Health & Medicine

For some, prenatal care is a community affair

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Credit:

Deborah Svoboda

Irma Vásquez, far right, listens during a Centering Pregnancy session at San Francisco's Homeless Prenatal Program. The program collaborates with San Francisco General Hospital offering space for the hospital to hold its meetings.

This is not your typical doctor’s appointment.

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Once a month, Irma Vásquez goes for prenatal checkups at a clinic in San Francisco’s Mission District. But instead of getting the usual one-on-one care, she meets with 12 other Latina immigrant patients.

The women begin their appointment by taking their own blood pressure, weighing themselves and writing down the results. They take turns seeing a midwife in a makeshift exam area in the corner of the room. The midwife checks each baby’s heart rate and talks privately with mothers-to-be.

Next, the patients sit in a circle and talk, in Spanish, about everything from how to eat well to problems at home.

Finally, there’s group meditation — Vásquez's favorite part. “It clears your mind of all the things that are going on around you, going on outside,” she says. “It makes you more relaxed.”

Vásquez, from Mexico, says she’s under a lot stress at home. She lives in a cramped apartment with her husband and his entire family. She says the group appointments help.

Vásquez and the other women are a part of a group prenatal care program called Centering Pregnancy. Women with similar gestational ages meet, learn and have group discussions.

Studies show group prenatal care leads to better birth outcomes. Women who participate in Centering Pregnancy are more likely to breastfeed and attend prenatal care appointments, and they’re less likely to have postpartum depression and preterm births.

There’s another benefit: Centering Pregnancy is linked to fewer Cesarean sections, which saves money. For California births without complications, C-sections cost nearly twice as much as vaginal births.

Margy Hutchison, a midwife, started Centering Pregnancy at San Francisco General Hospital 15 years ago for patients like Vásquez. Hutchison noticed many of her Latina immigrant patients, sitting alone and silent in the hospital’s waiting rooms, had chronic stress or depression. “It was really clear to me that many of them were really struggling,” Hutchison says. “And patients I continue to see are struggling with the impact of social isolation.”

Hutchison wanted to connect them, especially considering that stress, social isolation and depression are linked to preterm births and low birth weight

Initially, it was hard to convince some patients to participate in group prenatal care.

“If a woman’s depressed, that may be the last thing she wants to do,” Hutchison adds. “She wants to curl up in a ball and stay home.”

That was the case for Karent Novela, a Mexican immigrant who moved to to San Francisco a year before she became pregnant. Novela didn’t speak English, and the only family she had in the United States was her husband, who works 12-hour days. She was depressed, and was in no mood to hang out with other women.

Also, the Centering Pregnancy program at San Francisco General Hospital is run by midwives, and that scared Novela. A year earlier, in Mexico, she had seen a midwife without medical credentials and had a miscarriage. Now in the US, she wanted to see a doctor.

But the nurses at San Francisco General were persistent. They assured her that their midwives were trained professionals.

“The nurse that was with me, she told me, ‘You might try it. If you like it, you can stay. If you don’t like it you can just keep coming to your appointments with your doctor. But you decide. It’s your decision.'”

Novela enjoyed the first session and signed up.

“Having people who speak my language ... who are from my same background, that changed me. It changed my life,” Novela says.

Novela isn’t alone. Most Latina midwifery patients at San Francisco General are now choosing Centering Pregnancy over one-on-one care. And most of these women say they would do it again with future pregnancies, according to hospital officials.

Laurie Jurkiewicz, a midwife who runs Spanish-language Centering Pregnancy groups at San Francisco General Hospital, says some US hospitals hesitated at first to launch Centering Pregnancy programs — mostly because, like San Francisco General, they weren’t setup for group prenatal care.

“It’s out-of-the box thinking, right?” Jurkiewicz says. “And so our struggle was we’d get a room, and we’d get kicked out of a room at the last minute. And the rooms weren’t very nice.” 

San Francisco General, the city's largest public hospital, eventually got its program off the ground by partnering with community clinics to use their space for the group appointments. Other hospitals are now doing the same, or even partnering with churches for meeting space.

Jurkiewicz says the partnerships have allowed Centering Pregnancy to flourish at her hospital. When they first established the program in 1999, there were no other prenatal programs like it on the West Coast. Today, there are 21 Centering Pregnancy programs in California, mostly at public hospitals, where over half the patients are Latino. It’s also growing nationwide, especially among high-risk, low-income populations.

Novela, the Mexican immigrant, says she has built a community with the other Latina immigrants from her Centering Pregnancy group. They now call each other for support.

“They didn’t have family, they didn’t have friends, and most of them had their first baby like me,” says Novela. “So I just feel like, 'OK, I’m not the only one who is having these difficulties. I’m not the only one who is suffering for this.' My way of seeing my situation changed. So I start to change.”

Novela says Centering Pregnancy shook things up in her life and pulled her out of her out of her depression. And that, she says, empowered her to be a better mom.

This story is part of our health coverage partnership with the Solutions Journalism Network.

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    Credit:

    Deborah Svoboda

    Laurie Jurkiewicz, a midwife at San Francisco General Hospital, consults a patient during a Centering Pregnancy session.

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    Credit:

    Deborah Svoboda

    Patients take their own blood pressure while a facilitator reviews their files during a Centering Pregnancy session at San Francisco's Homeless Prenatal Program, which collaborates with San Francisco General Hospital and offers space for the meetings.

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    Credit:

    Deborah Svoboda

    Casts of pregnant bellies line a shelf in the room where Centering Pregnancy sessions meet at San Francisco's Homeless Prenatal Program, which collaborates with San Francisco General Hospital and offers space for the meetings.

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    Credit:

    Deborah Svoboda

    A patient weighs herself during a Centering Pregnancy session at San Francisco's Homeless Prenatal Program, which collaborates with San Francisco General Hospital and offers space for the meetings.

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    Credit:

    Deborah Svoboda

    Laurie Jurkiewicz, a midwife at San Francisco General Hospital, listens listens for a baby's heartbeat during a Centering Pregnancy session at Homeless Prenatal in San Francisco.

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