Tuesday, April 24, 2012

Friends requests re-evaluation of policy barring women from laboring at birth center at or past 41 wks pregnancy

In its capacity as the consumer advisory group to the PeaceHealth Nurse Midwifery Birth Center, Lane County Friends of the Birth Center recently sent the following letter. It expresses concern over and requests a re-evaluation of the new policy barring women from laboring at the birth center at or past 41 weeks pregnancy. 

Ms. Michele Peters-Carr, CNM
PeaceHeatlh Nurse Midwifery Birth Center
353 Deadmond Ferry Road
Springfield, OR  97477

April 12, 2012

Dear Michele:

On behalf of the Friends of the Birth Center consumer advisory group, I am writing to express concern about the new policy prohibiting pregnant women at or past 41 weeks from laboring at the Nurse Midwifery Birth Center. Since May 2011, several families have expressed their surprise and displeasure at losing access to a much-anticipated and planned-for out-of-hospital birth.

As a consumer advisory group, Friends of the Birth Center has the following specific concerns regarding the development and implementation of this new policy.
  • We have the impression that the decision-making process resulting in this change was set not by Birth Center midwives but rather for them. The Commission for the Accreditation of Birth Center requires that birth centers operate as independent practices with the necessary autonomy and authority to develop evidence-based standards for care.
  • The new policy runs counter to the 42-week standard (with increased surveillance) for out-of-hospital birth set by the Commission for the Accreditation of Birth Centers.
  • The Birth Center already has a thorough surveillance protocol for monitoring women at and beyond 41 weeks to identify risks making a birth center birth unwise. This protocol is consistent with evidence-based practice.
  •  The policy is not supported by the literature. All the references in the attached review confirm that risk rises with advancing gestational age. The issue that arises is not risk but rather how much risk is too much for out-of-hospital birth. The risk at 41 weeks is less than the risk of many other complications occurring in normal pregnancy.  Almost all of the referenced studies endorse expectant management with antenatal testing. This was the policy employed by the Nurse Midwifery Birth Center before May 2011.
In the more than 25 years since its inception, the Birth Center has developed a well-deserved reputation for excellence in practice. Its outcomes meet and exceed state, national and international standards and benchmarks. In light of this, we would like to encourage a re-evaluation of the current policy.

We encourage a return to a decision-making process that both respects the authority of the midwives, as providers, to oversee the development of standards of care and facilitates collaboration between them and  specialists. Such a policy would incorporate rather than override the preferences and values of pregnant women. If there is relevant new information, this can be incorporated into the decision-making and consent process already in place to support and aid women in making decisions about their care.

We appreciate the opportunity to share our concerns. We are optimistic that a review of the above items will facilitate a worthwhile discussion resulting in a satisfactory conclusion for all involved. Having the opportunity to be included would be most welcome by the Friends of the Birth Center

Katharine Gallagher, Chair 

Consumer Advisory Group Members
Maria Alisa Blum
Anna Chorlton Connelly
Katharine Gallagher
Lynn Kane

Emeritus Members
Eleanor Vandegrift
Karen Guillemin
Kathy Lynn
Renee Bailey

Kathi Levell, PHMG Executive Director, Planning
John Wire, PHMG Manager of Women's Services
Lane County Friends of the Birth Center blog (www.lanecofbc.blogspot.com)

encl: Post-date literature review

Post-date literature review
  • The American College of Obstetricians and Gynecologists (green journal) June 2003  Labor Induction Versus Expectant Management for Postterm Pregnancies: A Systematic Review With Meta-analysis
  •  American Family Physician May 15 2005 volume 71, number 10  Management of Pregnancy Beyond 40 Weeks' Gestation
  •  Journal of Midwifery and Women's Health Sept/Oct 2009  Comparison of Induction of labour and Expectant Management in Postterm pregnancy: A Matched Cohort Study
  • Journal of Perinatal medicine 38 (2010)  Recommendations and guidelines for perinatal practice  Guidelines for the Management of Postterm Pregnancy
  • Medscape reference 3/25/2011 author Aaron Caughey MD  Postterm Pregnancy
  • SOGC Clinical Practice Guideline  No. 214, September 2008  Guidelines for the Management of Pregnancy at 41+0 to 42+0 Weeks


  1. Becky SchwarzkopfApril 25, 2012 at 9:02 AM

    I am confused and disheartened by PeaceHealth's departure from evidence-based decisionmaking on this issue.

    Our daughter Madelyn was born peacefully at the Birth Center at almost 42 weeks in 2008. We were told about the policy switch to 41 weeks just a few weeks before our second daughter, Ellie, was born in June 2011, and spent the last few weeks of pregnancy worried about it. Luckily, she was ready on her due date and was born peacefully at the Birth Center in the same bed as her sister Madelyn was born in.

    A major change in care like this made without clear explanation and convincing evidence undermines the mission of the Birth Center, and I hope PeaceHealth will consider the evidence and correct course.

  2. Becky, thanks for your comment. It is much appreciated. And, congratulations on the arrival of Ellie in 2011!!!!

  3. I am so happy to see this! Thank you Lane County Friends of the Birth Center! I think giving an expecting mother and her midwife the choice to birth at either the hospital or the midwifery after 41 weeks is a wonderful step forward. Whether or not the mother & midwife choose to birth at the hospital or the midwifery after 41 weeks the important thing here is that they have a choice!!! I can not thank you enough for compiling this letter and advocating for women.

  4. Thank you Betsy for taking the time to read the letter and to share your thoughts - both are greatly appreciated!

  5. As the mother of two children who were born "on time" and one who approached the 42 week mark, I am extremely disheartened to hear of this new policy. Despite the fact that all three of my children were born at the birth center, I would strongly consider other options if I was going to have another child. How sad :-(.

    1. Thank you for your post Meredith - we really appreciate you taking the time!

  6. i am also very happy to see this! my son was born 8 days past his due date, one day over the limit for the birth center. in spite of great scores on the non-stress test and perfectly adequate amniotic fluid, i was forced (and i did feel forced) to birth at a hospital. it was so disappointing after all the research i'd done, and how strongly i felt about having a birth center birth. the midwives accompanied me to the hospital, and it wasn't terrible, but i still had to undergo inconveniences like EFM and having an IV put in. i also feel we were rushed after the birth in a way that complicated our nursing relationship.

    worst of all, however, was the disappointment in knowing that through no failure of health or intention on my part (or that of my son), without a basis in evidence, and while sitting firmly in the majority of women whose first pregnancies go well past the 'due date', the choice on where to labor was taken away from us. that choice is so personal, so intimate, and it hurts to have it taken away and your birth experience compromised for a purely bureaucratic reason.

    i hope this doesn't sound too negative toward the birth center. my birth experience had many positive aspects to it despite the hospital birth, thanks in large part to the kind and understanding midwives, and i'm grateful for all they did and do. but this policy certainly surprised and disappointed me, and i hope it will be reconsidered.

    1. Thank you for your post - we really appreciate the time and thought that went into it.

  7. Just curious, have you received any response/follow up to this?

  8. Hi Danielle,

    We have not received a formal response yet. As soon as we get one, we will share it. That said, if there is anything we can help you with in regard to getting information you need right now, please call me at 541.221.8892.

    Katharine Gallagher

  9. Thank you for submitting this letter. I am 8 weeks pregnant and exploring birthing options . I immediately began looking for non-hospital options that I could afford as a low-income woman. I was thrilled to learn about the birth center in Springfield, but when I learned about this new policy, it became apparent that if I plan a birth at the birth center, I will need to create a back-up plan to have a hospital birth due to my financial restrictions. I have learned that it is not uncommon for first-time mothers (which I will be) to deliver 1or even 2 weeks late, and with consistent monitoring there are no additional risks. It would be very unfortunate if this policy forced even one woman to have the unwanted experience of a hospital birth rather than the natural, gentle birth experience that the birth center can offer. I deeply appreciate this organization standing up for concerned women like me. Thank you.

    1. Thank you so much Lindsay for taking the time to share your thoughts. Congratulations on your pregnancy and we wish you all the best as you explore and make decisions about your birthing options.