title: In a hard spot: providing group prenatal care in two urban clinics.
abstract: OBJECTIVE
  CenteringPregnancy (Centering) group prenatal care has been demonstrated to improve perinatal outcomes and provide a positive experience of care for women, but it can be difficult to implement and sustain in some clinical settings. The purpose of this study was to examine the challenges encountered when Centering group prenatal care was provided, and the responses of Centering group leaders to these challenges.
  
  
  METHODS
  this was a longitudinal, qualitative study using interpretive description. Data collection included participant-observation and interviews with group leaders and women receiving group prenatal care.
  
  
  METHODS
  two urban clinics providing care to low income women in the northeastern United States.
  
  
  METHODS
  interview participants were 23 pregnant women (primarily African-American and Hispanic) receiving group prenatal care; other participants were 24 significant others and support staff participating in groups, and two nurse-midwife group leaders.
  
  
  RESULTS
  the clinics did not always provide full resources for implementing Centering as designed, creating numerous challenges for the group leaders, who were committed to providing group prenatal care. In an attempt to sustain the model in the face of these limitations, the group leaders made a number of compromises and modifications to the Centering model.
  
  
  CONCLUSIONS
  the limited clinic resources and resulting modifications of the model had a number of downstream effects, some of which affected relationships within groups, participation, and group cohesion.
  
  
  CONCLUSIONS
  modifications of the Centering model should be undertaken with caution. Strategies are needed to enhance the success and sustainability of Centering in varied clinical settings so that the benefits of the model, which have been demonstrated under more controlled circumstances, can be conferred to women receiving routine care during pregnancy.
authors.affiliation: Yale University School of Nursing, 100 Church St. South, PO Box 9740, New Haven, CT 06536-0740, USA. gina.novick@yale.edu
authors.forename: Gina
authors.initials: G
authors.lastname: Novick
authors.forename: Lois S
authors.initials: LS
authors.lastname: Sadler
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Knafl
authors.forename: Nora E
authors.initials: NE
authors.lastname: Groce
authors.forename: Holly Powell
authors.initials: HP
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D008137:Longitudinal Studies; D008880:Midwifery / Q000379:methods*; D017146:Models, Organizational; D009511:New England; D009721:Nurse Midwives; D057240:Patient Preference; D018802:Patient-Centered Care / Q000379:methods*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods / Q000523:psychology; D036301:Qualitative Research; D012681:Sensitivity Training Groups; D012944:Social Support; D012959:Socioeconomic Factors