Centering Pregnancy Program Expands to Address High-Risk Groups

Approach integrates prenatal education with peer support

Innovations in Obstetrics & Gynecology | Winter 2021

 Lulu Zhao, MD

 Maria Shaker, MD

University Hospitals’ Centering Pregnancy program, started more than a decade ago, has traditionally focused on women with low-risk pregnancies. But a grant from the Ohio Department of Health is going to help UH physicians expand the already robust program to serve different high-risk pregnancy groups.

The Centering Pregnancy approach integrates prenatal education with peer support, helping expectant mothers to understand pregnancy and to prepare for labor and delivery.

“When you look at women who participate in Centering, they have much lower rates of preterm birth compared to standard care, the traditional one-on-one visits,” says Lulu Zhao, MD, an attending physician in the Department of Obstetrics & Gynecology at University Hospitals Cleveland Medical Center and an Assistant Professor at Case Western Reserve University School of Medicine. “They tend to be better educated about their bodies and pregnancy. They tend to have higher rates of vaginal birth.”

HIGH-RISK PREGNANCY GROUPS

With demonstrated positive outcomes in low-risk pregnancies, a UH team including Dr. Zhao and Maria Shaker, MD, a physician with the UH Rainbow Center for Women & Children and an Assistant Professor at the School of Medicine, wants to tailor the program to serve different high-risk groups. Dr. Zhao is looking at developing curriculum geared specifically toward pregnant women with substance abuse disorders, while Dr. Shaker is concentrating on pregnant women with high blood pressure, diabetes and obesity.

Dr. Shaker and Dr. Zhao are already providing obstetric care to pregnant women in these high-risk groups, but they are challenged by the time constraints of more traditional care delivery. These patients have complex needs, and in a single appointment, the acute concerns must be addressed first. Yet, there is still plenty of room for these mothers to learn about their bodies, pregnancy and giving birth.

The grant from the Ohio Department of Health will help the physicians develop new, targeted curriculum and ideally roll out the new programming in the fall of 2021. UH is taking a multidisciplinary approach to this project. The physicians will help provide obstetric guidance for the Centering Pregnancy program, but the team also includes Celina Cunanan, CNM, Division Chief of Nurse Midwifery at UH Cleveland Medical Center, nutrition support, a trauma-informed psychologist and addiction experts.

The new curriculum will be developed using evidence-based treatment for these high-risk groups, layering on a focus on interpersonal relationships and infant-maternal bonding.

TRACKING OUTCOMES

Once the new curriculum officially launches, the team will carefully measure its success. “We don’t have enough data to know how we can affect these other medical comorbidities with group prenatal care,” Dr. Shaker says.

The team at UH expects the Centering Pregnancy intervention will have a material impact on outcomes, but they will be carefully tracking the data to understand how.

CONTINUED INNOVATION

While Dr. Shaker and Dr. Zhao are still in the early stages of launching the expanded Centering Pregnancy program, they are already imagining the future possibilities. Dr. Shaker wants to bring an exercise physiologist on board to provide insight during prenatal care sessions. She also wants to add a patient representative to the team, so the women they are trying to help have a voice in the process.

“I think it is really important that we give them opportunity to help with the planning process,” Dr. Shaker says. “The program can be their own.”

Dr. Zhao hopes that the program can build relationships in the community over time. She envisions a patient coordinator connecting women with community partners that can help them find stable housing, obtain vocational training and more.

“We want to build some partnerships so we can really give them a warm hand off to a whole network of support services that can continue to help them live their best lives,” Dr. Zhao says.

The UH Rainbow Center for Child Health & Policy has been integral in winning the grant and keeping the project moving forward. “Everyone has ideas of what would help patients, but getting that accomplished is a whole other job,” Dr. Zhao says. “UH has been really great about lending us that support.”

Ultimately, Dr. Shaker and Dr. Zhao want this program to continue growing and evolving to provide support to the mothers who need it most.

“Pregnancy is a snapshot in time in a patient’s life,” Dr. Shaker says. “I want to be able to figure out a way that we can really influence them to adopt healthy behaviors during the postpartum period and beyond.”

Contact Dr. Shaker at Maria.Shaker@uhhospitals.org or call Dr. Zhao’s clinic at 216-675-6653 to learn more about how UH is expanding its Centering Pregnancy program.