Vanderbilt program aims to help create healthier babies

Vanderbilt University is rolling out a new study that will test a method of delivering care to help women have healthier babies.

The United States has one of the 10 highest rates of preterm births in the world, according to a 2012 report from the World Health Organization. Compared with other developed nations, this country also has a relatively high percentage of preterm births.

But researchers at Vanderbilt University in Nashville and Yale University have teamed up with the United Health Foundation — a not-for-profit arm of UnitedHealth Group — to test a new prenatal care model. As part of this effort, Vanderbilt is inviting women to participate in the program, called “Expect With Me,” which aims to enroll up to 400 Nashville participants.

Expect With Me turns traditional prenatal care on its head. Instead of a series of one-on-one visits, the program offers a series of longer, guided discussions in a group setting in addition to typical checkups.

It may seem counterintuitive in a society that values individual attention, but results from an earlier trial in New York of the United Health Foundation study suggest group prenatal care can significantly reduce the number of babies who are delivered small for their gestational age.

The Vanderbilt trials will contribute to a larger, nationwide effort. “We’re in the second year of a three-year pilot period,” said Jessica Lewis, deputy director of the Connecticut Women’s Health Project at Yale’s School of Medicine. “But this will be rolled out in a thoughtful way as soon as possible.”

Preterm births carry a real cost burden.

The Institute of Medicine says preterm births cost the country around $26 billion annually, about $51,000 per infant, which is 10 times greater than the normal medical costs for a newborn. Families, hospitals and insurance companies all pay.

Certainly, there is a financial incentive for insurance companies to help find effective prenatal care, said Deneen Votja, senior vice president of clinical affairs for UnitedHealth’s Center for Health Reform and Modernization. But, she adds, “On the human side, if you’ve ever had a preterm delivery, it’s very stressful, and this is supposed to be one of the happiest points of your life. There is no more emotional unit in the hospital than neonatal unit.”

The goal of the program is to help more women avoid the neonatal unit. That’s not an exact science, said Deborah Wage, an assistant professor of Obstetrics and Gynecology at Vanderbilt. “There are many things that contribute to someone having a preterm birth. We don’t know what all those things are.”

But early observations suggest that in a group situation, women organically ask more and different questions than they would one-on-one. Also, group treatment forms a tightly knit group of women, all expecting a baby at the same time. That can have strong social pull, Wage says, in terms of influencing diet, health and lifestyle choices.

“I think that there’s a uniqueness about pregnant women and their families that allows them to connect,” Wage said. “They’re all expecting a baby — it’s so monumental.”

The sessions do include one-on-one visits with doctors, as well as vitals tests. “The idea is that by pooling women’s time, the necessary medical procedures only take about one to two minutes,” says Lewis. Women can then use a full two hours to discuss pregnancy-related issues.

“It’s really designed to help women take charge of their own health — their own pregnancy,” Lewis said. Instead of getting a pamphlet on nutrition, for example, women can discuss their dietary choices, their concerns, even their sex lives.

“To be honest, 80 percent of the questions wouldn’t have come up in a normal one-on-one conversation,” said Ashley Sullivan, a mother of three, who was part of the first Expect With Me study at Vanderbilt during her most recent pregnancy. She says her group really did gel. In fact, the women in her program formed their own Facebook page and are planning a reunion in May. “My husband and I have already talked about it — if we have a fourth child, I’d do Expect With Me again.”

But even if the program delivers stunning results, there are obstacles in the way of scaling Expect With Me to fit entire health systems. “You have to change your scheduling, you have to change your reimbursement models, you have to change your technology,” said Votja.

Along with operational changes, “This is a paradigm shift for clinical folks,” said Wage. “You’re actually learning a whole new skill set, you’re listening more.”

But as the United Health Foundation’s study continues through 2015, all collaborators will be watching the data carefully. And if evidence suggests that group care improves outcomes, it’ll offer real evidence that operations might have to change. Sure, it’s a paradigm shift, but the tradeoff could be healthier babies, and everyone’s on board for that kind of outcome.

Reach Shelley DuBois at 615-259-8241 and on Twitter @shelleydubois.