Especially for African-Americans, the camaraderie and education found in such group prenatal care programs as Centering Pregnancy has helped prevent premature births.
NEW HAVEN, Conn. -- In a spare, windowless room in the basement of Yale-New Haven Hospital, five women are laughing and munching on crackers, while music plays. They shift and wriggle in their plastic seats, the pregnant woman's endless and usually fruitless quest for a comfortable position.
Nurse-midwife Susan Hally demonstrates the stages of labor with a baby mannequin and plastic pelvis. Above, Michelle Lee, Dominique Stokes, and Tasi Spruill chat during a Centering Pregnancy session as Hally performs an ultrasound on Candice Salter.
One by one they take turns on an exam table in the back of the room, where nurse-midwife Susan Hally checks their bellies. All are within eight or so weeks of delivering. They are here -- two hours every other week -- for prenatal care through a program called Centering Pregnancy.
And despite the humble setting, the women potentially could reap huge benefits.
Contrary to popular belief, the traditional form of prenatal care -- 15-minute private visits with a doctor or midwife -- doesn't seem to prevent preterm birth. But the Centering Pregnancy model, combining camaraderie and education, was shown in at least one study to lower rates of premature delivery, especially among African-Americans.
Yale-New Haven's clinic is one of dozens around the country that have adopted the Centering Pregnancy model. At this meeting last year, Hally finishes the medical checks and starts the discussion. She asks the women about making lifestyle changes.
"I'm cutting down on my junk food," says Dominique Stokes, 22. A senior at the University of New Haven, Stokes is 32 weeks pregnant, with a girl. Like everyone in the group, Stokes is African-American. The women range in age from 18 to 29. Only one is married, and none had planned to get pregnant.
They talk about how they're feeling, whether they're sleeping enough, what to do if not. Hally describes relaxation techniques. She talks about distinguishing true labor from false labor. And with a baby mannequin and plastic pelvis, she demonstrates the stages of labor.
Audio: "Late in pregnancy . . . when you're in the group, everybody else is uncomfortable too, you're sort of invested in each other." -- Sharon Schindler Rising
After hearing all that, Taishi Covington has a question. "Do you get amnesia? Like people can have five and seven kids, and stuff — like do they forget the pain?" She guffaws. Covington is 19 years old and feeling mighty uncomfortable in her 34th week of pregnancy. The baby's father abandoned her when he found out she was pregnant.
Now everyone in the group joins in her laughter as she continues: "I want to keep my memory. I want to remember the pain because I don't want to go through this again."
In a study published in 2007, some 1,000 pregnant women aged 14 to 25 in New Haven and Atlanta were divided into two groups. Half received the usual, individual prenatal care. The other half participated in Centering Pregnancy groups. Some 80 percent of women were African-American.
Women who participated in Centering Pregnancy had significantly lower rates of preterm birth. The effect was even stronger when you looked only at African-Americans: only 10 percent of Centering Pregnancy participants had premature babies. (Nationwide, 18.1 percent of black babies are born prematurely.)
Why would something so simple have such a strong effect?
Sharon Schindler Rising, the Connecticut nurse-midwife who developed the Centering Pregnancy model in 1993, says a group has a powerful effect on behavior; most women improve their health habits. It also fosters what Rising calls "self-efficacy" -- the sense that what you do truly matters, that you have the power to make a healthy baby.
And why would the effect be especially strong among black women? Probably, Rising and others speculate, because black women bear more stress, and so get more benefit from its relief. "People talk about generations of stress that have really developed especially within the African-American community," Rising says. Women in Centering Pregnancy laugh, share experiences, acquire useful knowledge -- and so ease their burdens and hold onto their babies.
Audio: "Women tend to call less when they're in Centering [program]. They tend to come in later in labor, tend to use the emergency department less . . ." -- Sharon Schindler Rising
Did it work for this New Haven group? Hard to say for sure, but Hally reported recently that all five women delivered healthy, full-term babies.
VIDEO Yvonne Freeman Homeless when her fourth child was born at 24 plus weeks, Yvonne Freeman went on to become a nurse. "I was very interested in nursing because of the care that Xavier received. So right away, I wanted to go to nursing school. And I did." Watch the video
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