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365 Chapter 13 Circles of Community The CenteringPregnancy® Group Prenatal Care Model Sharon Schindler Rising and Rima Jolivet INTRODUCTION CenteringPregnancy® Program Description CenteringPregnancy® , a copyrighted program design, is a multifaceted model that integrates the three major components of prenatal care— health assessment, education, and support—into a unified program within a group setting. Eight to twelve women with similar gestational ages meet as a group with an obstetrical provider—midwife, physician, advanced practice nurse—and a co-facilitator for ten sessions throughout pregnancy and the early postpartum period. Together, they practice self-care skills, participate in facilitated discussions, and develop a support network with other group members. Standard physical health assessment is completed by the practitioner within the group space. Through this unique model of care, women are empowered to choose health-promoting behaviors. Health outcomes, specifically increased birth weight and gestational age for mothers who deliver preterm, and increased satisfaction expressed by both the women and their providers, support the effectiveness of this model for the delivery of prenatal care. Groups provide a dynamic atmosphere for learning and sharing that is impossible to create in a one-to-one encounter. Hearing other women share concerns that mirror their own helps women in CenteringPregnancy® groups to normalize the experiences of pregnancy. Groups are also empowering because they provide support to the members and increase individual motivation to learn and change. Professionals report that groups provide them with renewed satisfaction in delivering quality care. The model has been widely implemented across the United States, in private practices, and public health clinics, among women of different ages and different ethnic 366 s. s. rising and r. jolivet and cultural backgrounds, and with women whose pregnancies unfold under special circumstances, such as infection with HIV or incarceration. CenteringPregancy® programs are under way in Australia and Canada, and there is active model development in England. Sue Monk Kidd’s words illuminate the power of women sharing with other women: “Sometimes another woman’s story becomes a mirror that shows me a self I haven’t seen before. When I listen to her tell it, her experience quickens and clarifies my own. Her questions rouse mine. Her conflicts illumine my conflicts. Her resolutions call forth my hope. Her strengths summon my strengths. All of this can happen even when our stories and our lives are very different” (1995: 172–73). That power is what fuels the CenteringPregnancy® group prenatal care model. Pregnant women in group care reflect, learn, and share ideas and self-disclosures with other pregnant women. In so doing, they experience an affirmation of self that nourishes them as they participate in CenteringPregnancy ® groups. Their confidence in their ability to manage their own pregnancies grows as they learn to measure their own weight and blood pressure. Their sense of agency and personal responsibility grows as they learn to interpret these measurements and record them in their own medical charts. Women learn about childbearing by tapping into their own knowledge and the collective wisdom of the group during discussions that are facilitated by midwives and other childbirth professionals. The solidarity and community that grow out of group sharing becomes a base of support for women as they cultivate their growing bellies and their growing confidence in their ability to be mothers. The group provides a circle of safety for the expression of questions, troubles, and anxieties. The circle is also a place for sharing of joys, hopes, and dreams. As trust grows among the members, so does the quality and depth of intimacy and caring. It is natural for this sense of community to extend beyond the framework of the pregnancy and to persist after all the babies in the group are born, “because when you get to know everybody, you get to care about everybody,” as one woman in an early CenteringPregnancy® group commented.1 THE NEED FOR REFORM IN PRENATAL CARE Health care providers continue to search for ways to optimize the delivery of prenatal care. There is a recognized need to improve the process to provide the best possible outcomes for mothers and babies. It is problematic that in this era of evidence-based practice, the structure and the content of prenatal care continue to be defined largely by tradition. Almost two decades after the publication of the seminal U.S. Public Health Service Task Force report, Caring for Our Future, which highlighted the lack of [3.14.70.203] Project...

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