Low-Income Latinas Turn to Group Visits for Prenatal Care

Once a month, Irma Vásquez goes for prenatal check-ups at a clinic in San Francisco’s Mission District. But her appointment looks nothing like a doctor's appointment. Instead of getting one-on-one care, she meets with 12 other Latina immigrants for a group visit.

The women meet at a community clinic and first take their own blood pressure, weigh themselves, and write down the results. Then 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 each woman.

Afterward they all sit in a circle and talk -- in Spanish -- about everything from eating healthy to dealing with domestic problems at home. Finally, there’s group meditation. Vásquez says this is her favorite part.

“It clears your mind of all the things that are going on around you, going on outside,” she says in Spanish. “It makes you more relaxed.”

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

Vásquez and the other women are a part of a prenatal care program known as Centering Pregnancy. Women with similar gestational ages meet, learn about self-care, and have facilitated group discussions.

Better Outcomes -- for Mom and Baby

Studies show group prenatal care leads to better birth outcomes when compared against standard care. Women who do Centering Pregnancy are more likely to breastfeed, at least initially, and attend prenatal care appointments. They’re less likely to have postpartum depression and preterm births.

And there’s another benefit -- Centering Pregnancy is linked to fewer caesarean sections -- and that saves taxpayer Medicaid dollars. For California births without complications, it cost nearly twice as much for c-sections than it does for vaginal births.

Midwife Margy Hutchison started Centering Pregnancy at San Francisco General Hospital 15 years ago -- for people like Irma Vásquez. Hutchison noticed that many of her Latina immigrant patients suffered from 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 says she would see these Latina immigrants sitting alone and silent in the hospital’s waiting rooms. She wanted to connect them.

“Experience has shown me certainly that this group of people benefit tremendously from being in group prenatal care,” Hutchison says.

Hutchison says many of these women were suffering from stress, social isolation or depression -- which are all linked to preterm births, low birth weight, and damage to children’s cognitive skills. But it was hard to convince the women to do group prenatal care at first.

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

That was the case for Karent Novela, a Mexican immigrant who moved to San Francisco a year before she became pregnant. Novela didn’t speak English, and her only family here --her husband -- works 12 hours a day. She was depressed and not in the mood to hang out with other women.

In addition, S.F. General’s Centering Pregnancy program is run by midwives, and that scared Novela. She had seen a midwife, one without medical credentials, back in Mexico a year earlier, and she had had a miscarriage. Now in the U.S., she wanted to see a doctor.

“When they told me about midwifes, my first thought was, ‘Midwives, that’s what we call in Mexico, parteras,’” says Novela. “Parteras are like the same in Mexico, but without any degrees or studies, just by their basic knowledge they deliver babies. So I just said, ‘No!’”

But the nurses at S.F. General were persistent. They assured her that their midwives are 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 signed up. She loved it.

“Having people who speak my language, and having people who are from my same background -- like, they don’t have family -- that changed me. It changed my life.”

Choosing Centering Pregnancy over Traditional Care

Novela isn’t alone. Most Latina midwifery patients at S.F. General are now choosing Centering Pregnancy over one-on-one care -- and 95 percent of these women say they would do it again with future pregnancies. Internal hospital data show that Centering Pregnancy patients are more like to attend prenatal care appointments than midwifery patients who get traditional care.

Laurie Jurkiewicz is a midwife at S.F. General who runs Centering Pregnancy groups in Spanish. She says some U.S. hospitals hesitated at first to launch Centering Pregnancy programs -- mostly because, like S.F. General, they weren’t set up for group prenatal care.

“It’s out-of-the box thinking, right?” says Jurkiewicz. “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.”

S.F. General got the program off the ground by partnering with community clinics and using their space for these group appointments. Other hospitals are now doing the same or partnering with churches for meeting space.

Jurkiewicz says the partnerships have allowed Centering Pregnancy to flourish at S.F. General. When they first created the program in 1999, it was the only one like it on the West Coast. Today, there are 21 Centering Pregnancy programs in California alone -- mostly in California public hospitals where nearly half the patients are Latino. It’s also growing nationwide, especially among high-risk, low-income populations.

Karent Novela, the Mexican immigrant, says she's 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.

Clarification: The open in the radio piece above suggests that Centering Pregnancy was founded at S.F. General Hospital. But S.F. General was the first hospital on the west coast to offer the program.