Nine pregnant women get together on Friday mornings on Summa Health Systems’ Akron campus, in a room that looks more like a living room than a medical office. It’s time for blood pressure, urine and belly checks, and time to compare swollen ankles, back pain and sales on diaper bags.
But nine times, the chatter grows hushed. The women stop to listen to the fetal monitor detecting a heartbeat coming from the examination table behind a screen.
Ohio has one of the highest infant mortality rates in the country, with 7.1 infants in every 1,000 dying before their first birthday. The effort to get more babies past that milestone is focusing increasingly on a kind of support-group model for prenatal care.
Unlike other centering-pregnancy groups, though, this one is not formed around due dates of the expectant moms but around the experience of Bhutanese refugees.
Sanchu Rai shares the lessons she learned from three pregnancies with a shy newcomer, who is in the early stages of her first. Rai had her first son in the Nepal refugee camps where she and about 100,000 other Bhutanese refugees lived for two decades. Her second boy was born here, as his baby brother will be.
She says the differences are huge.
“Here in America ultrasound,” Rai says. “And everything, whether the baby was good or not, everything we know before giving birth.”
A Group Effort
Dr. Dante Roulette says that in many other ways, this group is not much different from Summa’s other groups
"Centering pregnancy is kind of a fancy name for group prenatal care,” Roulette says.
That means two-hour group visits with physicians, nurses, case managers and social workers. The first hour is all about the physical, Roulette explains: "Doing the traditional medical examination, where we measure the belly, listen to the baby's heartbeat and get vitals. Things everyone’s familiar with.”
The second hour, he says, centers around a group discussion.
"Really, it’s a discussion that is facilitated by the caregivers, but all of the education is coming from the women in the group themselves,” Roulette explains.
Michelle Kusic, the nurse practitioner who works with the group, explains that the Friday educational sessions can include a lactation consultant one week and a hospital tour another
She says in many ways, Nepali women are made for centering pregnancy.
“The Nepali population embraces the medical model, they are engaged in their care,” Kusic says. “They’re pretty bright as a population, so they tend to do very well and they’re pretty compliant with their care, which is good to see.”
Trust And Camaraderie
Kusic works behind the screen with each woman. But she's not alone: her questions are all asked and answered through Laxmi Dhimal Dhakal.
Dhakal moved from Nepal to Atlanta in 2008, and, like thousands of other Bhutanese refugees, migrated to Akron four years later. As a medical assistant and translator, she’s the bridge between the Summa staff and the women.
She says camaraderie is key for this group.
“And they will share their knowledge,” Dhakal says. “They will talk (with) each other in Nepali, and they are confident to talk to each other and share their views.”
Dhakal notes that health care was limited in the refugee camps, so many of the newcomers are more used to sharing questions about their pregnancies with each other than with doctors. She says the centering group combines the best elements of each.
Roulette says some in the groups initially had some mistrust, especially when it came to talking about related issues such as intrauterine devices and other birth control. He said IUDs were almost a cultural taboo.
“And when we talked about it as a group, it turns out a lot of them knew people who had been sterilized back home with IUDs that could not be removed,” Roulette says.
He says it was a moment for the caregivers here to understand real fears and to discuss ethical and moral parameters in U.S. medicine. Did that make a difference?
“Based on the uptick in intrauterine devices, I would say yes,” Roulette says. “But it was a long process.”
Roulette notes that studies increasingly link premature birth, infant mortality and health over a lifetime to stress. And he acknowledges that living decades in refugee camps – with lives largely on-hold – is a huge stressor, as is resettling halfway across the world.
Centering-pregnancy groups like Summa’s, Roulette says, are key to building trust as well as health over the long term.
This story is part of a collaboration between WKSU and the Huffington Post on the integration of Bhutanese-Nepali refugees, who began their migration to Akron a decade ago.