Reasons Women in Appalachia Decline CenteringPregnancy Care

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CenteringPregnancy, a proprietary form of group prenatal care, reduces rates of preterm birth when compared to traditional prenatal care. Appalachian women have high rates of preterm birth, yet several regional providers have struggled to recruit and retain women in CenteringPregnancy care. The purpose of this study was to survey women from one rural birth center in southern Appalachia on their reasons for declining CenteringPregnancy care.


Twenty-nine women whose charts noted they had declined CenteringPregnancy care were interviewed for this qualitative descriptive study. Conventional (inductive) content analysis of manifest content was used to analyze interview transcripts.


There were 3 broad reasons women did not use CenteringPregnancy care: they preferred one-to-one care, they experienced barriers to CenteringPregnancy participation, and they did not know group care was an option. Women who preferred one-to-one care gave reasons for their preference that included a dislike of groups, a fear of bodily or emotional exposure in the group, no need for change from existing individual care, and concerns about partner involvement.


Barriers to CenteringPregnancy found at the sample institution included a preference for individual care, including a dislike of groups and fears of exposure, and logistical concerns. Clinicians should consider adjusting promotional materials to use locally acceptable terminology and address privacy concerns. Modifications may increase utilization of this effective model. However, even with these changes, CenteringPregnancy may not meet the needs of all women. A large subset of women was averse to group care in any form. Clinics should continue to provide diverse options for prenatal care delivery to increase access to prenatal care for vulnerable women.

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