Centering Pregnancy: Establishing an Inpatient Model at Duke (2021-2022)

Background

Preterm birth – delivery before 37 weeks gestational age – is a major cause of illness and death in newborn babies’ first month. In the U.S., about 10 percent of pregnancies result in preterm deliveries; rates are 48 percent higher among Black women.

About a third of preterm deliveries are preceded by preterm prelabor rupture of membranes (PPROM). Management of PPROM involves hospital admission to the antepartum unit until delivery, which can span months. While any hospitalization is stressful, spending a long time in the hospital before giving birth can be particularly difficult for patients, who must be socially isolated while they are facing a new diagnosis with an unpredictable course. These mothers have a shared experience of loss of their normal support systems, work and sense of autonomy.

Group prenatal care models such as CenteringPregnancy© have shown improved pregnancy outcomes and have been shown to reduce racial disparities in preterm births. In a pilot study of an inpatient centering model for the Duke Hospital antepartum service, women enjoyed being brought together to create a community. Participants had significantly longer pregnancies, with greater effect among Black women. There were also improvements in breastfeeding rates after the women gave birth.

Project Description

This project will adapt the CenteringPregnancy group model, traditionally used as an outpatient service, to an inpatient antepartum service by expanding a pilot study performed in 2019-2020. The team will develop and implement a sustainable inpatient antepartum intervention through Centering groups that can benefit both pregnant women and their babies by increasing length of pregnancy and breastfeeding rates. The intervention will also foster community in a way that supports emotional and mental well-being.

Providers will recruit current patients and enroll them in inpatient Centering groups. Prior to their first Centering session, patients will complete a survey to assess their emotional and mental state, preparedness for the Neonatal Intensive Care Unit (NICU) and plans regarding breastfeeding. 

Patients will participate in weekly one-hour virtual Centering group sessions. Sessions will consist of a brief mindfulness activity followed by discussion and education about a particular topic or concern. These could include common antepartum diagnoses, pregnancy loss, breastfeeding, coping with separation from family and caring for a NICU baby. Team members will be directly involved in the weekly sessions, rotating roles on a monthly basis.

Patients will then complete surveys at the end of their hospitalization and six weeks postpartum to assess their emotional/mental state and feeling of preparedness for caring for a NICU baby. Prior to discharge, patients will participate in an interview about hospital well-being and the impact of Centering participation. 

Team members will analyze the data to assess the association between Centering groups and patients’ emotional well-being, preparedness for infant care and use of breastfeeding. The primary quantitative outcomes will be length of pregnancy. Secondary outcomes will include factors of maternal morbidity such as sepsis, blood transfusion or readmission. These measures will be compared to controls in the Duke Hospital PPROM database. A racial subanalysis will be conducted to compare the outcomes across different groups.

Learn more about this project team by viewing the team's video.

Anticipated Outputs

Sustainable inpatient antepartum CenteringPregnancy model that can be implemented across other institutions; data for further research on antepartum service models; manuscripts and publications

Student Opportunities

Ideally, this project team will be comprised of 5 graduate students and 3 undergraduate students. Interested students will likely be from health-related, humanities or bioethics majors and programs. Prospective team members would be prehealth and in interdisciplinary medical-related fields. Bilingual members with Spanish fluency are welcome given the diverse population of patients we anticipate working with. Ideally one member of the team will be artistically gifted, to contribute to the art therapy component of curriculum design and design advertisement and recruiting for the project.

The interdisciplinary team will consist of graduate and undergraduate students, antepartum nurses, midwives, residents, fellows and attending physicians. Other team members include NICU physicians, lactation consultants, family support staff and social workers. The students and the Centering advisor will meet weekly to discuss each week’s Centering plan, and the entire team will meet monthly to discuss overall progress and feedback.

Students will participate in rounding with the antepartum service to recruit patients and lead the sessions, create flyers and publicize the sessions, develop the curriculum and conduct surveys and interviews. Students will have the opportunity to participate directly in research and will hopefully have the opportunity to submit and present their research for publication and/or manuscript submission. 

Graduate students will have the unique opportunity to strengthen their communication and facilitation skills by recruiting patients, working with an interdisciplinary team and leading Centering sessions. These students will also have the unique opportunity to receive Basic Facilitation Training.

Onyinye Ohamadike will serve as project manager. 

Timing

Summer 2021 – Summer 2022

  • Summer 2021 (optional): Complete Centering certifications; begin weekly Centering sessions with survey administration; begin analyzing data
  • Fall 2021: Continue weekly sessions and analyzing data
  • Spring 2022: Review charts of fall Centering patients; continue analyzing data; submit data to research conferences; begin to draft manuscripts
  • Summer 2022 (optional): Continue writing manuscripts; continue weekly Centering sessions

This Team in the News

Collaborative Team Awarded Bass Connections Grant for Centering Project

Crediting

Academic credit available for fall and spring semesters; summer funding available

 

Image: Donna Tuccero, MD, demonstrates an infant exam during a CenteringPregnancy® prenatal care session for expectant moms and those that have recently delivered in the Duke Family Medicine Center at Pickens Clinic, by Jared Lazarus/Duke University

Donna Tuccero, MD, demonstrates an infant exam during a CenteringPregnancy® prenatal care session.

Team Leaders

  • Sarah Dotters-Katz, School of Medicine-Obstetrics and Gynecology: Maternal Fetal Medicine
  • Namita Kansal, School of Medicine–MD Student
  • Shauntell Luke, School of Medicine–MD Student
  • Amy MacDonald, School of Medicine-Obstetrics and Gynecology
  • Onyinyechukwu Ohamadike, School of Medicine–MD Student

/graduate Team Members

  • Alice Darling, Medicine MD Fourth Year
  • Julia Moyett, Medicine-MD
  • Khaila Ramey-Collier, Medicine-MD
  • Linda Zambrano, Medicine-MD

/undergraduate Team Members

  • Isabella Coogan, Biology (BS)
  • Natalie Gulrajani, Economics (BS)
  • Saisahana Subburaj, Program II (AB)
  • Keri Tomechko

/yfaculty/staff Team Members

  • Kateena Addae-Konadu, School of Medicine-Obstetrics and Gynecology
  • Amanda Craig, School of Medicine-Obstetrics and Gynecology
  • Stephanie Lim, School of Medicine-Obstetrics and Gynecology
  • Sarahn Wheeler, School of Medicine-Obstetrics and Gynecology: Maternal Fetal Medicine