Sep. 28----
Nurse-midwife Margie Rickell posed a question to the group of seven or eight women, seated in a circle, all pregnant and all due this month:
What kind of birth did they want?
The women, their belly baby bumps obvious, stood up and lined up along an imaginary spectrum. On one end were a few who wanted to try to have a totally natural birth, closer to the other end were those who would have the anesthesiologist's number on their phone's speed dial if they could.
Most clustered closer to the middle. The exercise started a discussion that exposed differences in philosophies of giving birth. In the end, they sort of settled on the notion that there was no right way or wrong way. For each woman, it was about having the type of birth she wanted and having a healthy baby.
What brought the women together at VCU Women's Health Center is a concept of prenatal care called CenteringPregnancy that seeks to empower women with knowledge and support to make those things happen.
A key feature of the CenteringPregnancy model is group care, with women due around the same time having prenatal visits together, meeting in a room large enough to accommodate everyone. At those visits, the women do some of their own medical checks, weighing themselves and taking their own blood pressures, for instance. Other checks are left to the professionals -- a nurse-midwife or doctor sees the women one at a time, listening to the baby's heartbeat and measuring the woman's belly.
Another feature is discussion time. Whereas in a traditional one-on-one visit, a woman might get a few minutes to ask her doctor or midwife questions, Centering groups last more than an hour and discussions cover issues and concerns of pregnancy, childbirth and just about anything else the women want to talk about.
"The moms love it," said Rickell, a certified nurse-midwife who oversees the CenteringPregnancy program at VCU.
"We think it's the group support that makes the difference," Rickell said. "The group starts to jell and take over and become their own entity around session four or five. People say things like we are going to have to get pregnant together again."
Groups are brought together after the first trimester. Members meet monthly at first, then more often as they get closer to their due date.
The CenteringPregnancy concept was the idea of a nurse-midwife, Sharon Schindler Rising, who developed the model in 1994, basing it on work she did while at the University of Minnesota. Rising now runs the Centering Healthcare Institute, based in Connecticut, offering training and approving sites to offer the group model of care.
The program has a workbook guide with suggested topics for each session based on how far along the women are in their pregnancies.
"The actual sessions evolve based on the needs of the group," said Dr. Christine R. Isaacs, an obstetrician-gynecologist and director of midwifery services at VCU. Isaacs also facilitates groups.
"It's also flexible, so that if we happen to be at around 24 weeks and this is where we talk about discomforts of pregnancy, we have different ways of facilitating that discussion," Isaacs said. "It's a very interactive approach."
As of last week, all but three of the women in the group had given birth, sharing baby photos with the group by e-mail. A reunion meeting next month will bring them back together to show off their newborns.
Erin McGrath specifically sought out a CenteringPregnancy group after finding out she was pregnant with her second child. She was part of a Centering group when she was pregnant with her 3-year-old daughter, and liked the experience.
"It's really nice to be able to weigh yourself, take your blood pressure, be involved with the medical aspect," said McGrath, who recently moved to Richmond from Chicago.
McGrath is in a group facilitated by Rickell and licensed practical nurse Casandra Quinones. The other pregnant women in the group included first-time moms, another second-time mom and even a fourth-time mom.
At any one session, a range of topics are covered: Braxton-Hicks contractions, sleep problems, nutrition and nausea. At one session a physical therapist demonstrated how to stand up while carrying the additional weight of a baby. Another time the talk was on false labor. "Everybody is having contractions -- who is aware of them?" Rickell asked at one meeting.
Three hands went up. Braxton-Hicks contractions, she assured them, are normal. Drinking more water often helps.
When to worry?
"If you have more than six contractions in an hour, you need to be checked out," Rickell said.
At a different session, Isaacs is facilitator and time is spent discussing contraception. It's not too early to start thinking about it, Isaacs said.
The workbook includes exercises designed to help the women start thinking about how their lives are about to change. One exercise they do with their husband or partner focuses on family dynamics and expectations -- who will change the diapers, feed the baby, decide on birth control, decide on the number of children they have, for instance.
"The difference between what we are doing in Centering and what you get if you go to a series of Lamaze classes or Birthing From Within, we really try to cover the whole spectrum of pregnancy, birth and their whole lifestyle," Rickell said.
Contact staff writer Tammie Smith at TLsmith@timesdispatch.com or (804) 649-6572.
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