From the Ground Up, Centering Group Prenatal Care: A Midwife’s Perspective


Walking into the big, bright group room in a Family Practice clinic you, a pregnant person is greeted with smiles and enthusiasm from the group facilitators. A midwife, a doctor, resident, Certified Nursing Assistant, and Registered Nurse. You are guided to make a name tag, take your own blood pressure and weight, and then record it in your own personal prenatal log and resource book. You sit down and await your turn, to get a belly and heartone check, with one of the facilitators, doctor or midwife. This is done in the same room, but away from the group. Music is playing in the background and a snack of cheese, hummus, veggies, and drinks are being munched on. Resource books come out, a self-assessment worksheet is completed, and the chatting begins. “How are you doing today?” “How are things going?” “Oh yeah’ that’s happening to me too” with giggles in between.The facilitator sitting in the circle, chats along and visits, as well. All facilitators return back to the circle.

“Welcome,” and we begin.The prenatal appointment/visit starts with a topic, ranging from what may be currently going on in pregnancy to what to prepare for and expect during birth and the postpartum period. A question comes up from the personal time given during the belly check. Questions may also arise from the other pregnant people in the group, you are encouraged to ask any and all questions that arise will be answered, for you are part of the birthing community.

This prenatal care is uniquely different. The participants are told that they have options for where they want to birth; in their home, a birth center/suite, or the hospital. Additionally, Medicaid and some private insurances will cover the costs of out-of-hospital births in the state of New Mexico further providing choices for families. This type of prenatal care has had significant results in lowering infant mortality rates and reducing the number of low birth weight babies. According to the New Mexico Vital Records and Health Statistics, the infant mortality rate among African American is 10.6 per 1,000 live births, not far from the national average of 11.1 per 1,000 live births. The population of African descendents in New Mexico is 2.6%.

We started this pilot program in Bernalillo County, which also includes the city of Albuquerque, because this area has one of the highest African American population in the state. This pilot program was made possible through funding from the New Mexico Office of African American Affairs, Health Outreach Committee, which originated from Senate Bill 69. The objective of the bill is lower the high infant mortality rate within the African American community by allocating funds to train doctors and midwives in the Centering Model of group prenatal care. I helped to get this bill passed and served on the Health Committee for the Office of African American Affairs for over a year. I was not only honored, when the office wanted a facilitator who reflected the population of this bill and pilot, but saw this as central to my mission as a midwife. Additionally, a staff member from the University of New Mexico Family Medicine joined me to help address the health inequities in our state and to decrease the infant mortality rate.

And so we began, myself, a Certified Professional Midwife, began co-facilitating the Centering Groups with family medicine doctors, in-clinic. Almost immediately, the challenge of finding pregnant African American people proved to be a challenge, on top of us having to begin the pilot program in the hospital’s new family practice clinic. Our luck finally changed, when two African American clients, whom were already in my care, were willing to join the group and also continue to still see me for our regular scheduled visits.

The individuals that participated in group prenatal care throughout their pregnancies had positive feedback. They enjoyed the conversation and often shared with one another the common joys and and challenges that come with pregnancy and parenthood. Due to the intimate nature of the visits, most of them can now say that they know their doctor and midwife, more so than they would have if they had chosen routine prenatal care. By the end of the session, questions have been answered, numbers exchanged, and they leave knowing that they’re supported. The caregivers have made it clear, that you can call or text anytime. So far, two people have birthed from the group; one in the hospital and one at home. They both birthed in their setting of choice, with a midwife, or with a doctor, who they knew, felt comfortable with, and whom they had spent many hours with. The few people that have birthed have reported feeling supported, prepared, and so far have had minimal interventions. They all birthed the way they wanted.

My perception of Centering prenatal care is very similar to what the midwifery model of care is all about, which is to provide individualized care. We have the time to answer every question, go over diet, water intake, exercise, and stressors of the day. In this model of care you are heard and valued. Training doctors, midwives and nurses in group prenatal care with this structure only enhances the experience for all. People walk away with a connection to others and a community that will last beyond their pregnancy. The Centering model of care can work for everyone involved. I see this model of care as a tool to greatly reduce the high infant and maternal mortality rates across the USA. In the future, I hope to see this as a standard of care, especially for hospital care.

References:

1. New Mexico Department of Health. New Mexico Department of Health, Indicator-Based Information System for Public Health. https://ibis.health.state.nm.us/. Published March 2016. Accessed November 23, 2016.

2. U.S Department of Health and Human Services Office of Minority Health. Infant Health & Mortality - The Office of Minority Health. http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23. Published August 2015. Accessed November 23, 2016.

3. U.S. Census Bureau. QuickFacts: New Mexico. //www.census.gov/quickfacts/table/PST045215/35. Published July 2015. Accessed November 23, 2016.

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Nandi Andrea Hill, LM, CPM

Nandi Andrea Hill was born and raised in the Chicagoland area. She moved to Albuquerque, New Mexico June 2000, to become a Midwife. She had birthed her first baby in 1996, unplanned at her mother’s home. She decided in that moment to learn Traditional Midwifery. Moving to New Mexico allowed her to practice legally. Nandi birthed two of three children at home, in New Mexico, before becoming a professional labor support person/Doula in 2005. In 2006 she began her Midwifery Apprenticeship, and in 2012 she received credentials as a Certified Professional Midwife and Licensed Midwife . In that time, she also served as a representative for the International Center for Traditional Childbearing aka Black Midwives and Healers, and currently serves on ICTC’s Board. Nandi is also, one of founding members of the New Mexico Birth Justice Coalition. Nandi is a dedicated to educating and decreasing the high infant mortality rates in the Black community. She owns her own maternity care practice in Albuquerque, New Mexico.

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