Prospective parents often know very little about their lives will change once they have a child. Centering is a form of care that can help them with this during pregnancy and when they become young parents. In a group setting they play an active part in the care process. This bears fruit for both clients and healthcare providers.
CenteringPregnancy is a form of group prenatal care that has been developed in the United States to promote the health and self-management of pregnant women, particularly those in deprived neighbourhoods. “I came across this method and it immediately sparked my enthusiasm. It seems crazy that we didn't think of this ourselves a long time ago,” says TNO researcher and midwife Marlies Rijnders.
Group of 8 to 12 pregnant women
It works like this: the individual prenatal check-ups that are customary in the Netherlands are replaced in CenteringPregnancy by group meetings. After the first consultation, which is an individual one, the subsequent check-ups during the pregnancy are offered to a group of eight to twelve pregnant women – with similar due dates – in sessions lasting two hours. These are led by a midwife and a second counsellor. The medical check-ups, such as blood pressure and the baby's growth, are combined with a sharing of knowledge and experience, learning health skills and encouraging mutual support and friendship. “This creates much more time and attention for advice that fosters good health and for 'stupid' questions. The women swap knowledge that can be supplemented by the midwife as and where necessary. There is less transmission and information-giving than in a classical one-to-one consultation with a midwife,” explains Symone Detmar, Programme Manager Youth.
“Using this method enables us to meet several aims in one go: we can teach parents something, promote the health of their child and expand social networks”
From the States to the Netherlands
Whereas the American version has been developed specially for vulnerable groups, the Dutch version is for everyone. “With the help of a grant, we have been able to trial the CenteringPregnancy concept at three midwifery practices in Amsterdam-North, Amsterdam Bijlmermeer and Wageningen – each with a different type of client group,” tells Rijnders. “Trainers from the US have trained staff including the midwives involved, someone from the professional association and from the midwifery training course to use the CenteringPregnancy method. After the first pilots, we adapted the method, in consultation with the US, to suit the Dutch situation. We are continuing to adapt modules and the method is continuing to develop. A foundation has now been set up, with which as TNO we are closely involved, to monitor progress. It is great to see that more and more practices are starting to adopt CenteringPregnancy.” Something like a hundred midwifery practices have now been trained.
Cost-savings in healthcare
In practice, CenteringPregnancy delivers better outcomes for mother and child, compared to individual care. And has been enthusiastically received by healthcare providers and pregnant women. Yet it also faces obstacles. “Centering is not yet being reimbursed by the Dutch Healthcare Authority,” says Detmar. “The start-up phase, in particular, requires an investment of the midwives' time, and that is tricky without reimbursement. The continuance and further rollout of the method are therefore at risk due to the cost element. This is a missed opportunity: centering can ultimately lead to cost-savings in healthcare, because it can reduce medical interventions and referrals.”
“Centering is a wonderful model that is well suited to today's climate of joint decision-making and patient-centred healthcare”
Continuing into youth healthcare
“Ideally, I'd like to see this group care continued in the youth healthcare system (JGZ). We are currently trying to set this up with mother and baby clinics, under the banner CenteringParenting. It is a shame to see it stop after pregnancy,” says Rijnders. The concept is the same: in a group-setting, with the emphasis on peer support, community building, interactive learning and self-management. “Ideally, CenteringPregnancy and -Parenting would be combined. But for this, too, funding is proving a challenge, with various financial streams and responsible parties. Moreover, it requires a mind shift on the part of healthcare providers. Their training will need to address that,” thinks Detmar.
Centering in Amersfoort
Amersfoort is one of the municipalities where both CenteringPregnancy and -Parenting are practised. “Centering fits well with our aim to give children a good start,” explains Fleur Imming, councillor for healthcare, housing and neighbourhood amenities for the municipality of Amersfoort. “Using this method enables us to meet several aims in one go: we can teach parents something, promote the health of their child and expand social networks. I notice that there is a lot of support for it among healthcare providers. There is already evidence that it works. I would recommend to local councils that they give Centering a chance and commit funding to it.”
“I notice that there is a lot of support for it among healthcare providers. There is already evidence that it works. I would recommend to local councils that they give Centering a chance and commit funding to it”
Ideas about funding structure
Centering is well suited to TNO's aim to help children get a healthy start in life and to invest in ‘the child's first 1000 days’. “The Centering method has been adapted to suit the Dutch situation. Now our role is mainly to continue developing the method, to underpin it and perhaps to translate the approach to other domains. In addition, we are keen to incorporate an E-health component. Furthermore, we are contributing to implementation studies, we give advice and help come up with ideas about the funding structure. Centering is a wonderful model that is well suited to today's climate of joint decision-making and patient-centred healthcare,” concludes Rijnders.
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