Clinical Innovations

Centering Pregnancy Program at UC San Diego Health Provides Exceptional Group Prenatal Care for Improved Pregnancy Outcomes and Customizable Birth Choice

UC San Diego Health's Centering Pregnancy Program is a community-wide highlight discussed here by Dr. Alice Sutton, Medical Director. Karen Perdion, Certified Nurse Midwife (CNM), Director of Nurse Midwifery Services, realized her vision to bring group prenatal care to UCSD in 2021. Since then, over 53 babies have been born to parents participating in Centering. Centering Pregnancy is an evidence-based model for prenatal care that has been shown to improve pregnancy and postpartum outcomes and decrease health disparities. Participants report benefits including strengthening of partner relationships, a better understanding of pregnancy, and increased self-efficacy. Centering Pregnancy fosters a sense of community that is highly valued by expectant parents. One UCSD participant wrote:

"It was so helpful to have conversations with other women going through the same things at the same time.  It was incredible, I would recommend it to anyone having a baby!" 

In a demonstration of the power of Centering to build community, the inaugural group of Centering Pregnancy patients returned to UCSD in October 2022 to participate in a panel discussion during Grand Rounds to celebrate the first anniversary of the Centering program. Their lively discussion and palpable bond was later captured by UCTV’s Motherhood Channel in this program that won a Bronze Telly Award. 

Centering also improves the health care provider experience by disrupting the usual prenatal care paradigm. Instead of repeating the same advice during a series of 15-minute return obstetric visits, Centering facilitators enjoy longer visits with their groups and the opportunity to foster conversation around important health issues.  The midwives facilitating Centering groups find the program is economic, efficient, and empowers patients to take charge of their care while still delivering the comprehensive support, prenatal screening, and pregnancy risk assessment that is a hallmark of prenatal care at UCSD.

Centering Framework

Centering groups are composed of 6-10 patients with similar due dates. Patients have at least one individual early pregnancy visit to confirm pregnancy dating, review their health history, and assess eligibility for group prenatal care. Each group typically meets 9 times, and the participants receive a schedule with the dates and times for all future meetings upon entry to the program.  In a Centering visit, the first half hour is a time for patients to socialize and take turns checking and recording their blood pressures, while the CNM and MA co-facilitators briefly check in with each patient and measure fundal height and fetal heart tones. Afterwards, the group assembles to do an opening activity and then moves on to a discussion of one or two key topics the facilitators have pre-selected based on gestational age. For example, during the first visit the group often discusses nutrition during pregnancy and common pregnancy discomforts and options for management. Participants can also bring their own concerns to the group for discussion. The session often closes with a mindfulness activity.

Meet the Centering Leadership and Team

Alice Sutton, M.D.
Medical Director

Vanessa Wright, CNM, WHNP-BC
UC San Diego Midwife
Reproductive Medicine
Centering Lead Facilitator

Karen Perdion, MSN, CNM
Centering Program Director
Director Nurse Midwifery Service

Lizette Lozano, MHA
Community Women's Health Program Manager
Midwifery Division and NICU
Follow-Up and Early Development Clinic

UCSD's First Centering Group with Vanessa Wright, CNM

Centering Framework

Centering groups are composed of 6-10 patients with similar due dates. Patients have at least one individual early pregnancy visit to confirm pregnancy dating, review their health history, and assess eligibility for group prenatal care. Each group typically meets 9 times, and the participants receive a schedule with the dates and times for all future meetings upon entry to the program.  In a Centering visit, the first half hour is a time for patients to socialize and take turns checking and recording their blood pressures, while the CNM and MA co-facilitators briefly check in with each patient and measure fundal height and fetal heart tones. Afterwards, the group assembles to do an opening activity and then moves on to a discussion of one or two key topics the facilitators have pre-selected based on gestational age. For example, during the first visit the group often discusses nutrition during pregnancy and common pregnancy discomforts and options for management. Participants can also bring their own concerns to the group for discussion. The session often closes with a mindfulness activity.

"When I first learned about Centering, I had trouble imagining how this would work. Would I trust patients to check and record their own vital signs? Would patients want to participate in 2-hour sessions? Would a group discussion of a sensitive topic spread medical misinformation? During facilitator training, I discovered that patients are empowered to manage their own health when they learn to check their vital signs. I also learned techniques for facilitating a discussion so that patients can teach each other accurate and appropriate information. Finally, I have observed that while the initial time commitment for Centering seems large, a visit that begins and ends promptly and is scheduled well in advance is more convenient than the traditional prenatal schedule for many patients." – Dr. Alice Sutton

 
CNM Annie Cooper's Centering Group Reunion

Creating and running Centering Pregnancy requires a group effort! Each Centering group at UCSD is led by two facilitators, a Certified Nurse Midwife (CNM) and a medical assistant (MA). The skilled CNMs and MAs selected for participation attended a 4-day intensive workshop to become Centering facilitators before the program was launched. The program is led by Program Manager, Lizette Lozano, and Centering Steering Committee members Vanessa Wright, CNM, Karen Perdion, CNM, and Alice Sutton, MD.

The Centering Pregnancy Program is located in a dedicated clinic space in central San Diego at the Kearny Mesa Clinic. If you are a patient interested in Centering, or a provider who would like to refer a patient, please contact midwifery@health.ucsd.edu. For more information about Centering and/or Midwifery at UCSD, visit Centering Pregnancy and Certified Nurse-Midwife Services. Centering Healthcare Institute is a national organization that provides accreditation, training and support to individual institutions. More information can be found at centeringhealthcare.org.