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Dougherty County CenteringPregnancy ®. A public-private collaboration to improve access to prenatal care and perinatal outcomes For Low-Income Women. Jacqueline H. Grant, MD, MPH, MPA Southwest Health District Director. Objectives.

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Dougherty County CenteringPregnancy®

A public-private collaboration to improve access to prenatal care and perinatal outcomes For Low-Income Women

Jacqueline H. Grant, MD, MPH, MPA

Southwest Health District Director


  • Describe the barriers to early entry into prenatal care for South Georgia low-income women

  • Review baseline birth outcomes data

  • Provide an overview of the CenteringPregnancy® model and steps towards implementation

  • Describe the public-private collaboration

  • Demonstrate its effectiveness

Barriers to Early Prenatal Care Access

Presumptive Eligibility Medicaid

Documents needed for Medicaid

birth certificate

picture identification card (16 and older)

proof of address

proof of family income

proof of pregnancy

Schedule and keep NOB appointment

Historical Perinatal Data

baseline OUTCOMES

Infant Mortality Rankings (Ascending) 1960-2002; Selected Countries (Health United States 2005)

Infant Mortality Rates 2004-2008

IMR= no. of infant deaths <1 yr/live births x1000


Georgia: 13.1

SWHD: 11.8

Baker: *

Calhoun: *

Dougherty: 12.6

Lee: 14.9

Mitchell: 9.4

Terrell: 15.4

Worth: 9.9


Georgia: 6.1

SWHD: 7.6

Baker: 0

Calhoun: 0

Dougherty: 11.3

Lee: 6.3

Mitchell: 7.2

Terrell: *

Worth: 11.1

% Low Birth Weight*: 2004-2008

*LBW %= % of births <2500 grams


Georgia: 14.1

SWHD: 15.6

Baker: 16.7

Calhoun: 13.6

Dougherty: 15.3

Lee: 14.3

Mitchell: 15.2

Terrell: 20.0

Worth: 15.1


Georgia: 7.1

SWHD: 8.0

Baker: *

Calhoun: 7.5

Dougherty: 9.0

Lee: 6.6

Mitchell: 8.2

Terrell: 10.1

Worth: 9.5

% Preterm Birth (PTB): 2004-2008

PTB=births before 37 completed gestational weeks


Georgia: 17.5

SWHD: 17.9

Baker: 25.0

Calhoun: 18.5

Dougherty: 17.6

Lee: 15.2

Mitchell: 19.4

Terrell: 19.8

Worth: 18.7


Georgia: 11.7

SWHD: 13.6

Baker: 8.6

Calhoun: 13.8

Dougherty: 13.8

Lee: 13.4

Mitchell: 14.7

Terrell: 18.1

Worth: 17.7

Steps Towards Centering

Developed the care delivery concept and applied for start-up funding

Selected centering team

Developed protocols including exclusion criteria

Team training

Staff preparation

Centering Health Institute

Made the case for centering with collaborating practices and partners

Purchased equipment, supplies

Mastered Scheduling

Collaborating Practices and Partners

Albany Area Primary Healthcare (Miriam Worthy Clinic)

Veranda Ob/Gyn

Phoebe Family Practice Residency Program

Phoebe Putney Memorial Hospital (childbirth/lactation and maternal outreach educators)

Karen Ryals, independent yoga instructor

Centering Health Institute

March of Dimes

Healthcare Georgia Foundation

Why Centering?

Evidenced-based model of group prenatal care

Study participants with similar demographics

Assessment (prenatal care)



Empowerment through knowledge and building skills

March of Dimes support

Essential Elements of Centering

Women involved in self-care

The “check-up” occurs within the group space

The group session is conducted in a circle

Group session not a class with an overall plan

Every person’s contribution adds to richness of group

Groups have 6-10 members all due within 4 weeks

Two hour sessions at routine prenatal care interval

Stability of group leadership


  • Women do self-monitoring of weight & blood pressure

  • Calculate weeks of pregnancy

  • Write in personal chart

“I love the fact that I get a lot of hands on experience”

Centering patient

The Prenatal Check-up

  • Individual physical


    within group space

  • Done by a licensed healthcare provider

“This is the first time in my life that I actually look forward to going to the doctor”

Centering patient

Educational Sessions

  • Facilitated sessions

  • Fun and Interactive

  • Everyone participates

“We learn more about what’s going on with our baby than we would be at a regular ob/gyn”

Centering patient

Educational Sessions

  • Nutrition and infant feeding

  • Oral health

  • Prenatal yoga for stress reduction

Educational Sessions

  • Family planning

  • Birth preparation and recovery

  • Newborn care


Centering patient

I like “having the company of other pregnant women around my age group that I can share my experience with”

Dougherty County CenteringPregnancy®

The DATA AS of 8/23/12

New Obstetrical Examination

227 new obstetrical (NOB) examination visits

Mean gestational age at NOB: 11 weeks

Mean maternal age at NOB visit: 22.4 year

Maternal age range: 13-44

Maternal Characteristics: Race

Maternal Characteristics: Ethnicity

Maternal Characteristics: Marital Status

Maternal Characteristics of CenteringPregnancy® Patients

Maternal Characteristics: Insurance

Maternal Characteristics: Medical

  • Majority nulliparous

  • Slightly less than 3% had a prior preterm birth

  • 25% were treated for sexually transmitted infections

  • 19% reported tobacco use and 10% tested positive for marijuana

  • Nearly a third were anemic

  • 18% were treated for asymptomatic bacteriuria

  • 5.6% reported depression

  • 4.5% had sickle cell trait

  • 6.1% developed gestational diabetes

Percent of Patients Attending No Sessions


Percent of Centering Patients Attending<3 Sessions

Delivery Outcomes

Centering: 2009-

Georgia : 2008-2010

Delivery Outcomes: Preterm Birth %

Delivery Outcomes: Low Birth Weight %

Breastfeeding Initiation Rates

Centering Patients

Dougherty County WIC

Patient Feedback

  • Average program rating: 9.5, scale of 1-10

  • Men in the group? 96% said yes

  • Rather have visit conducted in an exam room?

    • 89% said yes

    • 9% said no

    • 2% said either

  • 97% said they learned a lot about prenatal care

  • 93% felt they were well prepared for labor and delivery

  • 91% felt they were prepared to take care of their newborn

District 8-2 Centering Staff

Jacqueline H. Grant, MD, MPH, MPA

Karen Baker, F-NP

VaLenia Milling, RN

Denise Linnekohl, RN, BSN

Nancy Rumph, administrative assistant

Nettie Lilly, clerical/outreach worker

Sarah Shriver, WIC nutritionist

Lisa Malmquist, CNM (contract)

Vanessa Jones, F-NP

Christina Montelongo, program assistant/interpreter

Sheena Hargraves, LPN (interpreter)

Lupe Meade, LPN (interpreter)

Sharonda Barlow, MSW

Questions or Comments?

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