PeaceHealth's (1) Faulty Financial Arguments and (2) Absence of Mission and Ethics

Letter Countering PH on Financial Sustainability

Letter on PH Mission and Ethics 

Testimonies of Care
Media Coverage
Press Release

PeaceHealth administration and Department of Mission, Theology and Ethics fail to substantively engage with Friends of the Birth Center

PeaceHealth has begun to respond but continues to fall far short of our community's demands for input into its decision to close the Birth Center.  PeaceHealth COO Todd Salnas replied to our request for a meeting with PeaceHealth CEO Mary Kingston with a similar invitation to be heard only on the conditions determined by PeaceHealth administration.

Friends of the Birth Center also communicated this week with the PeaceHealth department of Mission, Theology and Ethics. We appealed to this department on the grounds that a sudden closure of the Birth Center stands in direct opposition to the values to which all PeaceHealth departments and employees are purported to adhere.  Again, we received a reply that did not engage with the content of our letter or offer to communicate further with our organization.

PeaceHealth CEO obfuscates reason for closure, declines to authentically engage with Birth Center community

On May 20, Friends of the Birth Center received a reply from PeaceHealth CEO Mary Kingston in response to our request for a meeting to discuss the Birth Center.  This reply invited one member of our Board to attend a meeting, on the condition that we limit our input to ways to "ensure that as we transition from the Birth Center to the integrated model of care at RiverBend we meet the full spectrum of birthing needs of our community and that our expectant mothers enjoy safe, satisfying and empowering childbirth experiences."  Because, as members of the Birth Center community, we know that midwives are already integrated and providing low risk care at RiverBend, and that  Birth Center clients already enjoy precisely these experiences under the care of midwives and staff, we declined to meet with PeaceHealth under this condition. Friends of the Birth Center is a consumer advocacy organization; we refuse to be used as a means by which PeaceHealth can purport to participate in authentic engagement with its patients even as it fails to address our concerns.  Instead, we will continue to advocate for our community by demanding that PeaceHealth meet with us to discuss keeping the Birth Center open.

On May 23, PeaceHealth COO Todd Salnas also responded (via telephone) to our request for a meeting with administration.  He asserted that PeaceHealth desires to convene with people who want to help PeaceHealth formulate a plan to incorporate midwifery services into the obstetrics model of care at RiverBend.  It is clear to us that PeaceHealth has NO current plan other than to close the Birth Center. We were told that our board is only invited to a meeting if we limit our discussion to that plan; PeaceHealth is not willing to hear our concerns about the Birth Center’s closure, or our ideas about how it could continue to exist in its current form.  

Financial unsustainability is the reason PeaceHealth continues to give for its decision to close the Birth Center.  This rationale is disingenuous; we know that PeaceHealth was making plans to hire additional midwives and expand the Birth Center's services as recently as March 2019. The premise PeaceHealth offers for the Birth Center's "unsustainability" is furthermore based upon incorrect data (midwives delivered far more babies than the numbers PeaceHealth has stated) and fails to take into account the comprehensive care that has been provided by the Birth Center in over 3,000 clinic visits since July 2018. Please see our response to Mary Kingston, which details the many ways that the claim of financial unsustainability does not withstand scrutiny, here.  

Women's Care recently decided to cease collaborating with Birth Center midwives and PeaceHealth seems to have decided to close the Birth Center instead of confronting this problem head-on, and working in collaboration with the Birth Center community to solve it. PeaceHealth has chosen to summarily close the Birth Center, thereby making its many invaluable services unavailable to women and families in our region. We continue to insist that PeaceHealth work to solve this problem by meeting with Friends of the Birth Center to discuss how to keep the Birth Center open.

Senior Vice President of Mission, Theology and Ethics declines to meaningfully engage with community’s concerns

On May 24, Friends of the Birth Center sent a thoroughly researched and carefully considered letter to the Board of Directors and others in the the PeaceHealth Department of Mission, Theology and Ethics, which you can see here.  This letter was sent with twenty-one pages of testimony provided by birth center clients and can be seen here.The letter and testimonies detail the many concrete ways that eliminating the Birth Center without any input from the community it supports is a violation of PeaceHealth's statement of common values.  Yet again, we urged PeaceHealth to respond to our specific concerns, and on May 28 we received a reply from Dianna Kielian, Senior Vice President of Mission, Theology and Ethics (available here) that did not engage with them in any way. Rather, it thanked us for sharing our "fond memories and special experiences," and reiterated the talking points with which we are now familiar.  

The Uniqueness of the Birth Center Model of Care

Thank you to Desiree Larson, RN and past IBCLC (International Board Certified Lactation Consultant) for this guest post on the importance and uniqueness of the birth center model of care.

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Midwifery practiced within Birth Center settings offers uniquely empowering care and support for women, babies, and families.  I have decades of experience as a nurse, lactation consultant, maternal-infant program developer and policy analyst, and mother of three children delivered by midwives.  My experiences in these roles have proven to me time and again that the birth center model of care addresses the lived experience of the whole woman in a way that cannot be replicated in other models of healthcare.  Babies, parents, and families thrive on the long-term support offered by birth center nurses, midwives, lactation consultants, and others.  I have dedicated my professional life to ensuring that Lane County families have access to this incomparable model of care. 

The birth center model of care is fully integrated and addresses the entire spectrum of medical needs that arise long before and well after a baby's birth.  As a lead member of Cottage Grove Hospital’s maternity staff, I was a lead in developing a 24-hour breastfeeding helpline, hospital- and home-based Lactation Consulting services, and prenatal clinic- and home-based maternity care coordination.  Each of these is an example of the far-reaching and personal aspects of a birth center model that seek to support the mental, emotional, and physical health of women and babies.  They are furthermore evidence of the ways in which the profound needs that arise when babies come into the world can be met by a holistic approach that extends far beyond a hospital building or doctor's office.

Birth center midwives compassionately attend to the many private and often difficult life experiences for which women need delicate support.  These include: trauma and betrayal in prior birth experiences, sexual abuse of all types, PTSD, depression, anxiety, phobias, past or present stillbirths, past or present postpartum depression, addiction issues for themselves or their families, social stigmas associated with homosexuality, and teen pregnancy.  Women also often endure a lack of confidence in our bodies as a result of culturally conditioned insecurities, modesty, and shame. As a professional in this field, I observe that obstetricians' training and service delivery model does not include addressing the lived experience of the whole woman, or this long list of challenges and traumas that might accompany a woman's birth experience.  But as a practitioner of the midwifery model, I developed programs to support these common elements of women’s lives. Midwives understand that women's needs are not strictly medical, and seek to support the whole person as she experiences the profound process of pregnancy, birth, and caring for a newborn.  The closure of the Nurse Midwifery Birth Center will make this model of compassionate care unavailable to countless families throughout Lane County and our region.   

Birth Centers play a crucial role in the health of newborn babies.  Far from being merely a place where babies are born, a birth center is the hub of a community that offers support of all kinds for new families.  Lactation consultation is part and parcel of the birth center model, and takes place both at birth centers and in families' homes.  By providing hands-on, concrete help to new parents in breastfeeding, Birth Center midwives seek to ensure that babies can reap the vast and undisputed benefits of breastfeeding. This is considered to be among the most important decisions a mother can make for her infant and a significant decision she can make for her own health.  I helped spearhead the Baby Friendly Hospital initiative in Lane County; Cottage Grove Hospital was the first in Oregon to earn this designation, and I assisted the Nurse Midwifery Birth Center in becoming Baby Friendly.  The Baby Friendly designation, which is an international standard, means that a birthing facility has met rigorous standards to consistently protect, promote and support breastfeeding. This designation gives confidence to mothers that their desire to breastfeed will be supported.  Birth Center staff is available 24 hours a day to answer questions, address concerns, and provide expert clinical support. 

Birth center communities offer other concrete services to ensure the health of new babies.  As a member of the midwifery community, I worked to ensure that settings such as these were accessible to the community.  At the PeaceHealth Nurse Midwifery Birth Center in particular, Baby Clinic is an informal setting where parents can bring newborns to be weighed and discuss infant feeding and growth.  Professional lactation consultants offer advice and assistance, and parents can ask questions and receive support during the very fragile first weeks and months of a baby's life. These settings, wherein both the physical and emotional wellbeing of babies and parents are being attended to by caring professionals, also foster crucial interventions into perinatal mood disorders and anxiety disorders, and offer access to facts about other issues such as safe sleep, SIDS, maintaining milk supply, working while breastfeeding, and referrals to other services.  Birth center midwives, nurses, and staff do not merely catch babies; they provide an integrated, wraparound model of care that seeks to ensure the health and wellbeing of mothers, babies, and families for months and years beyond a baby's birth.

Midwives do not view women as medical patients; they believe that women are experts on their own lives and feelings.  Birth center staff members work to support families throughout every challenging and joyful dimension of childbirth and raising a newborn.  In birth center communities, new parents' needs are validated and attended to by caring professionals.  The model of care practiced in these settings seeks to address the full complexity of women's experiences and vulnerabilities, and honors the strength women reveal throughout the very intense process of bringing new life into the world.  Birth centers offer true community healthcare, and all families throughout our region should continue to have access to this empowering kind of support and care.  

Desiree Larson, RN
past IBCLC

Dear Elected Representatives: #SaveTheNurseMidwiferyBirthCenter.

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Following is our first letter to all elected representatives with constituents in Lane County. Supporters might also enjoy seeing a letter of support from Sen. Merkley sent on the occasion of the Nurse Midwifery Birth Center's re-opening in 2010 at the Springfield site.  Supporters, when you contact your elected representatives, ask their staff members to make sure they see this letter and take the suggested actions (see letter) to #SaveTheNurseMidwiferyBirthCenter. 

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May 23, 2019

  

Re: PeaceHealth Nurse Midwifery Birth Center

    

    

To Our Elected Officials:

PeaceHealth has announced its intention to close the Nurse Midwifery Birth Center (NMBC) in Springfield. In light of your role as an elected official, Lane County Friends of the Birth Center asks for your help to reverse this plan. Unchecked, it represents a restriction on reproductive health choices.

The Nurse Midwifery Birth Center has served our community since the 1970s. It serves women and families from the Eugene/Springfield area, Salem, Albany, Lebanon, Corvallis, Sweet Home, Creswell, Cottage Grove, Roseburg, Coos Bay, Reedsport, Grants Pass, Oakridge, and Pleasant Hill. It is a nationally accredited and designated provider of evidence-based lactation support for mothers and babies. The current site was built from generous donor and community gifts only 9 years ago and celebrated the 1000th baby born on site this year. In partnership with PeaceHealth, it was made by and for the community and needs to remain open, as intended, for future generations.

There is good reason for the Nurse Midwifery Birth Center’s longevity. It provides a unique, integrated, and comprehensive model of care including family planning, prenatal, birth (out of hospital and hospital), pregnancy loss, postpartum, lactation support, a baby clinic for weighing and feeding support, and well woman care. The United States has the highest maternal mortality rate of our peer countries and spends more on healthcare than any other developed nation. The Centers for Medicare and Medicaid Innovation (CMMI) calls for scaling up of the freestanding, midwifery-led birth center model. This model improves health outcomes, patient experience, and reduces costs.

NMBC closure would have a disproportionate impact on low income and minority women. NMBC midwives do not limit or exclude OHP Medicaid clients, unlike other local practices. Furthermore, the NMBC has developed a partnership with the Community Health Centers of Lane County to serve women receiving this coverage as well as coverage through CAWEM. In its rush to close, PeaceHealth has failed to account for this critical partnership. Rather, a decision was made without consulting NMBC staff or this consumer group. PeaceHealth administrators, who have never visited the NMBC or taken time to understand its vital role, can do better than this.

Lane County Friends of the Birth Center is particularly concerned by what we have learned about the information gathering and decision making processes used to justify closure. Statistics cited by PeaceHealth are incorrect. These same statistics are used without context and mischaracterize demand for and outcomes associated with NMBC services. Participants (this consumer group and NMBC staff) who could have offered a corrective were fully cut out of the process.

Lane County Friends of the Birth Center asks for your support in the following ways:

●      Visit the Nurse Midwifery Birth Center, as soon as possible. We would be delighted to assist you in making such a visit possible. Communicate with us via lanecofbc@gmail.com.

●      Meet with PeaceHealth leadership, here and at the system level in Vancouver, to reiterate the importance and value the Nurse Midwifery Birth Center holds in this community.

●      Speak with administrators at Lane County Health and Human Services and at Trillium Community Health Plan. Both of these organizations are responsible for ensuring a high standard of maternity care for significant numbers of women in our community. We believe an insufficient understanding of and appreciation for midwifery-led birth center care currently exists and makes impossible the recognition of the avoidable risks involved with closing the NMBC and replacing it with what we anticipate will be physician managed midwifery care.  We would be happy to assist you with a list of recommended contacts. We would like to be included in meetings you attend. 

Following are specific topics Lane County Friends of the Birth Center would appreciate elected officials raising and inquiring about:

●    PeaceHealth has told us that some insurance plans do not have a reimbursement code for a birth center birth. As a result, PeaceHealth doesn't bother trying to get reimbursed for those births and just writes it off.

●  We understand that Trillium plans to start reimbursing according to risk level. Inevitably, low risk pregnancies will be treated as higher risk with the attendant (cascading) interventions.  This is an upside-down approach with very real ethical implications. Additionally, we do not know if Trillium has or will have a birth center-specific birth delivery reimbursement code. 

We are committed to inclusion and transparency with the community. We actively communicate using the social media channels below. On our blog, visitors have access to media coverage garnered thus far, a petition with nearly 7,000 signatures, and other valuable information for understanding why we advocate for the midwifery-led birth center care at the Nurse Midwifery Birth Center.

Blog:                         https://lanecofbc.blogspot.com/

Facebook:               Lane County Friends of the Birth Center

Twitter:                   @LaneCoFBC

Hash tag:                #SaveTheNurseMidwiferyBirthCenter

Included with this letter is a Guest Viewpoint that goes into further detail about the importance of the NMBC,

published in The Register-Guard last Sunday. Thank you for your time and consideration. Please let us know how we can anticipate working with you.

         

Sincerely,

Lynn Kane, PhD

Co-Chair, Lane County Friends of the Birth Center

Commissioner, Commission for the Accreditation of Birth Centers

Mother of two birth center babies (born 2010, 2012)

Ann Carney Nelson

Co-Chair, Lane County Friends of the Birth Center

COO, Inpria Corporation

Mother of two birth center babies (born 2012, 2015)

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Encl:       Kane and Carney Nelson: Keep commitment to Birth Center Families, Guest Viewpoint in

The Register-Guard

                 

                 

Board Members:

Lynn Kane, PhD

Co-Chair, Lane County Friends of the Birth Center

Commissioner, Commission for the Accreditation of Birth Centers

Mother of two birth center babies (born 2010, 2012)

Ann Carney Nelson

Co-Chair, Lane County Friends of the Birth Center

COO, Inpria Corporation

Mother of two birth center babies (born 2012, 2015)

Katharine Gallagher, MPP

Founding member & Former Co-Chair, Lane County Friends of the Birth Center

​Commissioner (Former), Commission for the Accreditation of Birth Centers

Centro Latino Americano, Social Services

Mother of two babies, one a birth center VBAC baby (born 2005, 2007)

Matt Huston

Employee Benefits Consultant - Hagan Hamilton 

Father of two birth center babies (born 2011 and 2016)

Heather LeCompte, MA in Counseling

Mother of one birth center baby (born 2015)

  

Jennifer Noyce, PhD

Mother of two birth center babies (born 2012, 2014)

Teresa Roark, MPH

Mother of one birth center baby (born 2018)

Lindsay Selser

Communications and Policy Analyst--Planning and Development Department, City of Eugene

Board of Directors, Sexual Assault Support Services

Mother of two birth center babies (born 2014, 2016)

Rabbi Jacob Siegel

Father of two birth center babies (born 2017, due 2019)

Emeritus Board

Katharine Gallagher

Eleanor Vandegrift

Karen Guillemin

Kathy Lynn

Renee Bailey

Anna Chorlton

Maria Blum

Jennifer Rinner

Sara Starlin