1. CENTERINGPREGNANCY® PROGRAM
IMPROVING ACCESS AND OUTCOMES IN THE
SOUTHWEST HEALTH DISTRICT

2. DISTRICT AND CENTERING CATCHMENT AREA
Ware
Burke
Clinch
Hall
Laurens
Early
Lee
Bulloch
Floyd
Wayne
Charlton
Fulton
Long
Coffee
Worth
Emanuel
Polk
Screven
Dodge
Troup
Carroll
Decatur
Camden
Bryan
Grady
Harris
Dooly
Cobb
Glynn
Brooks
Wilkes
Colquitt
Liberty
Thomas
Appling
Gilmer
Jones
Bartow
Rabun
Irwin
Sumter
Echols
Fannin
Tift
Coweta
Telfair
Walker
Union
Macon
Mitchell
Taylor
Lowndes
Elbert
Tattnall
Berrien
Washington
Talbot
Bibb
Hancock
Baker
Greene
Jasper
Stewart
Monroe
Upson
Wilcox
Crisp
Pierce
Pike
Brantley
Marion
Henry
Jefferson
Hart
Twiggs
Clay
Gordon
Gwinnett
Putnam
Murray
Heard
Cook
Miller
Toombs
Randolph
Bacon
Morgan
Terrell
Effingham
Walton
Wilkinson Jenkins
McIntosh
Cherokee
Houston
Chatham
Meriwether
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
Whitfield
Dawson
Seminole
Douglas
Bleckley
Oconee
Schley
Habersham
Fayette
Barrow
Spalding
Catoosa
Treutlen
Muscogee
Mont-
gomery
Taliaferro
Quitman
Glascock
Chatta-hoochee
Clayton
Rockdale
Stephens
McDuffie
Clarke
Peach
Webster
Dade
8-1
9-2
7
5-1
9-3
5-2
6
10
2
1-2
1-1
3-1
4
3-4
3-23-5
9-1
3-3
8-2
Georgia Public Health Districts
1-1 Northwest (Rome)
1-2 North GA (Dalton)
2 North (Gainesville)
3-1 Cobb-Douglas
3-2 Fulton
3-3 Clayton
3-4 East Metro
3-5 DeKalb
4 LaGrange
5-1 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)

3. 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

4. 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

5. 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

6. 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

7. 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

8. BASELINE OUTCOMES

9. District Perinatal Outcomes 2004-2008
0.0%
5.0%
10.0%
15.0%
20.0%
% PTB % LBW
18.2%
15.7%
13.7%
8.4%
12.1%
6.8%
NH Blacks
NH Whites
Hispanics

10. Breastfeeding Initiation Rates
39%
61%
Dougherty WIC
2008
Breast
Artificial 55%
45%
Colquitt WIC
2011
Breast
Artificial

11. Centering Data

12. Pre-term Birth Rates
0.0%
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 Centering
Ellenton Centering
District Hispanics
District NH Whites
District NH Blacks

13. Low Birth Weight Rates
0.0%
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 Centering
District Hispanic
District NH Whites
Do Co Centering
District NH Blacks

14. Breastfeeding Initiation Rates
Dougherty Centering Dougherty WIC-FY 2014
75%
25% Breast
feeding
Formula 51%
49%
Breast
feeding
Formula

15. Breastfeeding Initiation Rates
Ellenton Centering Colquitt WIC-FY 2014
75%
25% Breast
feeding
Formula
65%
35% Breast
feeding
Formula

16. 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

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

18. 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.

19. Southwest Health District
CenteringPregnancy™ Program:
A patient-centered model for prenatal care that is
expanding access to comprehensive care and is
making a difference!

20. QUESTIONS?