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CenteringPregnancy

Category

Child & Family Health

Child's Age

Prenatal

Participant

Parents/Guardian

Languages

English, Spanish, French, Other

Brief Description

Prenatal care group that connects birthing parents, due at the same time. CenteringPregnancy provides birthing parents and their partners with prenatal care that allows them to engage in their own healthcare, improve their self-confidence for labor/birth and newborn care, and helps them build a support system. 

Expected Impact

  • Lower risk/general reduction of preterm birth, low birth weight, and NICU admissions
  • General increase in preparedness for birth and newborn care 
  • General increase in breastfeeding initiation rates 
  • General increase in health equity and attendance/adequacy of prenatal care 
  • General increase in vaccination rates for the children 
  • General increase in women using family planning methods postpartum

Core Components for Model Fidelity

  • Group Prenatal Care Visits: 8-12 birthing people and partner/co-parent/support person(s) (if medical practice’s policies and space allow) at similar gestational stages participate in group prenatal care visits. Patients record their weight, blood pressure, and other health data for themselves. Medical providers hold a patient health assessment in a partitioned off area of the group space.
  • Group Prenatal Care Discussions: Facilitated discussions are led by two facilitators, at least one of whom can bill for medical expenses. Focused on relevant topics, and what the pregnant participants are interested in discussing. Includes interactive activities.
  • Population Recommendations: The purveyor recommends that CP groups serve a minimum of 120-150 new prenatal patients per year.

Languages Materials are Available in

English, Spanish, French, Other*

*Contact purveyor about additional available languages.

Delivery Mode

In-person group meetings.

Dosage

Ten meetings aligned with traditional prenatal appointments. Duration ranges from 90 minutes to 2 hours. 

Infrastructure for Implementation

Materials: Prenatal information materials. 

Space: Large conference room separate from exam rooms. 

Other: Key Information for Implementation

  • Planning Period: It takes an average of 4 to 6 months to launch the first session of CP.

Staffing Requirements

Group Facilitator

  • At least one must be a billable medical professional (such as Physicians, MDs, Dos, APP (Advanced Practice Provider), CNM, WHNP, PA, OB-GYN physician, family medicine physician, NP, or other billable healthcare providers). 
  • Training is available through the Centering Health Institute.
  • Although not required, facilitators may receive further credentialing for more information.

Training for Model Fidelity

The Centering Health Institute (CHI) provides virtual training and accreditation for programs to implement a CenteringPregnancy® group. 

Facilitator training is delivered over the course of 2 weeks as trainees complete 4 days of training (2 days per week) with each day’s training lasting 3.5 hours. There is no recertification or follow-up training required. Centering professionals can pursue further credentials as well. Visit Centering Healthcare Institute | Certification for more information.

Accreditation is not required by the purveyor but is highly recommended by NCPC and the purveyor for effectiveness and to ensure model fidelity. Accreditation is typically completed at the 12-month mark, which is about 6-9 months after the launch of the first Centering Pregnancy group session. Sites can continue to facilitate sessions while pursuing accreditation. Accreditation is monitored by CHI through an onsite, in-person session visit and ongoing annual reports.

Contact Information

www.centeringhealthcare.org 

857-284-7570

Lisa Stratton: Regional Director, Centering Healthcare Institute; 704-548-7707, lstratton@centeringhealthcare.org

Cost Estimates

Healthcare visits are billable through Medicaid. Please note: The Smart Start Network does not duplicate services. We fill in gaps not covered by Medicaid. 

Each medical practice implementing CenteringPregnancy pays an annual license fee ($1,000). 

There are two budgeting options for CenteringPregnancy.

  • Centering365 (recommended): 2-year Centering Implementation Pathway with advisor assistance for $28,995 per site. Includes in-person kickoff day site visit, advisor implementation support for 1 year, in-person accreditation site visit and determination, and 4 Centering Facilitation Training Seats.
  • DIY: 4 Centering Facilitator Training Seats ($995.00 each). Does not include support or advising through the accreditation process. 

Facilitator guide is available in English and provided during facilitator training or available for separate purchase ($75 each). The optional facilitator’s leadership kit is available for $300 and includes props such as a talking wand and chimes for starting circle time. Other optional items include patient notebooks ($22 each, in English and Spanish) and digital download resources ($400 per language, in Bengali, French, Creole, Somali, and Dari). 

All materials are purchased through CHI.

Purpose Service Code (PSC)

5413 - Prenatal/Newborn Services

Program Identifier (PID)

CenteringPregnancy

Minimal Outputs for NCPC Reporting

FY 24-25:

  • Number of medical practices participating
  • Number of group prenatal appointments offered
  • Number of pregnant people participating †

Minimal Outcomes for NCPC Reporting

FY 24-25:

  • Increase in parent social support

Minimal Measures for NCPC Reporting

FY 24-25:

  •   TBD

NCPC Evidence Categorization

Evidence Based- 1 randomized control trial and 3 retrospective cohort studies. All 4 studies used comparison/control groups.

Research Summary

The following studies were included based on relevance of outcomes and strength of study design. The results from Ickovics et al. (2007)1 showed that women in group care had less preterm births (33% less of a chance) and this result was even stronger for African American women. Women in group care were more likely to initiate breastfeeding, to receive adequate care, and felt more prepared for labor/delivery. Birthweight did not differ between the two subject groups. Crockett et al. (2019)2 found that group care was related to decreased odds of women experiencing preterm birth, low birthweight, or admission to the NICU (ITT). This study did not find differences between Black and Non-Black women, except for in the risk of NICU admission (ITT). However, within the Black sample there was a significant decrease in risk for low birthweight for both ITT and as-treated and for preterm births for the as treated level. In 2016, Gareua et al.3 found that participating in group care reduced the mothers’ risks of giving birth preterm by 36%, low birthweight by 44%, and of experiencing the NICU by 28%. Similarly, the results of Abshire et al. (2019)4 showed that women in group care had lower chances of preterm birth. The risk reduction was especially great for those who attended 50% or more of the sessions. Group care women had fewer babies with low birth weight and NICU experiences. Racially, the relationships were not significant for Hispanic women, but group care was significantly impactful for non-Hispanic Black women for all birth outcomes.

  1. ^ See Ickovics et al. (2007). The authors conducted a multisite randomized controlled trial at university-affiliated hospital prenatal clinics where women were assigned to either group (CenteringPregnancy) or individual prenatal care. The women were 80% African American, 14-25 years old, and in a low socioeconomic bracket. Data was collected through medical records and structured interviews conducted at the start of the study, during the 3rd trimester and during postpartum. Intent to treat analyses were used. 
  2. ^ See Crockett et al. (2019). This study was conducted as a retrospective cohort study that used propensity scores to compare women participating in group (CenteringPregnancy) and individual prenatal care. They analyzed a large, diverse group of women from across the state of South Carolina. Data was collected through birth certificate data. The results were found using intent-to-treat (ITT, primary) and as-treated analysis (secondary). Women’s risk decreased from 10.6% to 7.5% (− 3.2%, 95% CI − 5.3 to − 1.0%) for preterm birth, 10.7% to 7.0% (− 3.7%, 95% CI − 5.5 to − 1.8%) for low birthweight, and 10.1% to 6.2% (− 4.0%, 95% CI − 5.6 to − 2.3%) for NICU admissions for women in CP in comparison to individual prenatal care.
  3. ^ See Gareua et al. (2016). The study was designed as a retrospective cohort study using propensity scores to match the women that participated in either group (CenteringPregnancy®) or individual prenatal care. The sample included low-income Medicaid mothers living in an urban area and were matched based on age, race, clinical risk group, and Medicaid plan type. Data were collected using patient records, Medicaid claims, and attendance data. The analysis also showed an estimated state savings of $2.3 million dollars from the reduced adverse outcomes.
  4. ^ See Abshire et al. (2019). The authors used a retrospective cohort design with comparison groups for individual vs. group prenatal care. The women were self-selected and during analysis the authors made adjustments based on potential confounding factors. The population focused on low-risk women eligible for Medicaid. Demographically, the women who attended group care went to more sessions, were younger, typically a part of a minority, more likely to be unmarried and having had a preterm birth previously. The group care and individual care groups did not differ on education, tobacco use or number of sexually transmitted infections during pregnancy. Data were collected from billing databases, attendance records, birth certificate databases, and medical chart reviews.

Researched Population

  • People from racial and ethnic minority groups  
  • People/households with incomes below the federal poverty level
  • Medicaid recipients
  • Urban area residents
  • Pregnant people of various ages

Abshire, C., Mcdowell, M., Crockett, A. H., & Fleischer, N. L. (2019). The impact of CenteringPregnancy group prenatal care on birth outcomes in Medicaid eligible women. Journal of Women’s Health, 28(1), 919-928. https://doi.org/10.1089/jwh.2018.7469

Crockett, A. H., Heberlein, E. C., Smith, J. C., Ozluk, P., Covington-Kolb, S., & Willis, C. (2019). Effects of a multi-site expansion of group prenatal care on birth outcomes. Maternal and Child Health Journal, 23, 1424-1433.  https://doi.org/10.1007/s10995-019-02795-4

Gareua, S., Fede, A. L., Loudermilk, B. L., Cummings, T. H., Hardin, J. W., Picklesimer, A. H., Crouch, E., & Covington-Kolb, S. (2016). 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, 20, 1384-1393. https://doi.org/10.1007/s10995-016-1935-y

Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S. S. (2007). Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics and Gynecology, 110(2 Pt 1), 330–339. https://doi.org/10.1097/01.AOG.0000275284.24298.23



Local Partnerships Currently Implementing

Local Partnerships in purple have adopted CenteringPregnancy. Local Partnership contact information can be found here.