Reducing infant mortality in Cleveland by ‘centering’ on prenatal care

Sierra Germany, 23, expecting her second child, arrives at her prenatal appointment at 8:30 a.m. with her small son in tow. She grabs a bite to eat, takes a seat on the couch, and chats with the other mommies-to-be. Her son starts to play with another little boy attending with his mom.

Doesn’t sound like your typical prenatal check-up? That’s because it isn’t.

Germany and the others, all around eight weeks, are participants in the University Hospitals Rainbow Center for Women and Children’s CenteringPregnancy sessions. This form of prenatal care combines traditional checkups with additional time and attention in a group setting. An expecting mother will meet with her team of health-care providers as well as other women who are due near the same time for 10 two-hour sessions. The program is a way for the mommies-to-be to share learning experiences and to be involved in their own care.

<span class="content-image-text">An expecting mother will meet with her team of health-care providers as well as other women who are due near the same time for 10 two-hour sessions.</span>An expecting mother will meet with her team of health-care providers as well as other women who are due near the same time for 10 two-hour sessions.Germany participated in CenteringPregnancy with her first child.

“Every pregnancy is different,” she says. “But with the networking, you learn a lot. It gets your mind prepared for the best and the worse. It gets you prepared for labor and delivery, keeps you in a positive mindset.”

During her first birth, Germany experienced a lot of aches and pains and remained in labor for 14 hours without medication. She eventually had to undergo a Cesarean section.

“Centering helped me be prepared for the C-section,” she said.

So when she became pregnant a second time, she immediately called to inquire about going through CenteringPregnancy again and was welcomed back.

“It’s a good way to connect with other mommies,” she says. “It’s a relief to have someone in your corner. I found it very beneficial and would recommend it to others. Any little piece of information will save the baby.”

Germany, who is studying optical technology at Cuyahoga Community College, is one of the more talkative women in her group. She even shared with them the importance of wearing their glasses, if needed, to prevent eye strain.

CenteringPregnancy provides access to lots of resources as well, such as baby clothes, formula, pack-and-plays and other vital services, she says.  

Several CenteringPregnancy programs operate in Northeast Ohio, but UH’s is the longest running, celebrating its 10-year anniversary this month.  

UH’s CenteringPregnancy groups tend to be a good mix of first-time and multiple-birth mothers, majority African American, with a small percentage of white and Latino, ranging from teenagers to women in their 40s. They are either referred to or recruited into the program.  

“When patients have been through the program and enjoy it, they tell their friends and family,” says Giancarla Gervais, a medical assistant and the program coordinator and lactation coach. She has been a part of the program since its inception and actually went through it during her most recent birth two years ago.

“The [younger moms] helped me a lot with learning about new apps and gadgets around infant safety and other products.”  

The program, at 5805 Euclid Ave., tries to break down barriers that keep people from prenatal care. “We meet people where they are. We don’t want it to be difficult. We provide transportation and allow them to bring their children. ... Sometimes they feel prenatal is a waste of time, only attending the ‘important’ appointments. They come here because of the support. The food helps, too.”

Fathers and other supporters are welcome to attend as well. “It’s a nice added piece. You’ll be surprised what [fathers] know. It’s helpful what they bring to the group.”

<span class="content-image-text">All moms receive a notebook where they track everything, including vitals, movement, notes on how they feel, and questions to ask.</span>All moms receive a notebook where they track everything, including vitals, movement, notes on how they feel, and questions to ask.What CenteringPregnancy sessions look like

All moms receive a notebook they are encouraged to read and bring to each session. They track everything in it, including vitals, movement, notes on how they feel, and questions to ask.

No question is off-limits. “This keeps them out of ER for common discomforts,” Gervais says.

During the sessions, a nurse, a midwife, and one or two facilitators are present. A social service provider may attend as well. Each mommie-to-be checks in with the nurse and then the midwife. After everyone checks in, they begin to discuss the topic of the day.

Subjects include nutrition, common discomforts, body changes, medication, stress management, breastfeeding, birth control, oral hygiene, parental roles, labor, delivery and whatever else comes up, including “old wives’ tales.”

“Even if she’s an introvert, she can get something,” Gervais says. “In one-on-one, it's so quick. She may want to share but could be rushed out. More care is provided in the group.”

The program even assesses the expecting mom’s mental health to determine if she’s experiencing any mood disorders. And, because physical activity is encouraged, participants are introduced to “Dancing for Birth.”

“Dancing for Birth” teaches movement inspired by belly, African, Latin and Caribbean dance. It helps women become stronger, more agile, and more at ease with their bodies. It also, both mentally and physically, prepares them to embrace their unique birth experience and provides healthy exercise for the mother during pregnancy and optimal positioning for the baby.

“We teach them a little bit, and they teach us as a staff, too,” Gervais says.

Additionally, for the first six weeks postpartum, the CenteringPregnancy staff reaches out to the new moms to see how they are doing, while registered nurse Santianna Huggins and a physician focus on pediatric care and parenting for up to 18 months.

Less than a year ago, the CenteringPregnancy team partnered with The Centers for Families and Children, which provides home visits to make sure the mother has the tangible things she needs in addition to adequate support and care, even stressing the importance of keeping up with their appointments, whether they are in CenteringPregnancy or not.  

If the mother has other children in the home, this provider makes sure she is linked to the Head Start programs at the Council for Economic Opportunities and elsewhere. They will also link her with the Ohio Department of Health’s Help Me Grow program.

“It bridges the gap between birth and developmental stages,” Gervais says. “It’s another piece to help with reducing toxic stress.”

The CenteringPregnancy program works closely with the Cleveland nonprofit Birthing Beautiful Communities as well.

Some women prefer privacy, so it depends on the patient when determining if the CenteringPregnancy model is best, says Amy Rogers, a certified nurse midwife.

“I enjoy it more. It’s fun and interactive,” she says. “I love to hear the “old wives’ tales.”

In labor and delivery, Rogers says, the nurses can tell a CenteringPregnancy patient a mile away.

Does CenteringPregnancy help reduce infant mortality?

They still are trying to come up with a better system for tracking rates of infant mortality, Gervais says, but have unofficially found decreases in women who participate in their program.

Last year, the goal was to see 500 patients, she says. They saw 478 and lost four babies. “That’s just the ones we know of, the ones that report back to us. We did have a long stretch of time with no [known] losses. It’s been a few years. The numbers are always low.”  

“There’s good evidence it lowers the rates of preterm delivery,” Rogers says.

“Patients feel more comfortable asking questions, and they learn how to better advocate for themselves and their children,” she says. “Information is key. [CenteringPregnancy] allows a lot more information to be transferred. And it’s tailored to their needs. We’re able to cover a lot more stuff, a variety, and what’s important to the group at that time.”

It’s great for first-time moms, who can benefit from mothers of multiple births, Rogers says. “A lot of women are not so sure if it is for them. We ask them to try it once, and if they don’t like it, they don’t have to come back. A lot who think they won’t like it come and end up staying.”

Carmeshia Cody, 36, is expecting her first child. She suffered from fertility issues and received help conceiving. “I came to learn more about everything I could experience before and after she gets her,” said Cody, who is 31 weeks.

She started attending the CenteringPregnancy sessions at UH in December 2019. “It’s a good experience. I get to be around other women close to my due date and learn different things.”

She’s learned about birth control and breastfeeding, something she plans to do.

“Any woman going through pregnancy and is offered ‘Centering’ should give it a try. You might enjoy it and learn a lot of things,” she said.  

This story is part of a reporting collaborative called Beauty for Ashes, funded through an Informed Communities grant from the Cleveland Foundation, Akron Community Foundation, Knight Foundation and The Center for Community Solutions.

Rhonda Crowder
Rhonda Crowder

About the Author: Rhonda Crowder

Rhonda Crowder worked as a general assignment reporter for the Call and Post Newspaper for 11 years and has served as associate publisher of "Who's Who in Black Cleveland" since 2013. She currently runs a creative services agency, is VP of print for the Greater Cleveland Association of Black Journalists, and coordinates Hough Reads literacy initiative. Her debut novel is titled "Riddles."