BRONX, NY August 21, 2003 —

A new approach to pre-natal care gathers women for group check-ups.

Doctors are spending less and less time one-on-one with patients, and neither side is pleased. But at one healthcare system in the Bronx, physicians talk to pregnant mothers for hours at a time. In the first of a three-part series on childbirth, WNYC's Fred Mogul looks at a new program that takes pre-natal visits out of the exam room -- and into the classroom.

What if you had a medical appointment, and everyone came?

While Migdalia Atkins and Dr. Liza Kuntz listen to a sonogram of the baby's heartbeat, other pregnant women sit at a conference table, reading hand-outs and waiting for their turn. You might imagine an expecting mother's appointment with her doctor would be an intimate business. For that matter, you might imagine the idea of any patients sharing their doctor's appointments with a group would be strange or unpopular or simply unfair. But group visits are a relatively new way of helping doctors from a wide range of specialties spend more time with their patients. Dr. Peter Bernstein brought a national program called Centering Pregnancy to Montefiore Medical Center, making it the first facility in the area to offer pre-natal group visits.

Bernstein: Typically, a provider of pre-natal care can see about 10 women in 2 hours, seeing them consecutively. The program takes the same 10 women and sees them in the same two-hour period, but sees them as a group. Instead of having to say to each woman over and over and over again, You should breast feed. You should breast feed. You should breast feed, at each visit, you're now left with 30 minutes to talk about breast feeding and really cover it in some depth.

For decades, expecting mothers and fathers have taken classes to prepare them for childbirth and the brave new world that follows it. But Centering Pregnancy combines information-giving with basic clinical care. Health Psychologist Edward Noffsinger is a pioneer of what he calls shared medical appointments. He says these are not just group therapy or informational rap sessions - they're opportunities for doctors to get crucial information from patients that might not emerge in conventional one-on-one exams.

Noffsinger: Granted, there are some trade-offs in terms of confidentiality, because other patients are there, but it truly brings back some of that old-fashioned, Dr.-Welby-like relationship between the doctor and their patients and allows them to gather more information than they would normally be allowed to gather in their brief office visit.

Noffsinger believes more than 60 percent of medical procedures could be done in a group setting - delivering better care to patients and even higher profits to healthcare providers. Montefiore says its Centering Pregnancy program doesn't make - or save - any more money than standard pre-natal treatment, because it's so labor intensive: mothers get both group and individual visits. For patient Migdalia Atkins, it's ideal.

Atkins: You can ask whatever questions, you know, and if you don't feel comfortable in the group you can have a one-one session after the group so you really don't have to say everything in the group.

For Heather Childs, group visits at Montefiore have provided better pre-natal care than she received for her previous two pregnancies. As much as Childs likes the doctors and nurses, she says she might be getting even more from her fellow patients.

Childs: When you get to notice you're not the only one by yourself you know that everyone's feeling that certain symptom or fear, it helps you out it makes you feel like, It's not so bad.

Outside of Montefiore, some doctors and patients suspect the main point of group visits for pregnancy or anything else is cost-cutting. Even Ed Noffsinger, though an obsessed evangelist for group visits, is concerned that they could be abused by insurers and others eager to milk new efficiencies and profits out of the healthcare system. Dr. Bernstein says there's another way group visits can help cut costs: polls show that patients who have a good relationship with their providers are less likely to sue them.

--Centering Pregnancy
--Montefiore
--Health Psychologist Edward Noffsinger on Group Visits
--PBS Health Week on Group Visits
--Group Visits, a managed care perspective
----Group Visits, some possible downsides