Background

Preterm birth, or 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. Of note, this rate is 48 percent higher among Black women.

About one-third of preterm deliveries are preceded by preterm prelabor rupture of membranes (PPROM). Management of PPROM often involves hospital admission to the antepartum unit until delivery, which can span weeks to months. Hospitalization is stressful for any patient, but prolonged admissions pose a uniquely challenging burden to pregnant patients who are often admitted with new diagnosis and an unpredictable course. These mothers admitted to antepartum share the experience of loss of their normal psychosocial support systems, time away from work, and sense of autonomy in their health decision-making.

In the outpatient setting, group prenatal care models such as CenteringPregnancy© have shown improved pregnancy outcomes such as decreased racial disparities in preterm births. No studies to date have attempted to apply the concepts of connectedness and group prenatal education in the inpatient setting. 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 team 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 and team members 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 and assessing their satisfaction with the content of our prenatal education topics for the week(s) that they attended. 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. We will also assess frequency of postpartum visit attendance. 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. A scoring system will be developed to assess patient satisfaction with the content, frequency, and design of the Centering sessions. 

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

Timing

Summer 2022 – Summer 2023

• Summer 2022 (optional): Complete Centering certifications; continue weekly Centering Sessions led by outgoing year 3 medical students while transitioning oncoming board members to leadership positions 
• Fall 2022: Continue weekly sessions and analyzing data compiled from surveys; finish writing manuscript about our pilot study; finish writing manuscript for medical education pilot; bring undergraduate students to labor and delivery for recruitment; begin undergraduate course concerning basics of obstetric care 
• Spring 2023: Consider logistics of transitioning to in-person sessions or continue with weekly Centering Sessions; submit abstract(s) to research conferences
• Summer 2023 (optional): Continue weekly Centering sessions; reach out to new Centering “experts” to create Centering curriculum for the year 

See earlier related team, Centering Pregnancy: Establishing an Inpatient Model at Duke (2021-2022).

Image: CenteringPregnancy® at Duke Family Medicine Center, by Duke Family Medicine and Community Health