By NANCY FRAZIER O'BRIEN
When Isel DelVillar had a prenatal visit before the May 3 birth of her second son, Jeriel Torres, she knew she would have plenty of time to discuss her concerns.
That's because after a private meeting with certified nurse midwife Michelle Djevharian to check her vital signs and the baby's size and weight, DelVillar joined with 10 to 12 other mothers-to-be for a group session lasting about an hour and a half and focusing on a variety of topics.
The session is part of the Centering Pregnancy program at the St. Joseph Medical Center Downtown in Reading, Pa. It combines health assessment, education and support into one program that gives women up to 20 hours with their health care provider over 10 sessions, compared to the usual snippets of 10-minute prenatal visits and separate childbirth classes.
Isel DelVillar and son Angelo Torres await the start of a Centering Pregnancy session.
"There are a number of things that come up that would never come up during a normal prenatal visit," said Djevharian. "For example, this morning we talked about spanking and whether it is child abuse. You never would talk about that at all with routine prenatal care."
At another session, participants talked about their five-year plans and "thinking ahead about your actions," she said. "On a one-on-one doctor's visit, you don't get that."
The mothers-to-be also get assorted perspectives on child-related topics from infant feeding to postpartum depression to how parents plan to divide up the duties that come with a new addition to the family. Guest speakers demonstrate crib safety, how to give infant CPR and breast-feeding techniques.
About half of the participants in a typical class already have children, so they become teachers too, Djevharian said. Some come with their partners and some bring along their children.
The mothers-to-be meet other women with similar due dates, giving them the opportunity to establish relationships that can provide ongoing mutual support after the births.
The best thing about the program, according to DelVillar, is that "you get to spend more time with the doctor and you get to chat."
Sometimes other women raise questions that "you didn't think to ask" or were not comfortable asking, she said. One woman's question about how to deal with pregnancy-related constipation prompted much discussion and many suggestions, for example.
Improved outcomes The Centering Pregnancy model began at Yale University in the 1990s, and the model also has been applied to well-woman care and well-baby care. There are now more than 125 certified centering clinical practice sites nationally for prenatal care, well-baby parenting and well-woman care.
"Through this unique model of care, women are empowered to choose health-promoting behaviors," according to the website of the Centering Healthcare Institute. "Health outcomes for pregnancies, specifically increased birth weight and gestational age of mothers that deliver preterm, and the satisfaction expressed by both the women and their providers, support the effectiveness of this model for the delivery of care."
The American College of Nurse-Midwives says in its position paper on group prenatal care that programs like Centering Pregnancy "maximize women's potential for self-empowerment, growth and lifestyle changes, all resulting in improved perinatal outcomes."
Djevharian, who has two children of her own, ages 2 and 5, began offering the Centering Pregnancy program at St. Joseph last summer. She leads separate classes in English and Spanish.
Building a healthy community The Centering Pregnancy program fits with the population-based approach to health care being pursued by St. Joseph Regional Health Network at its St. Joseph Downtown Reading campus, an urban outpatient facility that operates on the patient-centered medical home model. Shared medical appointments for patients with the same condition, diabetes for example, are part of its approach to leveraging health care resources to provide expanded access to cost-effective care in medically underserved areas.
In addition to diabetes care and prenatal care for underserved patients, the network's "Creating a Healthier Community" multiyear initiative offers obesity programs and self-esteem and fitness programs for elementary and junior-high girls.
A recent community health needs assessment mandated by the Affordable Care Act and conducted by the St. Joseph network and four collaborating organizations found that one in seven adults — or 44,000 people — in Pennsylvania's Berks County has been diagnosed with diabetes. Nearly one-third of adults in Berks County are obese and another 35.9 percent are overweight.
The assessment also found "cultural and linguistic factors that lead to disparities in accessing essential health care, particularly for the Hispanic and Latino community.
"Residents of the city of Reading, blacks and Latinos are in poorer overall health, are more likely to be obese and are more likely to have diabetes, high blood pressure or a mental health condition than other residents," the report said.
At a February news conference, the St. Joseph Medical Center Foundation announced $726,000 in grants designed to meet the unique linguistic and cultural needs of the Hispanic and Latino communities in Reading through the Creating a Healthier Community program.
"The health status issues in Reading, as raised in the needs assessment, cannot be addressed without more effective, comprehensive and collaborative approaches to primary care," said Sharon Strohecker, vice president of clinical services and chief nursing officer at St. Joseph.