The waiting room at the obstetric office in Lake Saint Louis has been transformed. The rows of chairs are moved into a circle. The magazines pushed aside. A blanket covers the television.
In one corner, nearly a dozen patients — all about five months along in their pregnancy — take turns recording their weight and blood pressure. In another corner, behind a folding screen, a doctor listens to the fetus heartbeat and discusses any private concerns individually with patients.
The doctors at Midwest OB/GYN are using a growing approach in prenatal care shown to produce happier moms and healthier babies. They have taken the women out of the exam room by offering group appointments — an option the private practice has provided since August.
After taking a seat in the circle, the participants play a game that involves knowing each other's names and working together. Next they talk about finding ways to relax. Then they move on to a discussion about birth control options.
Participant Jess Rowan is in her second pregnancy. "I'm learning so much more," said Rowan, 27, of Warrenton. "Your doctor may go over these things, but they don't necessarily go into depth."
The office is using a model called CenteringPregnancy, and it's catching on in the St. Louis area thanks to a grant from St. Louis University to provide training. Fueling interest is research showing participants are much less likely to deliver prematurely, especially African-American women, and more likely to breast-feed.
"That really caught our attention," said Dr. Emily Sammons, one of three doctors holding group appointments at Midwest OB/GYN, where about 70 women — 30 percent of the eligible pregnant patients — have chosen to participate.
Studies also show that women in group appointments are happier with their care, better educated about pregnancy and more prepared for labor.
The discussion about ways to relax among the group at Midwest OB/GYN led to questions about the safety of using hot tubs and taking long baths. Nikki Hemmer, 31, of O'Fallon, Mo., said the experience is far different from the 10-minute prenatal appointments she had with her first child. "You could ask questions, but you knew they were rushing you," she said. "You knew they needed to move on."
Other participants said they like sharing their problems with understanding peers and learning answers to questions they might not have thought of.
"Before, I would sit in a waiting room and read a magazine. Then I would go to the (exam) room and wait some more," said participant Alicia Simpson, 27, of Warrenton. "I was bored."
In group prenatal care, the appointment lasts two hours. The group consists of about eight to 12 women, all with about the same due date. They meet together for 10 appointments, the first in the third month of pregnancy and the last one after the birth.
The participants set and monitor goals for their health. The women discuss a range of topics about pregnancy, labor and caring for a newborn — from dealing with common pregnancy discomforts to postpartum depression.
The group model is more satisfying for providers as well. Doctors say they are able to provide better care, and it's more fun. And prenatal appointments can get monotonous.
"We answer the same questions all day long. Whereas in group, we answer the question one time and we delve into other issue that we normally don't have time to discuss," Sammons said. "It helps me get to know my patients much better on a personal level."
Nurse-midwife Sharon Rising developed CenteringPregnancy more than 15 years ago while caring for pregnant women and teaching at Yale University School of Nursing. She began testing and writing about its benefits.
Growing interest prompted in 2001 the formation of what is now known as the Centering Healthcare Institute, which trains and supports providers in using the model. About 250 sites across the U.S. offer CenteringPregnancy with 25 more starting in the next six months, said Tanya Munroe, the institute's program services director.
"It's one of the only evidence-based interventions that can reduce the prematurity rate and be replicated," Munroe said.
FEWER PREMATURE BABIES
A 2007 study of more than 1,000 patients at two hospital clinics showed that women in group prenatal care were 33 percent less likely to deliver prematurely than those in individual care. When comparing just black women, those in group care were 41 percent less likely to have a preterm baby.
That's important news when one in every eight babies in the U.S. are born preterm, before 37 weeks' gestation. Premature birth is the leading cause of newborn death and babies who survive an early birth often face lifelong health problems.
Striking racial disparities also exist in preterm birth. The preterm birth rate is 17.5 percent among African-American women, compared to 10.9 among white women, according to the latest federal statistics. Black infants are also more than twice as likely to die in the first year of life compared to white infants.
Because of the model's potential to affect preterm birth, the March of Dimes over the past three years has provided more than $3.5 million in funding to cover the costs of training providers in CenteringPregnancy.
A March of Dimes grant to St. Louis University in 2009 expanded group prenatal care to eight different offices and clinics in the St. Louis area as well one in Springfield, Mo. Pamela Xaverius, community medicine researcher at SLU, said she was interested in bringing the program to the area because of dismal preterm birth rates in the city of St. Louis — 22.5 percent among black women, and 13.8 percent among white.
A separate March of Dimes grant to Ste. Genevieve County Memorial Hospital this year also aims to train more providers in rural areas. "We're anxious to spur its use even more across Missouri," said Mary Elizabeth Grimes, director of the Greater Missouri March of Dimes.
The teen clinic at Barnes-Jewish Hospital has provided CenteringPregnancy for 10 years. The March of Dimes grant helped expand the program two years ago to the hospital's adult clinic, said clinic coordinator Kate Barbier. Of the 66 adult patients who received group prenatal care last year, not one had a premature baby, she said.
Grace Hill South Health Center on South Broadway in St. Louis, which cares for patients regardless of their ability to pay, started group prenatal care two years ago through the grant. The patients in group care have seen a 27 percent lower preterm birth rate than those in individual care at the clinic, according to coordinator Annie Laws. Because of the success, the Grace Hill Soulard-Benton Health Center began a CenteringPregnancy program in September.
Research is under way to determine why group care produces healthier babies. Providers suspect a myriad of reasons: The group provides accountability and motivation. Women feel more in control of their health. Patients develop a support system. They feel less stressed. Care is sensitive to their needs, culture and background.
At the end of a recent group appointment at Grace Hill South, nurse practitioner Angela Scheifelbein asks each woman — one as young as 17 — to write down five things she loves about herself and five things that are going to make her a great mom.
Several women have talked about being scared, so Scheifelbein rolls out mats and dims the lights. She asks them to lie down, close their eyes and imagine they are at the hospital.
"Picture yourself strong, maybe in pain, maybe crying, maybe yelling, but strong ... ," she said softly. "Imagine how it's going to feel when they put that baby on your chest, and you get to meet your baby for the first time. ... Imagine whatever that baby needs you are going to be able to do, because you're strong."