Home Prenatal "Centering"??? ummm

[oobiecoo]

DH and I toured the birthing center we hope to use for exams and the birth once we move in a couple of months. One thing mentioned was that they will be starting a new technique of prenatal care called "centering". Basically, it sounds to me like a few pregnant women meet in a large room to discuss the pregnancy and their body''s changes and each woman is taken off to the side for her exam on a mat on the floor. Meanwhile, the other women continue to chat and are aware of and can possibly see the woman''s exam. This apparently is a new thing and has been proven to have benefits such as lowering the risk of pre-term labor.

Really though, I''m not so sure about this. I''m a pretty modest person and want to be able to discuss anything and everything alone in the exam room. I also don''t want the other women(and possibly their HUSBANDS) to see anything they really shouldn''t. The director told me they will REQUIRE their patients to try it but they can go back to the regular type of care if they want afterwards. Has anyone had any experience with this seemingly odd type of care?

 

[Hudson_Hawk]

Um, what kind of exam are we talking about??? I''d be totally fine with the group therapy session, I like talking about myself and am definitely not shy when it comes to personal stuff, but I don''t think I could let someone check my cervical dilation in a room full of people!

 

[Jas12]

Whoa, really? I don''t get it, what is the purpose of the public exam? Are we talking just fundus measurements and blood pressure, or pelvic exams?
I don''t really see how they can make someone participate in that. I am really liberal and have a pretty granola view of birth, but i wouldn''t want to be examined in front of a crowd unless it was just stuff like BP etc.

 

[meresal]

You had me until public exam... I think that is something that is very personal.

 

[oobiecoo]

Its a full on exam like you would normally get in a one on one appointment. I can understand how the group discussions would be useful and *possibly* reduce the pre-term birth risk but I really don''t understand the exam part. Its so bizarre! If they really try to make me do the group appointments then I''m going to tell them no way Jose. Also, one of the options for practices implementing the "centering" technique is for the women to check their own weight and blood pressure and that sort of thing. There is also the option for the midwives to provide a screen or curtain to go behind during the exam but it depends on what the particular facility chooses. My birthing center director said the women will be able to see you out of the corner of their eye so that means no screen.

 

[luckystar112]

lol. This sounds like a horrible dream to me.
I just can''t imagine walking into a room with a bunch of smiling pregnant women, talking about my fears and hopes, and then excusing myself so I can go off to the side for an internal while they watch. Bizarre!

 

[yssie]

The group counselling sounds like something I think I would definitely benefit from.


I want children but I have to be honest and say that the pain of labour is something I''m very, very scared about. In early secondary school our class viewed a live birth, and I''ve had a very real very deep fear since then - I''m sure expecting pain won''t help, and talking with other women about our fears can only help.


A public exam, though - no way!

 

[lucyandroger]

I''m not pregnant and have never heard of this before but...

Don''t you only get pelvic exams at the very beginning and towards the end of a pregnancy? My guess would be that for the pelvic exam visits, patients get more privacy.

 

[Hudson_Hawk]

Maybe it''s supposed to provide a non-threatening environment to get used to the idea of being spread eagle and vulnerable in front of strangers? Still, that wouldn''t be my sort of thing.

 

[Lilac]

I''m uncomfortable enough half naked in stirrups in front of my own ob/gyn (who I absolutely adore) - I would NEVER want to be in that position (literally!) in front of other women and possibly their husbands!

Group therapy is one thing and I can see the benefit in that. Group pelvic exams? Not so much.

 

[Puppmom]

Oh, hell no!

 

[Shoopy]

I''m surprised they would allow the husbands there during these meetings.

I''m also curious to hear what their schedule is like. My "full" exams happened when I got a pap at the very beginning, a transvaginal u/s up until 15 weeks (which was only given twice), and then internals starting at 36 weeks. Every other appointment was to listen to the heartbeat (occassional u/s to check that placenta moved up). I''d think it would be weird if they checked out your ladybits at every single appointment without a reason to.

Besides that, this actually sounds like a great resource.

And maybe this was just my experience but by the time I hit my internals, I was pretty much over being shy. Then when I went in to labor, I was completely over it

 

[Jas12]

Ya, now that i think about it more, i bet it''s just listening to the HR, measuring the belly and taking mom''s BP. Are you positive the group thing involves a full pelvic exam?
Internals are *sometimes* done at the start of pregnancy (however, i am 24 weeks and have not had one this pregnancy) but usually just at 36 weeks to do the Strep B swab and to see if anything is happening. The fewer internals, the better. They can introduce infection and are uncomfortable for the mom and unless there is a problem that needs to be monitored, they don''t tell you much anyway.

 

[swimmer]

O, the birth center near me does this (not surprising, you know my hood) and friends have reported that it is sort of like a support group. Just to clarify, there are no internals done at these regular appts, that as has been pointed out before, doesn''t take place other than at the very beginning or end of pregnancy (unless you are high risk or something and then a birth center might not be your best idea). So no one''s husband would see anything perhaps other than your belly being dopplered, (always wear pants to appts) or that you are over at the scale. Many of the ladies in our birth class participate in the group visits and they seem so pleased with the "de-medicalization" of pregnancy. I mean, we aren''t sick, we are having babies, this is normal, everyone (other than pod people of course) came out of a woman, this has been done before and it shouldn''t be as scary and clinical as it can become. I sort of wish we could do something like that setup, knowing that others are going through this is so helpful, heck it is why we are here right? Discussions about diet, exercise, complications are going to be pretty much the same thing for most of us, why not combine it into a setting full of support rather than/or in addition to statistics? I would go for it if we could, but figure out where your comfort level lies. Perhaps a tour would help the decision or emailing with a woman who has participated already?

 

[Puppmom]

Phew...now that I know full on exams aren''t a part of this, it doesn''t sound so bad. It might be good to hear other people''s questions and experiences. I still don''t think I would do it. DH and I are very private people so this just wouldn''t be our style.

To your point Swimmer, I would totally love if the environment for my appointments or delivery would be less medical. For some reason, those surroundings make me nervous.

 

[oobiecoo]

When we spoke to the director, she made it seem like whatever kind of exam you need will be done in the group setting... including internal ones. Some facilities utilize this method for the entire pregnancy so do you have the group session and then also a private session?

Swimmer, I hope the way you explained it is the way my birthing center will be doing things and I just misunderstood. I just couldn''t see why public internal exams could possibly be a good idea!!

 

[Hudson_Hawk]

Date: 2/17/2010 12:46:17 PM
Author: oobiecoo
When we spoke to the director, she made it seem like whatever kind of exam you need will be done in the group setting... including internal ones. Some facilities utilize this method for the entire pregnancy so do you have the group session and then also a private session?


Swimmer, I hope the way you explained it is the way my birthing center will be doing things and I just misunderstood. I just couldn''t see why public internal exams could possibly be a good idea!!

Yea, eff that!

 

[Octavia]

I don't understand how they could do internal exams on a mat on the floor

. It seems like there wold be logistical and sanitation issues, right??

Oobie, can you call back and request a detailed description of what happen at each group session and private session? I'd think they would be used to people putting their foot down about intimate exams during group sessions, I really don't know who would want that. Heartbeat and external measurements that can be done while mainly clothed are one thing, but I just can't believe they could force you to do other exams (or really, even those) In front of the other patients. At some point it would seem like a HIIPA violation if you don't consent, or am I off-base here?

 

[lucyandroger]

Date: 2/17/2010 10:29:54 AM
Author: swimmer
O, the birth center near me does this (not surprising, you know my hood) and friends have reported that it is sort of like a support group. Just to clarify, there are no internals done at these regular appts, that as has been pointed out before, doesn''t take place other than at the very beginning or end of pregnancy (unless you are high risk or something and then a birth center might not be your best idea). So no one''s husband would see anything perhaps other than your belly being dopplered, (always wear pants to appts) or that you are over at the scale. Many of the ladies in our birth class participate in the group visits and they seem so pleased with the ''de-medicalization'' of pregnancy. I mean, we aren''t sick, we are having babies, this is normal, everyone (other than pod people of course) came out of a woman, this has been done before and it shouldn''t be as scary and clinical as it can become. I sort of wish we could do something like that setup, knowing that others are going through this is so helpful, heck it is why we are here right? Discussions about diet, exercise, complications are going to be pretty much the same thing for most of us, why not combine it into a setting full of support rather than/or in addition to statistics? I would go for it if we could, but figure out where your comfort level lies. Perhaps a tour would help the decision or emailing with a woman who has participated already?

Thanks for this explanation, swimmer. I googled "prenatal centering" and this thread was the fourth link. I would hate for a woman looking for more info to pass up a great resource because of some misinformation.

 

[Hudson_Hawk]

I keep thinking the title of this thread is prenatal CATERING, not centering.

 

[oobiecoo]

Swimmer, your friends'' account of how the care works is exactly what I''ve been looking for online but hadn''t found any information or reviews written by the actual patients and the websites promoting it are just plain unclear. Many just say *complete* or *comprehensive* exams will be done. For a first time mom like me, I don''t know what exactly that entails but assumed it meant feet in stirrups.

I did FINALLY (like 10 minutes ago) find a website that says "If needed, private examination rooms are used for medical concerns requiring privacy such as cervical and vaginal assessments".

Like LucyandRoger, I don''t want women to see this thread immediately and be turned off. The group support sounds like a great idea... I was just looking for some clarification that other women and their husbands wouldn''t be looking at my hoo-ha and now I feel I have that!

Maybe I should have the thread removed or the title changed.

 

[oobiecoo]

Date: 2/17/2010 7:58:43 PM
Author: Hudson_Hawk
I keep thinking the title of this thread is prenatal CATERING, not centering.

Sounds like a great idea! A personal delivery service or chef for those pregnancy cravings!

 

[VRBeauty]

Date: 2/17/2010 7:58:43 PM
Author: Hudson_Hawk
I keep thinking the title of this thread is prenatal CATERING, not centering.

I thought it was centering as in "OHMMMMMM"

 

[lucyandroger]

Date: 2/17/2010 8:01:44 PM
Author: oobiecoo
Swimmer, your friends'' account of how the care works is exactly what I''ve been looking for online but hadn''t found any information or reviews written by the actual patients and the websites promoting it are just plain unclear. Many just say *complete* or *comprehensive* exams will be done. For a first time mom like me, I don''t know what exactly that entails but assumed it meant feet in stirrups.

I did FINALLY (like 10 minutes ago) find a website that says ''If needed, private examination rooms are used for medical concerns requiring privacy such as cervical and vaginal assessments''.

Like LucyandRoger, I don''t want women to see this thread immediately and be turned off. The group support sounds like a great idea... I was just looking for some clarification that other women and their husbands wouldn''t be looking at my hoo-ha and now I feel I have that!

Maybe I should have the thread removed or the title changed.

Hey oobiecoo, I wouldn''t have the thread removed or titled changed because there really weren''t too many easily accessible sites with info on this. Perhaps you can have the mods add an update to the first post with the new info about private rooms for internal exams. Who knows, you might end up helping out a lot of new moms!

 

[swimmer]

I don't know about you, but none of my OB appts have had anything to do with my vag. The baby isn't down there at all, at the very very end they look for cervix stuff, but in the meantime, cervix can still be checked by u/s more effectively. Seriously, they are all over my belly! listening, measuring, or u/s because until yesterday we were high risk, but not once in my pregnancy (29weeks now) have I had a pelvic or even seen stirrups.

I have 0 modesty, swim team and military service beat that out of me, but I would prefer to have a visit that seemed more supportive and community oriented, less clinical. Reading Meresal's posts about her doc rushing her through and making her anxious about weight gain is so upsetting! I think in a group setting where everyone is thinking about diet, exercise, devt stuff, that it would be less common. Just the dynamic of so many women all focusing on the same stuff and clearly different places on the bell curve would force a doc to (for once) take the time to think about the repercussions of putting us all on a chart and assuming that we all must statistically conform to the norm. My OB totally listens, I just rarely see her. I see a NP for most of my visits and she takes an hour to listen to us, but most of what we have to ask is total repetition for her I'm certain.

Yes, a few weeks ago a midwife asked me if I had "considered doing any exercise" I have to just assume she is an idiot and that since I had never met her before she just wasn't looking at my chart. Perhaps the group setting would ensure more continuity in care providers? I don't know, but am fascinated by the possibility of doing something less clinical.

For example, I am going to stay at home as long as we can when labor starts since I know that once we get to the hospital I will be seen as a patient with a problem and not a woman having a baby. This shift towards community focus is pretty dang ideal. Sort of like learning from each other, but with medical expertise supporting everything. Like the old days when everyone knew how to deliver a baby and a community of women got together barn-raising style, to support each other when their time came, but with the huge improvement in terms of medical care. OK, now I'm rambling, but I hope that I've cleared it up that there would be NO PUBLIC NUDITY OR "FULL EXAMS" but a huge chance for developing great support networks of women who will also be raising kids the same age as yours.

 

[Shoopy]

Oobie-I wouldn''t worry about deleting or chaning the thread title. When you look up prenatal centers in google, this thread isn''t even in the first 5 pages (most don''t go past page 1 anyway). When you look up prenatal centering it is on the first page but the only thing that is shown is "DH and I toured the birthing center we hope to use for exams and the birth once we move in a couple of months. One thing mentioned was that ..." Anyone doing research can''t get enough info just looking into those first few lines and if they click on the link, they can read what has been said on the thread.

 

[Jas12]

I think it''s a great idea, for the reasons swimmer pointed out (minus the pelvic exams) we (as in north america) really need to start reclaiming some of the normalacy of birth, the womanhood involved, and the spirit of it. I know that sounds a bit corny, but birth is so medicalized in our culture it''s really scary IMO.
I had an OB for my first birth and everythign was so clinical. I liked him but i doubt he even knew my name, he only saw me for maybe a min or two each appnt. There was no dialogue and appnts were purely medical in nature. Worst of all, he wasn''t even on call i day i had my son, so i got some other OB that i hated.
This is *vastly* different from my pregnancy now with a midwife. My midwife appnts are over an hour each, she talks about fears and lifestyle, my postpartum period, support networks, diet, hopes for the birth, she knows my husband and son, she shares personal ancedotes with me and recommends books. IMO this is what prenatal care should be like. OBs should be reserved for problems. I don''t want to be just a vagina and a BP measure when i am about to embark on such a life changing event. I think if i had my middie for my son''s birth things would have been so different (my hospital experience was stressful, scary and disempowering, to say the least. I was able to have a mostly drug-free,vag birth, but seriously had to fight for it).
So i am all for programs that encourage something other than medical exams and charting stuff. I think this is very promising !

 

[Ninna]

Odd+
Can they use a dummy for that? just wondering.........

 

[Octavia]

I just re-read what I wrote before and I think it might have come off too harsh -- in a lot of ways I completely agree with Swimmer and Jas, and I think it would be awesome to have group support when my time comes to be pregnant (though it could be a little awkward at first, until all the participants get to know each other...but I bet it could also lead to great friendships). Obviously, I know nothing about what happens at prenatal checkups, but from that side of things, I think it''s super important for the staff at these centers to fully explain the process and for prospective patients to make sure that all questions are fully answered. It''s new and unfamiliar to most people, so clarification is really essential.

I still don''t think that people should be forced into participating if they don''t want to, though, and I still would be slightly concerned about medical privacy issues. I''d like to know what happens if, heaven forbid, something goes wrong with a participant''s pregnancy or if health issues are discovered in the child. Do you stop attending group sessions and if so, what are the other participants told? Or do they have you stay and talk about it? These are questions I''d certainly be asking if I ever use this approach to care, since I''m sure different centers have different answers and they''re all well-versed in the issues. I''ll bet it works out wonderfully 95% of the time, I''m just sort of thinking out loud here...