Six women on their hands and knees giggle as they arch their backs and pull their pregnant bellies spineward. Most of them have never tried yoga before, but then again much of this is new: the growing lives inside them, and this experience of being part of a group going through what is typically an individual health care journey.
Centering Pregnancy is a prenatal care model that serves pregnant people in a pack. Instead of getting 10 or 15 minutes with a provider, groups of up to 10 women at similar stages of pregnancy spend up to two hours in conversation and in learning, bookended by blood pressure, weight and glucose checks they often perform themselves.
The stress management techniques these women are practicing today are a fraction of a 10-part curriculum that will teach them how to care for their pregnant bodies and minds. But besides creating a sense of community, being a part of a Centering Pregnancy group has also been proven to improve birth outcomes and satisfaction with prenatal care.
“It’s really nice to make them think that they are they’re not alone,” said Marla Garcia, the Centering coordinator and supervisor at Covenant Community Care in Detroit. “They have resources, and they have power, and they have education.”
An unclear path to a clearly positive outcome
Centering Pregnancy is patient-focused care that has been shown to reduce preterm birth rates and reduce or even eliminate racial disparities in those rates. Preterm birth is the leading cause of infant mortality, particularly for Black babies, who, along with their mothers, continue to experience deep disparities within the health care system.
Centering has also been shown to increase rates of breastfeeding uptake — a practice that can be protective against infant mortality, which affects Black babies in Detroit at a disturbingly high rate of about 18 deaths per 1,000 births.
A 2020 study cited previous research findings that “Centering has shown benefits for women in their mental health, prenatal knowledge, level of involvement in their own care, adherence to attending their postpartum visit, as well as meeting social support needs and overall care satisfaction.”
Though Centering was started in the 1990s, Dr. Deb Landis Lewis, an OB-GYN at Trinity Health Ann Arbor, said it’s even more relevant today.
“It really does speak to empowering pregnant people, patients, women, their families, letting them know that their doctor or midwife believes in them, trusts in them and empowers them to know what’s best for them and their families.”
The science isn’t laid out in a straight line; it’s not perfectly understood what kind of causal relationships there are between Centering Pregnancy and improved health outcomes. “Some of those things are more of the soft markers,” said Sonya Datta-Sandhu, a certified nurse midwife at Bronson Health in Kalamazoo. But she said the role of community support, knowledge and stress management should not be overlooked.
‘In it for the patients’
Providers and practices find benefits from Centering, too. “We all really do benefit from being part of a group and sharing those experiences and getting to know our patients on a deeper level,” said Landis Lewis.
She said it also allows providers to stop regurgitating answers to the same questions about nutrition, back pain and what to expect during labor over and over again throughout their office days.
And it lowers costs; decreasing prematurity decreases the amount of support these babies need when they come out, including expensive interventions such as NICU stays.
Datta-Sandhu said that while she’s glad it saves the system money, the important part is the reduction in prematurity rates that disproportionately affect Black babies. “I’m really in it for the patients,” she said. “You see the impact on our community, and you see the impact on our system.”
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Looking out for families, not just pregnancies
Centering Pregnancy isn’t always an easy sell. Some patients don’t have child care for older children or can’t step away from work for such long appointments. Others bristle at the idea of sharing so much during a vulnerable time.
“This is America,” said Datta-Sandhu. “We are very private and individualized about our health care. And so the idea that you would go and get your prenatal care in a group is really wacky to some folks.”
Centering coordinator Madison Bullis, who recruits patients at Bronson, said she tries to convince all pregnant patients to try just one session. Usually, she said, they stick around.
Those who do find that providers are keeping an eye out for more than just pregnancy-related needs.
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Centering participants at Bronson have access to community health workers and social workers. The providers at Covenant have linked pregnant parents up with cleaning services, diapers, food and occasionally shelter. Trinity Health Ann Arbor has sent Centering patients home with bags of fresh produce from its hospital-based farm.
The Centering sessions, which follow a nationally set curriculum but allow for local customization, create facilitated conversations about safe relationships and peripartum mood disorders. Although women are screened for these things during conventional prenatal care, this program offers a lot more time for discussion — for opening up and asking for help.
Banishing isolation
Despite comments from strangers and unsolicited advice from co-workers, going through pregnancy can feel isolating. We live in a disconnected world already.
“One of the main public health risks for our society has been identified as loneliness,” said Landis Lewis.
Rachel Campbell, a certified nurse midwife at Covenant, said the area’s large immigrant population creates a strong sense of community in some ways, but can leave pregnant people feeling isolated, especially when they’re far from family and their main sources of support. “I think it helps just to bridge some of that loneliness and we see that peer support being really powerful,” she said.
‘Now I have someone’
For some Centering groups, the connection doesn’t end after the babies are born. They often stay connected through text or Snapchat or Facebook Groups. They go to lunch or on walks with their babies as a group, compare developmental milestones and even check in on each other’s mental health.
But some health systems are formalizing that collective experience into Centering Parenting groups, which bring the same parents and babies back together as they transition into pediatric care.
Covenant’s program brings clinicians up from another floor to provide care for the Centering babies beginning at their one-week visit, and all the way until their second birthday. Garcia said she starts recruiting new parents into the program as they’re nearing the end of the pregnancy program.
The yoga mats and folding chairs are easily rolled up and pushed back as mats and blankets go down for the babies to roll around on.
“Right now my parenting group has five patients from the same (Centering Pregnancy) group,” Garcia said, “and it’s a really nice way of getting baby care as well, because they already know each other.”
One of those parents, an immigrant, told Garcia she had been afraid to have a child in this country. “Who was going to sing ‘Happy Birthday’ on the first birthday?” she had lamented.
“And now I have someone,” the woman told her.
Jennifer Brookland covers child welfare for the Detroit Free Press in partnership with Report for America. Reach her at [email protected].
