre G, Darolia R, et al. The effect of Centering Pregnancy versus traditional prenatal care models on improved adolescent health behaviors in the perinatal period. Journal of Pediatric and Adolescent Gynecology. 2015;28(5):395–401. Accessed on September 15, 2016
Trudnak 2013* - Trudnak TE, Arboleda E, Kirby RS, Perrin K. Outcomes of Latina women in CenteringPregnancy group prenatal care compared with individual prenatal care. Journal of Midwifery & Women’s Health. 2013;58(4):396–403. Accessed on September 15, 2016
Zielinksi 2014 - Zielinski R, Stork L, Deibel M, Kothari CL, Searing K. Improving infant and maternal health through CenteringPregnancy: A comparison of maternal health indicators and infant outcomes between women receiving group versus traditional prenatal care. Open Journal of Obstetrics and Gynecology. 2014;4(9):497–505. Accessed on September 15, 2016

Citations - Implementation

CHI - Centering Healthcare Institute (CHI). CenteringPregnancy overview. Accessed on August 18, 2016
UW-CenteringPregnancy - University of Wisconsin Health System. Obstetrics and Gynecology. CenteringPregnancy Program. Accessed on August 18, 2016

Page Last Updated

September 15, 2016

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