Today we are fortunate enough to be talking about
CenteringPregnancy with certified nurse-midwife,
Vanessa Wright. Welcome, Vanessa.
Thank you.
Thank you for joining us.
So glad to be here.
What is CenteringPregnancy?
CenteringPregnancy is group prenatal care,
where women who have the same
due dates all meet together and
they learn about
their pregnancy together and they go through
their entire pregnancy together in a group setting.
It's like a childbirth education class,
it's your routine prenatal care. It's wonderful.
It sounds like it builds in
a really nice support structure.
What is each visit like?
Each visit is two hours in length.
It starts at the same time and ends at
the same time every session.
That's wonderful that you're not
sitting in the waiting room
waiting for your visit to start.
You're not waiting if your provider's behind,
you can start and stop at the same time.
It's really nice to get
your day going and your time is valuable.
You'll come to your first prenatal group
and you will come in and you will take
your own blood pressures and
your own weights and
your own vital signs and you'll record them.
That way you're in charge of
your own prenatal care and recording
and you know exactly what's going on with your pregnancy.
What if I don't know how to collect
my own vital signs? That sounds intimidating. [LAUGHTER]
We will show you. [LAUGHTER] It's pretty easy.
You just will check your weight and
then you'll do your blood pressure and
she'll show you how to do it
and pushing the button and all that good stuff.
Then each session has its own set topic.
We'll meet together 10 minutes
and we'll have an opening,
a warm session, getting to know
everybody and it'll change every time.
Then individually you will have
3-5 minutes where you'll meet with a midwife.
We'll do tummy checks,
you can ask any questions.
Primarily, the questions that you
ask the provider we will put on
a whiteboard for the group to
discuss because everybody pretty
much has the same questions.
Am I gaining too much weight too quickly?
Am I feeling the baby move?
Things like that that we can all answer as a group.
After that, everybody gets back
together and we talk about
the discussion that people have in
the group topics for the day. It's wonderful.
The experience of CenteringPregnancy sounds like it
probably is very different from individual visits.
What would you say are the main differences between
individual prenatal visits such as
the traditional model versus
the CenteringPregnancy model?
I find that centering is very much like what I think
midwife free and it's a lot of education and
support and bonding with my patients.
In a 15-minute return OB visit you just
really don't have the time to get
to know your patients as well.
You still get in all of
the medical things that need to be done,
just the vitals and checklists,
but the actually knowing
how they're doing, where they are,
what their family dynamics are,
where they need support,
you really do get to suss that out in centering visits.
What if you have any individual questions for
your provider that you don't want to
discuss about with the whole group?
More intimate questions?
Yes. That will be discussed
with your provider at that time or
you can wait if it's something that's
more sensitive and more time-sensitive,
you can meet after the group to discuss individually.
The individual fundal height checks and heartbeats,
are those done separately? How does that work?
They're done individually.
There's about 20-30 minutes
built-in while the rest of the group is talking.
Individually I'll pull a person, say,
to come to the exam room for like three minutes
where I've already prepped the chart and any questions.
Have you scheduled your anatomy ultrasound?
Make sure that we've got the [inaudible]. These things
are individual to this patient.
Then we'll do the fundal height and we'll listen to
the baby's heartbeat and any questions
or concerns you have.
For example, our last group last month,
there was a lot of weight gain questions.
There were a lot of I can't feel the baby move yet,
all normal at their gestation,
and then we just brought it back to the group.
Nobody had any pressing questions that were
sensitive or that needed any additional things.
So after everybody has had
their individual time with a midwife,
then we meet as a group again.
From previous exam when I
worked elsewhere doing CenteringPregnancy,
we would have questions about
a possible sexually transmitted
disease testing and things like that,
which I met with after and I would say, "Okay,
I'm going to order that for you and I will
follow up with you after the results."
Just like our patient in clinic,
I would follow up with after when the results come in.
That's nice. There's still that opportunity for
[OVERLAPPING] care that you would
like to be private.
Yeah, and have continuity.
Yeah. Yes. At the very beginning,
we sign a little thing that it is
a group prenatal care and this
is a group session and it's
private and sacred and everybody is a safe space to
share information and thoughts
and feelings, it's wonderful.
If I'm a patient considering centering,
one of the things I might be thinking
about is just wanting to make sure
that I still get the
personalized medical care that I need.
How do you make sure that
that medical care is
achieved through the centering sessions?
Well, with centering, you do have
that individual one-on-one time with your midwife.
Then because you're going to have the same midwife
or provider throughout the rest of your pregnancy,
I am intimately involved in your care
and so I might try messaging you back
and forth more so than with
a regular prenatal visit where I'm seeing
multiple different people and you may not see
me for a couple of visits.
This way I'm seeing your labs,
messaging you, following
up on things that we talked about last session.
I think the continuity gives you
more personalized individual care by your provider.
About how many people are there in a group?
Some people may risk out or need more individual thing,
but we usually keep it 16-18 on average.
Currently, at UCSD we have a group of
six moms and no partners right now for the first session,
and their due dates are around November, December.
That group is really bonding well.
You mentioned that some women might
risk out of CenteringPregnancy.
What does that mean? How do I know if I'm
low-risk enough to be able to do it?
The criteria for the CenteringPregnancy program
involves just having a singleton pregnancy,
so one baby, relatively normal pregnancy,
straightforward, no high-risk pregnancy.
Your provider will go over that with you at
your new OB visit and
let you know that you're a good candidate.
The patients who are participating in
centering at this time at UCSD are all COVID vaccinated,
so that's can be rest assured may be a benefit for you
knowing that everybody that you're in
this group with has also been vaccinated.
Does having something like gestational diabetes or
chronic hypertension or a history of a C-section,
do those things require
that I do individualized prenatal care instead?
That is a really good question.
No, that does not prevent
you from doing CenteringPregnancy.
In the instance of gestational diabetes,
you will meet with our diabetes
and pregnancy program directors
and submit your sugars and
we'll go over them at your individual 3-5 minutes session
and follow up on the back-end.
Previous C-sections, you are eligible
for vaginal delivery if you so choose.
If you wanted to repeat C-section,
you can still come to centering.
For chronic hypertension,
we would co-manage you with a physician,
but that would just be a couple of visits
in addition to your centering program visits.
That's nice. I guess what I'm hearing is
that you will let me know if there's
the need for me to have
a higher level of individualized medical care.
Yeah.
I can still do CenteringPregnancy
and still get that additional care as needed?
Yes, and all that support.
If you need additional testing,
something comes up on
an ultrasound and you need additional something,
we'll be the primary prenatal care
and then any additional things we'll just
do and supplement as needed.
If I am a mom who is pregnant at age 35 or above,
I know that that makes me advanced maternal age.
Does that mean that I can't get my care by a midwife?
Do I need to see a physician? How would that be handled?
I would say majority of my patients are
advanced maternal age, geriatric.
It's my least favorite term.
Yes, that doesn't preclude you from
having midwifery care or CenteringPregnancy care.
It just means you may need that extra ultrasound or two
and some antenatal testing as
you get further into your pregnancy,
but still having CenteringPregnancy
as your base prenatal care.
For women that are doing CenteringPregnancy,
can you tell us about who are the facilitators running
the visits and what do they do? What's their background?
Right now at UCSD,
the midwifery group is spearheading
the CenteringPregnancy program and finally got it here.
Your sessions will be led by two co-facilitators.
One will be a certified nurse-midwife
and the other will be a medical assistant
and we will equally share
responsibility of the centering group.
You get your care as a provider from the nurse-midwife.
Nurse midwives, we have 14 here at UCSD currently.
We are all advanced practice nurses,
who specialize in midwifery and normal pregnancy.
I know that during the sessions you mentioned
that they will be done by
both certified nurse midwife and then
working with a co-facilitator, a medical assistant.
Yes.
What does that medical assistant's role
and does it differ from
individualized medical
assistant role for individualized care?
When you go to a regular visit,
a 15-minute regular OB visit,
you will have a medical assistant who will check you in,
who will record your vital signs,
and make sure your pharmacy
hasn't changed and things like that.
Then your provider will see you and do
your tummy check and listen to
the baby and ask any medical questions.
That's the same throughout the CenteringPregnancy.
The medical assistant will be inputting
the vital signs that you
are recording yourself into your electronic chart,
and the midwife will be doing your visit,
listening to fetal heart tones and fundal height.
But as for the group and the education of the session,
we will both be doing that part.
What would I do as a patient if I
was in a CenteringPregnancy group,
but I needed to see my midwife
either in between sessions or
if I missed a session, could I still see her?
Yes. Of course,
life happens and illness
and vacations and things like that.
The other benefit to centering is that you will have
your prenatal visits scheduled
out all the way through the rest of your pregnancy,
dates and times, and that won't change.
So you'll know when
your next visits are and
can plan accordingly and whatever.
But if you do miss
or are unable to attend the centering visit,
you can schedule a 15-minute visit
with your primary midwife,
the centering midwife, or another midwife.
I would of course make time for my centering patients.
But yeah, you can get it in.
What type of patient do you think benefits
the most from CenteringPregnancy?
I think anyone can benefit from CenteringPregnancy.
I worked previously at the Navy,
doing it in a lot of dependent patients
who didn't have any family
nearby and their partners were deployed,
and so it's a really great support system.
It's great for people who have had kids before,
and so just to
collaborate with other moms who are in the same boat.
It's great for people who just want
to have a sense of community,
and it's a wonderful place to meet people who have the
same literally experiences you're
going through at this moment in your life.
It does strike me, especially with
all the isolation so many of us experienced during COVID,
that childbirth is a time where women coming together has
been historically so important as part
of feeling supported and empowered during pregnancy.
How long has this model
of CenteringPregnancy been around?
For years, I'm not
100 percent on exactly how long it's been.
I know it's been at least 10 years,
maybe even 20. It's wonderful.
It does foster that sense of community.
A lot of people are displaced from their family,
who Midwest East Coast and they don't
have their core nuclear family here,
and this is a nice way to substitute and supplement that.
What are some of the things that patients
worry about before joining CenteringPregnancy?
Or what are some of the misconceptions
about CenteringPregnancy that you've heard?
I think that they're going to be
maybe forced to participate
or that it's going to
be feel awkward and put on the spot.
It's very organic and it's actually really a lot of fun.
Almost everybody communicates after
and have made a little network within.
Is the same provider involved for all of the sessions,
and then how does giving birth work?
Is it typically with the same provider?
Tell us [OVERLAPPING] about that, please.
That's a good question. Yes, it's with us.
It's continuity, so it'll be the same group.
Around the first and second sessions,
we may keep adding more people or people may decide
that it's not working for them or scheduling events.
But then after about the third session on and there
are 10-12 sessions for the rest of the pregnancy,
including the postpartum reunion,
it'll be the same midwife,
it'll be the same medical assistant,
and the same core group every single time.
You'll meet every month
just as you would in your pregnancy,
regular prenatal visits,
and then as you get further into your third trimester,
they meet more twice a month.
As for who, it's wonderful if I get to catch
babies of my personal centering groups
because we've definitely bonded,
but it's not always work out that way.
Whomever is on when
you go into laborers who will catch your baby.
Where do patients typically deliver?
Jacobs Medical Center. The midwifery patients
who are eligible and can deliver in the birth center.
Then if you don't want to do
the birth center and you would like
your epidural on admission,
you can have the midwives and
your particular provider on labor and delivery.
So you get that choice,
[OVERLAPPING] still, either way?
Yes. It's just like birth your way,
however you want it to go,
we're here to help support you.
That's great. Then how does the postpartum visit work?
The postpartum, it's very nice as
people obviously deliver whenever
babies are ready to come.
Sometimes patients will come with
their babies to visit
where most people are still pregnant,
and then they can talk about their experience
and how it went.
Then the postpartum reunion visit,
pre-COVID was a big potluck and we
would all eat and celebrate with all the babies,
and that's around 6-8 weeks after the due dates.
It's fun. We put the babies in a little circle with
their heads and then take pictures and it's just great.
Everybody's just talking about how everything went.
Then they make mommy groups
with each other and do play dates and things like that.
I imagined that breastfeeding support
is [OVERLAPPING] facilitated by this type of model?
Yes. It's just support all around.
It's lactation support,
birth support, and education.
We do make sure that everybody's doing well and
the babies are feeding
and any questions and things like that.
Tips and tricks for breastfeeding
are always shared at the postpartum visit.
Is there anything that I would miss out on by
not doing individualized prenatal care?
Waiting in the waiting room. I don't know.
[LAUGHTER]
When would I check my e-mails?
Or not have a kid on here, if you have other children,
you're like, this is my alone time.
I think it's nothing but benefit if
it works for your personality and your schedule,
it's a great thing all around.
Even people who are more introverted
or reserved and not so extroverted,
it's still a benefit.
You don't have to participate
completely to get the benefits.
You can just be more quiet and
participate at your comfort level.
Vanessa, thank you so much for taking the time
to tell us about centering and pregnancy today.
It really sounds like
an important step that UC San Diego Health is
taking towards supporting women in
a way that is actually very innate.
That community of women coming together to support
each other through their pregnancy
with the guidance of a skilled,
certified nurse midwife,
and the support of UC San Diego Health's medical system.
It sounds like a real opportunity.
Thanks so much for your time today.
It was my pleasure being here
talking about CenteringPregnancy. I love it.
Love CenteringPregnancy, and
I wish everybody could participate in it.
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