Graduation Year

2011

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Public Health

Major Professor

Karen Perrin

Keywords

birth outcomes, group prenatal care, Hispanic, maternal weight gain, pregnancy

Abstract

CenteringPregnancy is a model of group prenatal care that replaces routine, individual prenatal care. The program brings women together into small groups to receive their care and prenatal education, and is based on three components: risk assessment, education, and support. The model is client-centered, designed to empower pregnant women and support persons, and involves the woman in small group discussions of 8-10 other women of similar gestational age. The group discussions provide support, help women educate each other, and invoke self-monitoring. Currently, there have been few publications that closely examined maternal weight and obesity and associated outcomes in women involved in CenteringPregnancy; and there are a limited number of studies that examined Spanish-speaking CP groups with Latinas. Therefore, the primary purpose of this retrospective cohort study was to compare pregnancy outcomes of Latina women who completed CenteringPregnancy in a public health clinic to women who completed individual care in the same clinic during the same time. The secondary purpose of this study was to understand perceptions of care among multiparous women who recently completed CenteringPregnancy and completed individual prenatal care in the past. Both quantitative and qualitative methods were employed to examine differences in pregnancy outcomes and maternal factors in both prenatal care groups, and to understand women's perceptions and experience in both CenteringPregnancy and individual prenatal care. A total of 487 patient charts were obtained for data collection (Intervention n= 247, Comparison n=240) and 10 women who recently completed CenteringPregnancy at the health department and completed individual prenatal care in the past completed in person in-depth interviews. The results indicated that there were no differences in infant birthweight or gestational age at delivery between the groups. Compared to women in individual care, women in CenteringPregnancy had increased odds of: having a vaginal birth as opposed to a primary cesarean section, aOR =2.57, (95% CI: 1.23-5.36), attending prenatal care visits, aOR=11.03, (95% CI: 4.53, 26.83), attending postpartum care visits, aOR=2.21 (95% CI: 1.20, 4.05) and formula-only feeding their infants, aOR=6.07 (95% CI: 2.57-14.31). Compared to women in individual care, women in CenteringPregnancy had decreased odds of gaining below the recommended amount of gestational weight, aOR=0.41, (95% CI: 0.22, 0.78). Qualitative findings indicated that women who complete CenteringPregnancy were more satisfied with their care, received more education and support and were more empowered to make decisions about their pregnancy and childbirth. The program provides a system of social support that encapsulates all types of social support to provide relief of stress, encourage positive relationships and empower women to help facilitate healthy pregnancies. CenteringPregnancy at the Pinellas County Health Department increased health care utilization and informed and empowered women through social support.

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