Day: May 23, 2019

I recently read Jennifer Margulis’ The Business of Baby and was fascinated by her chapter on the American postpartum experience. Typically, a postpartum mother has one check up at 6 weeks. Her baby, on the other hand, has well visits at 2 days, 2 weeks, 2 months, 4 months, 6 months, 9 months, and 12 months. At these visits, mom and baby meet with a pediatrician or family practitioner. The baby is weighed and measured; questions are discussed; immunizations are administered; and recommendations for sleep, introducing solids, and milestones are given. I used to jokingly call these my “mom tests.” I passed if my baby didn’t have a hint of diaper rash, was sleeping well, and had met his milestones. I often dreaded these visits for fear of “failure.”

In her book, Margulis highlights a new kind of well visit in which moms with the same aged babies meet in a group with two professionals, one of which is a health care provider, and the other typically some form of therapist or counselor. This is a well-baby and well-mom model. Moms can raise questions, give each other advice and tips, and the licensed professionals can be there for back up and individual check ups with baby.

Here’s an excerpt:

Laura Wise, a family practice doctor based in Oakland, California, understands [mothers’] concerns. She thinks the biggest downside to well-baby care – which is a problem of medical care in America in general – is that it is too fragmented. Wise believes in order for checkups during the first year of a baby’s life to really promote a baby’s health and well-being, the mother’s health needs to be considered as well. “The mom and baby in the first year of life are so inextricably linked in their well-being,” Wise tells me in a phone interview as she leaves her office on the way to the gym. “If the mom is depressed, it impacts the baby. If the baby is colicky and doesn’t sleep well at night, it has a huge impact on the mom.”

Wise herself was isolated as a new mom. When her daughter was born in Petaluma, California nine years ago, Wise knew very few other first-time moms. None of her med school friends had had children yet, and she found it lonely to be home all day with the baby without family in the same town or a community of friends. Despite being a medical doctor, she felt unmoored. “I didn’t know what I was doing,” she admits. “I got postpartum depression. I had doctors and could get medication, but I didn’t have any support.”

Then, in 2006, six weeks after her second child was born, a colleague who was going out on maternity leave asked Wise to run a group for her. In this model of group care, pairs of moms and babies come together for a two-hour appointment facilitated by two people, one of whom is a health care provider, usually a pediatrician, family doctor, or a nurse practitioner. Well-woman care (including family planning, mental health, and achieving weight goals) is combined with well-baby care (including safety, immunizations, and developmental assessments). Unlike in the traditional medical model, the group appointments always start on time, patients have a full two hours with the provider (who is there the whole time, although she does the physical exams on each baby in a space apart), and moms learn as much from each other as from the health professionals guiding the group.

When parents bring concerns – a three-month-old baby who has stopped pooping frequently, for instance – they hear from other parents who are experiencing the same issue, and often learn that it’s not actually a cause for concern. The group wisdom also gives women a chance to try less invasive alternatives to clear up medical problems, Wise says. In one of her Spanish-speaking groups a baby had eczema and another mom suggested trying a gentle moisturizing soap. If Wise had been alone with the patient, she might have written a prescription for a topical steroid cream. But the next month the mom came back with a rash-free kid.

“What I wouldn’t give to be receiving care that way,” said a mom of a two-month-old baby in Silver Spring, Maryland, who goes to the same church as Sharon Rising, CenteringParenting’s founder. Laura Wise agrees. “Having a group of moms at the same stage would have been so helpful to me,” she admits. “If my doctor had taken the time to understand my background, and what I brought to mothering, it would have made a huge difference to my daughter’s well-being. I was not outwardly high risk but if you knew me, you would know that I had a lot of risks for postpartum depression. There was so much that I didn’t know. It’s kind of intense. If someone had just given me a Moby wrap, and said, ‘Just put your baby in here and walk around and you’ll have a much better day.’ That’s what happens in a parenting group, someone gets a good carrier and they share it with someone else. It’s transformative.”

First started in 2006, there are now thirteen health centers in the United States where women and their babies can receive CenteringParenting postnatal care. In one randomized controlled study with ninety-seven mom and baby pairs, participants had better attendance, recalled getting more education and advice, and generally reported higher satisfaction than with traditional care. Lead research on this study, Ada Fenick, a pediatrician with more than fifteen years of experience who teaches pediatrics at Yale School of Medicine, says almost twice as many of her medical students requested to receive training to do group well-baby care this year than last. “These residents are learning a lot from the moms in their group, and about how to talk to people. I think it’s wonderful,” Fenick says. “And the parents are getting a lot out of it. For me it’s very exciting. You’ve got the moms teaching each other; every now and then you look over at the doctor, who’s nodding, because that’s just what she would have said.”

Despite the positive results, in the Oakland area, Wise has found it challenging to get her colleagues to embrace group care. “We are trained to take care of people in the exam room, and we are trained to be or act like experts,” Wise explains. “The idea of a facilitated group, which can be chaotic and draws on the knowledge of the people in it, is uncomfortable for health care providers who haven’t been trained in that way.” But, Wise believes, it’s a battle worth fighting. The biggest difference between this kind of well-baby care and a more traditional model is that it changes our current pediatric paradigm by embracing “the radical idea that patients have more knowledge about their health than anyone else.”

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You can respect the education and knowledge that a health care provider brings to the table, however, group wisdom, especially growth into motherhood, is incredibly valuable. Moms supporting moms as they are simultaneously supported by a practitioner. What do you think about this model of care?