Monday, July 12, 2010

Looking back at Centering Pregnancy

Donna at Banned from Baby Showers writes about her excitement that CenteringPregnancy is coming to her area. (You can read a description of Centering in her post, and learn more about the model at the Centering website.) That reminded me that I just finished the last visit for the Centering group I have been co-faciitating and have been wanting to write a post about the experience.

The group I worked with was led by a CNM, and co-facilitated with me and one other volunteer. (Like Donna mentioned, Centering was started by, and is most often facilitated by midwives, and is a great example of a midwifery model of care. However, I do know of family practice docs and OBs in our area who do Centering!) She was fabulous, an experienced Centering facilitator. My first vision of Centering was that a woman would ask a question, and the midwife would answer it so everyone could hear it and learn together. Instead, a woman would ask a question, and the midwife would turn it right around. "Oh, what helps with leg cramps? What's good for leg cramps, everyone? What do you do?" Oftentimes she never even gave her own answer to a question - the group did, finding their own answers and gaining confidence in the process.

She was also a real midwife, not shy about bringing up potentially delicate topics. "I have trouble sleeping," someone would say. She would turn the question back around to the group, and then at the end of all the suggestions she would say "" (It was actually a Spanish-speaking group so she would say "Y...el sexo?" which somehow was even funnier). I thought all these shy Hispanic ladies would just turn beet red and clam up - especially in the presence of their boyfriends/husbands - but instead everyone started talking. "But what if you don't want it? What if you do - how much is too much? What if you don't want him to even TOUCH you?" It was pretty funny and great to watch.

I kept wondering, in my didactic mindset, "When are we going to teach about birth?" I was all ready to break out the Childbirth Graphics posters. Instead, the midwife took the group on a hospital tour. She walked them through the halls and we took over a birthing room. We fetched birth balls and had the women try sitting on them. We got a squat bar and the midwife got up on the bed and got one of the women to pretend to catch her baby in different positions. She told us that the nurses know when a Centering mom is checking in because "She asks for a lot of stuff!" We had a reunion visit with another group whose babies were several months old, and they talked about requesting birth balls and how nice they were to labor on. I also discovered that the women in our group didn't know that they could decline to have students in their room, and we talked about the power they had to make decisions over what happened to them in their health care.

The women in the group were lovely. It was a fairly quiet group, but we had some nice discussions (not just about sex!) I did the reminder phone calls for each visit, and they started to recognize my number and answer the phone with "Bueno, Rebecca?" They had a lot of struggles - partners working far away, one deported while the group was happening, trouble finding work, difficulty navigating a new country and an unfamiliar language. But they were always so gracious and appreciative.

At the end of the last visit, we all stood in a circle. The midwife took a ball of yarn and wrapped the end around her wrist. She tossed it to the next person, who had to wrap the yarn around their wrist twice and say an appreciation for the group, or wish for the group. One of the women thanked the facilitators for taking the time to help them, because she felt like most people in the U.S. didn't. Another thanked the midwife for the personal care and attention, and said she was only sorry that this was the first time she was experiencing it, during her last pregnancy. At the end we were all linked by overlapping strings of yarn. We each cut the yarn close to our wrists and tied it up, a little blessing-bracelet from the group.

It was sad to say good-bye! There were a lot of hugs. I'm so excited for each person to have their babies, and to see them at the reunion visit in a couple of months. It really has been such a great experience. I'm already looking for another group to join. (Although another co-faciliator told me "Watch out, Centering can be habit-forming.")

If you can choose Centering care for your pregnancy, I highly encourage it! If you're interested in working with Centering groups, see if there are any in the area that need assistance. The Centering program I've been volunteering with depends hugely on volunteers as co-facilitators - it is based out of a community health center with minimal resources.

And just in case you don't catch this on the Centering website, Centering decreases preterm birth rates and increases breastfeeding rates. All this touchy-feely stuff isn't just touchy-feely - it is evidence-based and improving outcomes. And I really believe based on what I've seen that Centering helps women take control of their health care and be better self-advocates. I hope to write more soon about the Centering module I've been developing on health disparities - but that's another project for another day...

Edited to add: Amy Romano of Science and Sensibility mentioned in the comments that she recently wrote an article for RH Reality Check on how Centering can reduce our infant mortality disparities. Check it out!


Amy Romano said...

What a lovely post - thank you Rebecca! I followed a Centering group from start to finish as a student as well, and it was one of my most powerful learning experiences and made me a life-long Centering die-hard. I don't know if you happened to have seen my article last week on RH Reality Check. Here's the link:

I hope you're having a great summer!

Rebecca said...

I hadn't seen that post, and what a great post it is - I'm going to add the link.

Centering really is kind of transformative, isn't it? When I weigh the pros/cons of a future midwifery career, I now put Centering as a great big PRO, because one of the things I'm most concerned about is whether I would have the ability to really work in a midwifery model of care in conventional settings. Centering is proof that yes, it can be done!

Christie B. said...

I've noticed quite a few birth blogs mentioning that you can decline to have students in the room lately. It's great that people know their choices. As a newly graduated RN, I wanted to say how truly grateful I am to all of the women who allowed me to share in their births as a student. I do worry that if women choosing natural childbirth disproportionately decline health care students, there will be fewer providers capable of and experienced with caring for them. Choosing to allow a student to see and participate in your care is a wonderful gift to the student and to the women he/she will care for in the future. There are a lot of choices you can make between allowing a student full access and barring them completely. This could be something to think about and include in your birth plan.

From a less altruistic point a view, having a second pair of hands on your nursing staff can mean getting things you want more quickly (water, ice, new linens, help to the restroom, etc.) :-)

Rebecca said...

Christie: As a student of various kinds myself, I share your appreciation for patients allowing me to shadow during their care! I think it's great when women who are having unmedicated/physiologic births welcome students, and encourage them to do so if they're comfortable with it. With the Centering group, my main point was not that they should decline students but that they could decline students, which they weren't even aware of. What prompted our discussion was not the presence of a nursing student, but a group of medical students who were shuffled in for the previous birth of one of the group members. It frightened her that the room suddenly filled with people when the baby was about to come, and when she asked later what had happened (assuming there had been something wrong with the baby) she was told it was a group of students. That's the kind of thing that really bothers me. I think that Hispanic/immigrant/poor/etc. women tend to get taken advantage of - consciously or unconsciously the care providers think "Mrs. Smith the CEO won't be OK with students, so we won't ask her, but we don't even need to ask Mrs. Hernandez because she won't know the difference anyway".

Amy Romano said...

I agree - Centering makes it possible to do "real" midwifery with the whole range of populations. Thank you for documenting some of your experiences with the model here.