American healthcare has a dominant, traditional paradigm: we go to the doctor, see him or her for a few minutes, get advice and prescriptions, and then we don’t see them again for weeks to years. While this is effective at preventing certain conditions and treating specific health problems, it is difficult to overstate how much of our health is not taken into account during these brief encounters. At such visits, we necessarily cannot take into account the vast majority of what we know determines our health: our diet, exercise, ability to afford medicines or access healthcare, and other personal factors are addressed only peripherally in such short visits.
Even more to the point, we now know that our zip code determines more about our health than our genetic code. Where we live—the safety of our neighborhoods, the quality of our employment, the availability of grocery stores, the trust we have in our neighbors, the safety of our water, the availability of social services, public and private transportation options, and myriad of other factors—do more to determine our long-term health than visits to the doctor. These factors, which are so important to our health and quality of life, simply can’t be addressed by the prevailing healthcare system.
This is why I was excited when I discovered a new model for healthcare delivery that attempted to incorporate some of these important determinants of our health. CenteringPregnancy is a model for group prenatal care that brings up to 12 pregnant women together for their prenatal visits, encouraging them to talk about their experiences, learn from a medical provider and each other, and address common concerns. In my personal experience as a facilitator of a group, the women found comradery and community as they met together, and were also able to help each other navigate the medical system, apply to Medicaid, and discuss options for childcare and post-birth employment. They were able to build social capital together, and help each other with the advice that doctors often don’t or can’t give in their short visits; how to find the cheapest reliable stroller, how to include extended family in the post-partum period, how to identify and get help for post-partum depression, how to get charity care at Duke hospital, etc.
I naturally wanted to spend my research year at Duke studying this model for healthcare delivery. I explored existing research about the women involved in this model and found that preliminary results were positive for these women; there is tangible benefit for women who want to get their care in groups to do so. However, there was no data on whether or not this kind of care delivery benefitted their children. I determined to take data from our local health department and see if there were health benefits or detriments to the children born to these women.
For 12 months and under the instruction of Drs. Beverley Gray and Geeta Swamy I designed and then implemented a retrospective study to determine if children born to mothers enrolled in CenteringPregnancy were more or less healthy than other children. I looked into intensive care hospitalizations, certain diagnoses in the intensive care setting, ER visits, breastfeeding rates, vaccination rates, “sick” visits to the doctor, and other metrics. Given the data available to me for the one-year time period I looked at, we determined that there is no difference in the selected health outcomes for these and other children. We concluded that those women who feel that they would benefit from getting their prenatal care in groups can do so with the assurance that their child will have basically the same outcomes as other children, and they can feel free to choose such care without worry for their child.
CenteringPregnancy is only one method for attempting to integrate medical care and the social determinants of health. I look forward to continuing this integration throughout my career.