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CENTERINGPREGNANCY® PROGRAM

IMPROVING ACCESS AND OUTCOMES IN THE SOUTHWEST HEALTH DISTRICT

DISTRICT AND CENTERING CATCHMENT AREA

Ware

Burke

Clinch

Hall

Laurens

Early

Lee

Bulloch

Floyd

Wayne

Charlton

Fulton

LongCoffeeWorth

Emanuel

Polk

Screven

Dodge

Troup

Carroll

DecaturCamden

Bryan

Grady

Harris

Dooly

Cobb

Glynn

Brooks

Wilkes

Colquitt

Liberty

Thomas

Appling

Gilmer

Jones

Bartow

Rabun

Irwin

Sumter

Echols

Fannin

Tift

Coweta

Telfair

WalkerUnion

Macon

Mitchell

Taylor

Lowndes

Elbert

Tattnall

Berrien

Washington

TalbotBibb

Hancock

Baker

Greene

Jasper

Stewart

MonroeUpson

WilcoxCrisp

Pierce

Pike

Brantley

Marion

Henry

Jefferson

Hart

Twiggs

Clay

Gordon

Gwinnett

Putnam

Murray

Heard

CookMiller

Toombs

RandolphBacon

Morgan

Terrell

Effingham

Walton

Wilkinson Jenkins

McIntosh

Cherokee

Houston

Chatham

Meriw

ether

Jackson

Turner

Banks

Paulding Oglethorpe

Atkinson

Johnson

White

Pulaski

Calhoun

Baldwin

Warren

Lincoln

Newton

Lumpkin

Richmond

Madison

Wheeler

Crawford

Columbia

De Kalb

Butts

Candler

Franklin

Evans

Haralson

Dougherty

Lamar

Lanier

Chattooga Pickens

Ben Hill

Forsyth

Jeff Davis

Towns

Whitfie

ld

Dawson

Semi

nole

Douglas

Bleckley

Oconee

Schley

Habe

rsh

am

Fayette

Barrow

Spalding

Catoosa

TreutlenMuscogee

Mont-

gome

ry

Taliaferro

Quitman

Glascock

Chatt

a-ho

oche

e

Clayton Rock

dale

Stephens

McDu

ffie

Clarke

Peach

Webster

Dade

8-19-2

7 5-1

9-3

5-26

10

2

1-2

1-1

3-1

4

3-43-23-5

9-1

3-3

8-2

Georgia Public Health Districts1-1 Northwest (Rome)1-2 North GA (Dalton) 2 North (Gainesville)3-1 Cobb-Douglas3-2 Fulton3-3 Clayton3-4 East Metro3-5 DeKalb 4 LaGrange5-1 South Central (Dublin)5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus)8-1 South (Valdosta)8-2 Southwest (Albany)9-1 Coastal (Savannah)9-2 Southeast (Waycross) 10 Northeast (Athens)

Problem Being Addressed• Barriers to early access to prenatal care for low-income women

▫ African-American women 14 county predominantly rural district, many counties no

obstetrician Loss of three high-volume OB/GYN Medicaid providers in

Dougherty, 2008 Dougherty County: 64% African-American Dougherty County accounts for a third of the district’s population Presumptive eligibility for pregnancy Medicaid not accepted by most

obstetricians in Dougherty County

▫ Hispanic women The District’s southernmost counties are agricultural hubs Colquitt County’s Hispanic population estimated at 14% - probably

significantly under-estimated due to a large number of undocumented Hispanic farm workers

Transportation issues June, 2010 – prenatal care for undocumented low-income Hispanic

no longer financed by the Babies Born Healthy (BBH) Program

What Is Centering?• National model of group prenatal care• Groups of 6-8 women whose due dates are in the

same month• Nine two-hour sessions

• Individual assessments• Facilitated discussions

• Sessions are fun and interactive• Time for socializing and refreshments• Sessions are held at the same intervals as

traditional prenatal care• Monthly until 28 weeks gestation• Every two weeks until 36 weeks gestation

What Is Centering?• Support people involved in sessions• Social Worker co-facilitates sessions

• More experience with depression, domestic violence and other social issues

• More likely to pick up on non-verbal cues related to some of these issues

• Patients participate in their prenatal care• Take their own blood pressure• Weigh themselves• Plot and monitor their weight• Wheel out their gestational age

Maternal Characteristics: Medical

Dougherty County Health Department•Slightly less than 3% had a prior preterm birth•30% were treated for sexually transmitted

infections•18% reported tobacco use and 15% tested

positive for marijuana •Slightly more than a third were anemic•18% were treated for asymptomatic bacteriuria•5.5% reported depression•4.5% had sickle cell trait•6% developed gestational diabetes

Maternal Characteristics: Medical

Ellenton Clinic•12% treated for sexually transmitted

infections•None reported tobacco use or tested positive

for marijuana •None reported a history of asthma•Over half were anemic•16% developed gestational diabetes•4% reported depression

Historical Perinatal Data

BASELINE OUTCOMES

District Perinatal Outcomes 2004-2008

% PTB % LBW0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%20.0% 18.2%

15.7%13.7%

8.4%

12.1%

6.8%NH BlacksNH WhitesHispanics

Breastfeeding Initiation Rates

39%61%

Dougherty WIC 2008

BreastArtificial

55%45%

Colquitt WIC 2011

BreastArtificial

Southwest Health District

Centering Data

Pre-term Birth Rates

Series10.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

8.8%

9.0%

12.1%

13.7%

18.2%

Dougherty CenteringEllenton CenteringDistrict HispanicsDistrict NH WhitesDistrict NH Blacks

Low Birth Weight Rates

Series10.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

5.3%

6.8%

8.4%

11.8%

15.7%

Ellenton CenteringDistrict HispanicDistrict NH WhitesDo Co CenteringDistrict NH Blacks


Dougherty CenteringDougherty WIC-FY 2014

75%

25% Breast feedingFormula

51%49%Breast feedingFormula


Ellenton Centering

Colquitt WIC-FY 2014

75%

25% Breast feeding

Formula 65%

35% Breast feedingFormula

CenteringPregnancy®: Expanding Services Through

the Use of Telemedicine

* Better coordination of services

* Easier access to subspecialists:• Maternal –Fetal Medicine• Cardiologist• Mental and Behavioral Health• Dermatologist

Access to telemedicine allows ultrasounds and Maternal Fetal Medicine consults to be done on-site

Through a partnership with Women’s Telehealth in Atlanta, Dr. Anne Patterson is introduced to each Centering group and included in facilitated discussions in sessions on pre-term labor and gestational diabetes via the telemedicine cart.

Southwest Health District CenteringPregnancy™ Program:

A patient-centered model for prenatal care that is expanding access to comprehensive

care and is making a difference!

QUESTIONS?