Community for Antepartum Patients (CAP) (2025-2026)

Background

Preterm birth, or delivery before 37 weeks gestational age, is a major cause of illness and death in newborn babies. In the U.S., about 10 percent of pregnancies result in preterm deliveries. 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. Pregnant people admitted to the antepartum unit often experience loss of their normal psychosocial support systems, ability to work and sense of autonomy in their health decision-making.

Preterm birth and PPROM disproportionately affect Black mothers in the U.S. Non-Hispanic Black women have nearly twofold greater risk for preterm birth compared with non-Hispanic white women. Causes for this disparity are multifactorial and poorly defined, but increased psychosocial stress and inadequate access to prenatal care for Black women are often cited as reasons.

In the outpatient setting, group prenatal care models 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 help mitigate psychosocial and socioeconomic factors contributing to preterm birth through free, in-hospital, structured educational and community-building opportunities (called CAP sessions) for antepartum patients.

This is a continuation of a previous Bass Connections project that adapted the CenteringPregnancy© outpatient group model to an inpatient antepartum service. The previous team facilitated 264 CAP sessions on the antepartum unit. The project has received consistent positive feedback, especially since returning to in-person weekly sessions. CAP sessions offer community and solidarity during what can be a stressful and isolating experience for patients.

Each week providers and CAP team members (medical students and undergraduates) recruit admitted patients for the weekly program. Interested patients then participate in a one-hour in-person CAP session held in the antepartum unit of Duke University Hospital. Sessions begin with introductions and a brief mindfulness activity followed by discussion and education about a particular topic or concern that is relevant to antepartum patients, such as common antepartum diagnoses, pregnancy loss, breastfeeding, coping with stress and separation from family, caring for a NICU baby or pelvic floor physical therapy. Each CAP session is attended by both a medical student and undergraduate team member, with rotating participation that allows all CAP team members to participate in the sessions.

This year, the project aims to double the number of CAP sessions offered, half of which will be dedicated to educating patients on relevant prenatal topics while the other half will focus on community-building through crafts and other activities. The team will also create a CAP booklet and pre-made packages of crafting supplies to distribute to patients.

Anticipated Outputs

Sustainable inpatient antepartum group model that can be implemented across other institutions; quantitative data on obstetric knowledge for undergrads; undergraduate curriculum on obstetrics with an interdisciplinary lens; possible manuscripts and publications

Student Opportunities

Ideally, this project team will include 2-3 graduate students and 3-4 undergraduate students interested in pre-health and in interdisciplinary medical-related fields. Bilingual members with Spanish fluency are encouraged to apply. In addition, one member of the team will ideally be artistically inclined and contribute to the art therapy component of curriculum design and design advertisement and recruiting materials for the project.

Team members will visit the antepartum service to recruit patients and lead the sessions, create flyers and publicize the sessions, develop curricula and propose new topics. Students will have the opportunity to participate directly in research and quality improvement projects if desired. Graduate students will also gain leadership experience. Additionally, students will have the opportunity to engage with the local organization Breastfeed Durham through a continuing partnership with the team.

In Fall 2024, the team will meet on Wednesdays and Thursdays from 3:30-4:30 p.m.

Students will meet weekly with the CAP team adviser to discuss each week’s CAP plan, and the entire team will meet monthly to discuss overall progress and feedback.

Timing

Fall 2025 – Spring 2026

• Fall 2025: Begin weekly undergraduate seminars; orient undergraduates to hospital sessions; read about the history of medical racism
• Spring 2026: Continue weekly undergraduate seminars; undergraduates will lead seminars and in-hospital sessions with guidance from medical students; complete project of choice; compile a literature review

Crediting

Academic credit available for fall and spring semesters

See earlier related team, Community for Antepartum Patients (CAP): Establishing an Inpatient Model for Group Prenatal Care at Duke (2024-2025).

 

_{Image: Centering Pregnancy at Duke was created to bring expectant mothers and families together during pregnancy, by Duke Health}