Who knew that prenatal care could be so much fun?

"Centering Pregnancy" is a prenatal care model that brings together a group of about 10 pregnant women who are having their babies at around the same time. The women meet throughout their pregnancy for about 10 shared prenatal sessions that usually last an hour and a half to two hours. Each also gets a quick individual checkup in a discreet corner where any medical problems that need more thorough or more private follow-up attention are identified.

I learned about Centering at an IHI conference a few months ago, and I have since done a bit of reading and had some phone conversations and emails with some practitioners (mostly midwives and advanced practice nurses). The idea overlaps a bit with "shared visits" that doctors have been using to treat chronic diseases like diabetes, but the structure is more "patient-centered" and prenatal care is of course usually more about wellness than disease management. A health care professional takes part, serving as a facilitator and making sure the essential health take-home points get brought out. But the moms-to-be do a lot to educate themselves and each other through their discussions. Groups are often run at clinics that serve young low-income, immigrant, or minority women. But not always—the model also draws older and more affluent women. I heard about a group of 30-somethings in Seattle that would continue their sessions over dinner, and later with their newborns at potlucks, healthy walks and reunions.

The midwives who work with "Centering" groups say the women—including low-income teens at high risk for premature births and low birthweight babies—love the visits and they and their babies do great. Some groups of potentially high-risk women have even transitioned into well-baby care groups and continued for another year or more. One study by public health researchers at Yale found that the "Centering" approach lowered the risk of preterm birth for inner city women aged 14 to 25 by one third compared to the traditional care model, and also encouraged more breast-feeding.  "Nothing has found a result like this," says Sharon Rising, founder and executive director of Centering Healthcare Institute in Connecticut, which among other things trains group facilitators around the country. Premature births of course are expensive, and place the child at risk for all sorts of physical and developmental problems.

"Sitting around and talking can make a difference. There's time to share joys and concerns, to build communities, to do creative problem solving," says Rising. She has found that young teen mothers who take part in the Centering approach are less likely to get pregnant again quickly. Positive peer pressure from the group probably reinforces some good habits, such as smoking cessation or good nutrition. The women also do "self-care" at each visit. They weigh themselves, take their blood pressure, etc.

A lot of the questions pregnant women have are common—about morning sickness, weight gain, nutrition, round ligament pain, indigestion, safe over the counter drugs, early contractions, etc etc. A group conversation is an efficient way to share information. The women get much more time to have questions answered—and they get to hear answers to questions that they hadn't even thought to ask. Also, instead of the women having to go around to other experts, for say nutrition counseling or lab work, the care comes to the group. Fewer things get delayed, overlooked, or otherwise fall into the cracks "We bundle the care," says Rising. "Everything comes to the group." One midwife I spoke to here in DC said she just found it so much more rewarding and interesting to spend these long chunks of time with groups of women, time that was so much richer and less predictable than quick visits answering the same routine questions.

Shared medical visits have also been used for conditions like diabetes, high blood pressure, and weight management. As a family doctor, Dr. Brent Jaster of JasterHealth Inc is building a practice that focuses on preventive care (including disease management) using nutrition and lifestyle changes in a group format. As a consultant, he helps other physicians implement shared models and says it can work for numerous clinical needs, including depression, high blood pressure, and chronic pain.

Think about geriatrics. One reason medical spending in the last six months of life is so high, Jaster says, "is poor planning. It's rarely because we expect the outcome to change. It's because we never asked the right questions." Frail elderly patients need face time with the doctor to discuss complex conditions, to understand choices, to deal with advanced directives. They may need things explained slowly, or repeated. But in a traditional model, an office visit may last only 10 or 15 minutes—and an elderly patient may need several minutes just to walk from the waiting room into the exam room. Particularly with patients who may travel far, or have difficulty arranging transportation, a long trip combined with a lengthy wait for a brief appointment is way more frustrating than a 90 minute shared session, with plenty of time for questions and answers, with a doctor and patients who have the same concerns. Given how isolated (and afraid) some of our elderly are, a group may also fill all sorts of social or emotional needs.

Expectant young moms like the social aspect too. Sharon Rising says sometimes her biggest challenge is getting them to leave and go home! "We have a ritual closing because people don't leave. We say , ‘The group is over now and we'll see you in two weeks.' That gets them out—even if they go hang out together some place nearby."