Family Nurse Practitioner Karen Baker, left, explains proper nutritional habits to patient Quaiesha Mathis during an OB admissions visit at the Dougherty Health Department’s Centering Pregnancy office Thursday.
ALBANY -- When Dr. Jacqueline Grant saw some alarming trends surrounding the access of prenatal care in Southwest Georgia, she knew something had to be done.
Enter Centering Pregnancy.
Grant, director of the Southwest Public Health District, said the program's model, while implemented in the region just over two years ago, has shown promising results for moms-to-be in the area in need of medical care and guidance.
"We've actually had people come down to look at the program," said Grant, who is an obstetrics and gynecology specialist. "It has gained a lot of statewide attention."
The original developer of the Centering model, Sharon Schindler Rising, piloted it in 1993-94 when she was a nurse-midwife providing care in a private obstetric office, a hospital clinic and community health center in Connecticut. She graduated from the Yale School of Nursing in the late 1960s, taught at the faculty there and started the graduate program in nurse-midwifery at the University of Minnesota, a historical overview on the Centering Healthcare Institute website says.
While there, she developed the Childbearing Childrearing Center for comprehensive prenatal, well-child and well-woman care to women and families seeking care at the university. Nurse-midwives and pediatric nurse practitioners provided the care and encouraged couples to join with others of similar gestation in a group that met for six months during late pregnancy and early postpartum.
This experience provided some of the groundwork for further development of the model to include care assessment, education and community building all within the group space, the historical overview continues.
The program in Dougherty County, headquartered at the health department on South Slappey Boulevard, started in October 2009 after the March of Dimes awarded the health district a three-year, $150,000 grant.
Since that time, it has served Dougherty as well as other counties that touch it.
"At the time, there was a relative shortage of OBs (obstetricians) taking Medicaid," Grant said. "The 2008 Georgia Health Disparity Report showed the low birth weight rate to be 8.1 percent, and that Dougherty County had gotten the grade of 'F' in prenatal care.
"We felt it was time for public health to weigh in and do something to improve the outcome."
As luck would have it, Grant found a possible answer to the problem when she attended a prenatal conference and heard about the Centering program.
"I was intrigued by the national outcomes," she said. "Nationally, the low birth weight rate had decreased -- and there is an increase of breastfeeding rates and of the spacing between babies.
"It was a patient-centered model. We thought the area would benefit."
Training of the staff, who had little to no previous experience in prenatal care, began before the grant award became official. Most of the training was done by the Centering Healthcare Institute.
Despite appearances, health district officials say they are not getting into the business of birthing babies.
"We've had doctors partner with us to care for them (the Centering patients) after hours, after 36 weeks and for deliveries," Grant said. "We give practices an overview of the data and ask them to partner with us.
"If a patient becomes too high-risk or meets the (Centering) exclusion criteria, they will take them early."
The four practices the program is partnered with are Mirian Worthy Women's Health Center, The Veranda, Women's Health Professionals and Southwest Georgia Family Medicine Residency.
"We are providing a system of entry so women can get in earlier for prenatal care," Grant said. "Without the barrier of health insurance, we can get them OB care and get them (connected to) Medicaid."
Before even getting them connected to health care coverage, there are some things women will get immediately -- including supplements, Grant said.
To date, there have been nearly 180 patients that have come in for initial visits to Dougherty's Centering program. Roughly 25 percent of women do not make it back for a second visit, usually because they either opt out or end up relocating, Grant said.
"By the third session of Centering, they usually stay with us," she said.
There are currently 25-30 women participating in the program.
The sessions, usually two hours in length, start off with one-on-one prenatal assessments behind a screen while the others work on assessment sheets and watch videos.
After that portion, which takes a total of 30-40 minutes, the groups move on to their education and support piece. The sessions are scheduled to coincide with how often the participants would be visiting their doctors during pregnancy, which depends on how far along they are.
The groups generally consist of eight women and their significant others, and are divided out by the month in which its members are due. They also learn to take their own blood pressure as well as calculate their due date and body mass index.
"We get to know them, and they get to know us so that they are more comfortable talking to doctors," Grant said. "It helps them to learn to feel comfortable with providers and ask them questions."
Some of the discussion topics include nutrition and weight gain, substance abuse and relaxation, and stress reduction -- for which a yoga instructor is brought in to assist. Childbirth education, as well as topics including pre-term labor, contraception, child care safety and breastfeeding, are also part of the program.
"By delivery, they are already well-educated," Grant said. "They know what to expect. They go in much more empowered."
Demographics indicate that the median age of participants is 22.6 years. Eighty-seven percent have been African-American, and the mean gestation upon entry to the program is 10 weeks.
Grant said the low birth weight rate for the program is 6.9 percent, compared to an overall Dougherty County average of 8.4 percent and 14.1 percent among the area's African-American population.
Meanwhile, the breastfeeding rate among Centering participants is 68 percent. This is above a baseline rate for the Women's, Infants and Children program in Dougherty of 39 percent, Grant said.
"We are really very proud of these results," she said. "Several health districts elsewhere are actually exploring providing Centering in their district.
"We believe our model is one that can be replicated throughout the state."
To date, public health officials in Augusta, Clayton County and Macon are among other places in Georgia that have expressed interest in how the Dougherty program works.
The very first Centering pilot included 13 prenatal groups, three of them teen groups. The results of this pilot are published in an article by Rising in 1998 and helped support the professional training workshops that began the same year.
In 2001, as interest in the model was growing, the Centering Pregnancy and Parenting Association was formed as a 501(c)3 nonprofit. The name was changed to Centering Healthcare Institute Inc. in 2006, according to the organization's website.
Aside from the Dougherty program, the health district also has a Centering Farm Worker Health Program based in Colquitt County.
That program -- which kicked off a few months ago -- is catered to Hispanic migrant worker families.
"These people are not often eligible for Medicaid," Grant said. "I suspect we should see promising results there."
Between the Dougherty and Colquitt programs, there are a total of 12 public health staff members, including Grant, working with expectant mothers in Centering. The health district is looking to add three more people, including a social worker and a nurse, with additional funding.
In the meantime, Grant added that monetary support for Centering is currently being sought through the Healthcare Georgia Foundation.
Among others currently working with the program is Karen Baker, a family nurse practitioner with the Dougherty County Health Department. Her job is to conduct the admissions process, do the initial physical exam and help with sessions.
"I have been here 23 years, and this is the first time I have worked in prenatal," Baker said. "I've loved the education piece. There is power in education.
"There are women here that have been pregnant before. They've said they've learned more with this pregnancy than any other one."
Probably the most valuable part of the program, officials say, is the participants -- those becoming new mothers as well as veterans -- talking and learning from each other.
"This program was needed, most definitely," Baker said. "We are in a good position to catch people. We are initiating early care.
"People in the delivery room are impressed because when they (the patients) are in the delivery room, they will know what the staff is talking about. This program was needed. It's a different way to provide care, and the need was there."
According to information on Centering's website, the only other location in Georgia that offers the program is based in Athens.
As far as public health officials are concerned, the more that can be done to improve access to care the better.
"We get a lot of positive feedback on it," Grant said. "Even if they (the participants) have had babies before, they've said they've learned so much.
"This is still one of our best-kept secrets. People don't know what we're doing or why we're doing it."
There are some women who have to be excluded. The district's Centering program can't take those carrying twins, who will likely be transferred out early if they do come in. Officials say they also can't take heavy drug users, diabetics on insulin, those with hypertension that is hard to control, those with uterine defects or those beyond 20 weeks.
For more information, contact the Southwest Public Health District or visit www.centeringhealthcare.org.