Ishaan Shah

My specific civic interest is the social, emotional, physical, and mental burdens of pregnancy on mothers and families. I am particularly interested in the postpartum period given the lack of well-structured postpartum care.

I became interested in this subject after reading about California’s Maternal Quality Care Collaborative and seeing if something similar existed in Missouri. I interviewed moms, providers, and community organizations in St. Louis about maternal health disparities. I had the wonderful opportunity to present to clubs on campus, write in local publications, and host the first ever St. Louis Mom’s Panel at WashU, where we brought four African-American mothers from the Enhanced Centering Pregnancy project (ECP) to speak as experts on St. Louis’s maternal health disparities.

In my Civic Scholars Class, I conducted a literature review of the CenteringParenting and CenteringPregnancy programs in the context of providing health literate care. I first learned about CenteringPregnancy from Dr. Ebony Carter, a faculty fellow at WashU, whom we interviewed about pregnancy-related disparities in Missouri. Dr. Carter advises the ECP program and runs her own CenteringDiabetes groups. In conducting my review, I found that while CenteringPregnancy has robust RCT evidence which demonstrated that CenteringPregnancy can close racial disparities in preterm birth rate from trials conducted or being conducted by Dr. Ickovics, Dr. Jafari, and Dr. Crockett among others, CenteringParenting does not have nearly the same evidence-based support. In America, we have approximately 12 to 14 prenatal visits and a single postpartum visit, even though the postpartum period is when new parents are adjusting to a new child, restarting their careers, and most financially and socially stressed. Given the current lack of structure and support in postpartum care, I think it is particularly important to build an evidence base behind CenteringParenting to advocate for a substantially expanded postpartum care support network. CenteringParenting and CenteringPregnancy are distinct from regular medical visits because they bring 6-10 patients at similar stages in their healthcare together for a 2-hour session instead of the normal 15-minute visit. The same individuals show up to each visit, allowing participants to build connections with each other at a time when they may be experiencing deep social isolation and to learn from each other’s experiences.

Last November, I learned that the first randomized clinical trial of CenteringParenting was happening while I was doing my literature review and stumbled across their clinical trial registry page.  I reached out to the lead PI, Dr. Renee Boynton Jarrett, at Boston Medical Center to see if I could help with the study. The study is situated within a community organization called Vital Village, which specifically works as a community engagement network for early childhood advocacy in Boston and is trying to scale strategies for other community organizations to improve their own early childhood advocacy. The trial’s primary outcome is early language development measured by the Macarthur-Bates CDI, a measure of language that has been well validated internationally in dozens of languages and has been shown to explain variation in early childhood educational achievement and school readiness. The trial works closely with Centering Healthcare Institute, a non-profit organization focused on scaling group care models in America. They have a map of their practice sites here and were recently a part of the innovative Strong Start study to transform prenatal care with their group prenatal care model.

CHI has received funds to provide 60 CenteringParenting implementation grants to provide in-kind consultation to hospitals and community health centers around the country. These sites were built into the study; half are randomized to individual well-child/postpartum care, and half will receive group care. While working with the study, I have had the opportunity to learn about CenteringParenting from a research, practice, and implementation perspective, which has helped me learn more deeply about the program. I work closely on the direct management of the study, helping decide some of the instruments we use, monitoring and administering our recruitment, and explaining it to lay audiences. I also had the opportunity to attend CHI’s group facilitation training where I sat in on a 2-day workshop to practice being a part of real CenteringParenting and CenteringPregnancy groups and learn about how facilitation is taught by CenteringHealthcare Institute. Lastly, I have had the opportunity to learn from a variety of CenteringHealthcare staff and members of the CK-READY study about the diversity and nature of the CenteringParenting program. Contrary to what most people may think, the curriculum offers immense flexibility for providers to insert their own activities and change up the entire structure of the program (and completely discard the handbook that CHI provides!). This variability does not seem to mediate the fidelity of the program itself.

Group care overall is a wildly different paradigm from the individual visit structure that our current healthcare system almost exclusively uses. Understanding how group care can be integrated into our healthcare systems may allow us to implement it better, understand its benefits, and determine which group models are appropriate/ not appropriate. Studying it formally will also help people take group care more seriously given the massive cultural shift required to move from an individual care model to a group care model. I am excited to see CenteringParenting programs implemented and researched around the country. I was delighted to see that the place that I received the majority of my own pediatric care, Palo Alto Medical Foundation, is starting one of their own CenteringParenting programs this year.