August 27, 2019
An Open Letter To Our Community:
We all desire safe, healthy, and supportive births for families in our community. We recognize the important role that hospitals and obstetricians play in helping our community achieve those goals and recognize the need for PeaceHealth and Women’s Care to improve and expand the services they offer. However, we also believe that families have the right to birth in a place and with a provider where they feel safest and most supported, which may not be a hospital or with an obstetrician. We are concerned that PeaceHealth’s latest “fact” sheet is misleading, confusing, and does little to address community concerns about the elimination of a birth center option and the reduction of midwifery services. The “midwifery model of care” is a specific model of care that has similarities to, but is not synonymous with “maternity care,” “women’s health,” or “obstetrical services.” In addition, a low-risk, in-hospital model does not fully replicate the unique attributes of a freestanding birth center. What PeaceHealth is proposing does not expand birth plan choices, nor does it allow all birth providers to practice fully and autonomously according to their unique scopes of practice.
PeaceHealth says: The Birth Center facility is not closing.
The Reality:
While the building itself may remain open, after August 31 there will be no more births at the NMBC, thus no more birth center. No new clients have been accepted for months, the dozens of prenatal clients due after August will have to make alternate plans, and gynecological clients will be forced to find new providers.
The NMBC facility was not a pre-existing facility that was retrofitted to be a birth center. When nearly 200 donors gave $774,000 toward the project (PeaceHealth may quibble with this number, but it is public record), the building was constructed uniquely and purposefully as a birth center. Re-naming and re-purposing the birth center for anything else will diminish its value and is insulting to the donors, who have a right to expect that their gifts will be used according to the original vision.
PeaceHealth: We are committed to ensuring continuity of care as we transition services and do not anticipate gaps in care.
The Reality:
Birth center services are not transitioning. Birth center births are being eliminated, all birth center midwives are being terminated, and PeaceHealth has no future plans to offer out-of-hospital births. No matter how home-like a hospital makes its labor and delivery rooms, a low-risk, in-hospital model will never be a free-standing birth center as defined by the American Association of Birth Centers. This results in a total gap in community birth center care, even as national and global public health initiatives are calling for the scaling up of the birth center model and the increase of midwifery services.
In 2018 nearly 25% of all vaginal births at RiverBend were attended by NMBC midwives (in addition to the 70 birth center births). After September 30, 2019, it is fair to anticipate that there will be no guarantee of a CNM-attended birth at RiverBend for the foreseeable future. This does little to ensure continuity of care, or the “smooth, seamless transition” PeaceHealth has promised to midwife clients.
- For the time being, clients on the Oregon Health Plan (OHP) will still be able to access midwifery services at the Community Health Prenatal Clinic, but this privilege is not available for women with any other insurance type. Furthermore, these OHP clients will no longer be able to birth with the midwives they have come to know and trust during their prenatal care, but will instead be assisted by whichever doctor is on call at the hospital when they arrive in labor.
- None of the current NMBC midwives are on-boarding to work at Women’s Care.
- Women’s Care is in the process of hiring CNMs from out of the area, and hopes to have three in place by October 1. However, new Women’s Care clients will not be able to see a midwife until they have met first with an obstetrician, and the practice is unable to guarantee a midwife for deliveries. Even when a Women’s Care midwife is available, she will be partnered with an OB for the birth, as hospital by-laws require that new practitioners be closely proctored for several births, depending on their level of experience. While we wish these new CNMs all the best, there is no way that these three providers will be able to fulfill the promised seamless transition for the hundreds of midwifery patients who were formerly served by 11 established midwives at the NMBC.
This will NOT be a midwife-led practice. This will be an physician-run, hospital-based practice. While there may be midwives, this is not a guarantee that clients will be truly experiencing the midwifery model of care, which is fundamentally different in scope and practice from a medical model. Furthermore, outside of home-based midwifery, for the first time in 40 years there will be NO out-of-hospital birth center option in Lane County.
PeaceHealth: PeaceHealth will continue to offer midwife-led, low-intervention deliveries.
In partnership with Women’s Care, our goal is to expand, not limit, these services including midwifery, overall well woman care, prenatal and postpartum care, including lactation support.
The Reality:
Once the NMBC closes PeaceHealth will outsource midwifery care to Women’s Care, an independent physician group with its own business priorities, mission, and values. PeaceHealth will no longer be the employer for midwives at RiverBend, thus PeaceHealth cannot guarantee our community anything midwifery related. PeaceHealth ultimately has no control over whether or not midwifery-led, low-risk deliveries remain a top priority at RiverBend (as we have recently seen when Women’s Care decided not to renew its contract with the NMBC).
No matter how many “new” services are offered, eliminating a CNM out-of-hospital birth center option, and allowing one private practice to monopolize maternity care at RiverBend is not giving women access to more birth plan choices.
While many wrap-around services will continue to be available to the community, they will no longer be housed in one common space. Rather than one location where women can access all of their health needs, clients will have to go to multiple locations (and possibly multiple providers and/or community organizations) to access prenatal care, labor and birth, postpartum support, and gynecological services.
PeaceHealth’s promise in letters to current clients informing them of the impending closure: “This is a sacred time and we are committed to providing you with the most supportive and compassionate care possible. We look forward to keeping you informed and meeting your health needs well into the future.”
The Reality:
Thus far, this “supportive and compassionate care” amounts to nothing more than sending out letters informing current clients of the dates by which they will need to find new providers. Women’s Care was asked to extend its contract with the NMBC through the Fall so that current prenatal clients would not have to change providers in the middle of their pregnancy, but Women’s Care declined. Even if a client goes into labor on September 30, at midnight on October 1 the NMBC midwives will no longer be allowed to attend the birth at RiverBend.
It is presumptuous for PeaceHealth or Women’s Care to think that women will readily transfer their care to a new practice and a new provider (as many current clients have already eloquently expressed). NMBC clients understand and value the nuances of midwifery care, and do not take lightly the fact that they are being stripped of their right to an informed choice about what is best for their own bodies and their family’s health. Pregnancy is not an illness and there are many reasons that families would prefer not to birth in a hospital. Many current clients have already made the decision to birth at home or at other accredited birth centers outside of Lane County in response to the NMBC closure.
PeaceHealth: PeaceHealth will continue to partner with community organizations to provide prenatal services to the underserved, including those on OHP, Medicaid, CAWEM or without coverage.
The Reality:
We sincerely hope this is true, but have heard many stories from women on OHP who have difficulty transferring to independent providers. While hospitals can not lawfully turn away patients on Medicaid, private practice offices do not have this same restriction, and are known to reject these clients due to the lower Medicaid reimbursement rates. In other instances, while clients are waiting for their OHP or Medicaid to be approved, they must pay up front for initial services, which is a barrier to receiving vital prenatal care. Many private providers also establish expectations of patients that can be difficult to meet for women who face language barriers, childcare and transportation challenges, or financial hardship.
PeaceHealth has not given its 90-day notice of a change in contract to the Community Health Clinic, thus they continue to be responsible for providing care for these prenatal clients. Given that PeaceHealth has already demonstrated its willingness to renege on its commitments to midwifery clients at the NMBC, we sincerely hope they keep their commitment here.
Research by the Center for Medicaid and Medicare Improvement, in which our own NMBC participated, found that the birth center model of care, in particular, provides an important corrective to the challenges related to social determinants for the health of mothers and families in our community, and recommends birth centers play an increasing role, not a diminished one.
PeaceHealth: We’ve had numerous conversations with representatives of LaneCoFBC and have invited them on several occasions to work with us to help identify what our future model of obstetrics care will look like as part of our community advisory committee.
The Reality:
We are the Lane County Friends of the Birth Center. Our mission, which remains unchanged, is to represent the consumer voice in support of the unique services offered by a midwife-led, freestanding, accredited birth center. While we applaud PeaceHealth’s desire to improve birth experiences at the hospital for those who desire or need them, our role is to advocate for continued access to the birth center model of care, which pregnant people also have a right to choose. We have documented our interactions with PeaceHealth officials here.
The local community (including birth center clients, midwives, elected government officials, physicians and providers, non-profit organizations, and Sacred Heart Medical Center Foundation donors) has already provided a great deal of input to PeaceHealth about the kind of birth choices our community desires and deserves, but PeaceHealth has chosen to ignore this input.
The current hospital work group organizational structure is heavily weighted towards obstetricians and hospital administrators, rather than CNMs and birth center staff--their own local experts on low-risk, physiologic birth who have been practicing a robust, evidence-based, fully-integrated model of care for many years within the PeaceHealth system.
But....are birth centers safe???
Two large-scale U.S. studies 30 years apart (the second in which our own NMBC participated) both demonstrated that the birth center model of care is not only safe, but that it also consistently produces significantly lower rates of cesarean sections, premature birth, and low birth weights, as well as higher rates of breastfeeding success–all while saving the health care system millions of dollars. Systemic reviews of studies on birth center data show maternal and fetal outcomes for low-risk women that are equivalent to or better than women who deliver in a hospital, with higher degrees of client satisfaction.
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine Specialists have explicitly endorsed accredited, freestanding birth centers as an “integral part of regionalized care” in their August 2019 levels of maternity care obstetric care consensus, and as part of the solution to improving maternal and fetal outcomes.
Our NMBC has shown a commitment to excellence and safety from its inception as one of the oldest nationally-accredited birth centers in the country. Not only is the NMBC regularly reviewed by the Commission for the Accreditation of Birth Centers to ensure it is adhering to best practices, outside consultants hired by PeaceHealth also praised the birth center as the “jewel” of PeaceHealth’s maternity system.
The NMBC is staffed by Certified Nurse Midwives, all of whom are recognized as licensed, fully independent practitioners under Oregon state law, and who have exceeded the international standards for midwifery education and training, which have also been endorsed by ACOG. While CNMs in Oregon consult with obstetricians as needed, they are recognized as autonomous providers with prescribing privileges, and do not need the supervision of physicians in order to practice safely or legally.
Planned hospital births also have inherent risks, including significantly higher rates of cesarean birth, and other obstetric interventions, which should also be communicated with clients as a matter of informed consent. Given that numerous public health initiatives are prioritizing the lowering of non-medically indicated c-section rates, it is surprising that PeaceHealth would choose a private-practice model that recent studies show is associated with an increased cesarean rate.
The 2015 OHSU study, which PeaceHealth has cited as evidence for the need to move all births to RiverBend, does not, in fact, conclude that community births be eliminated, but rather that “Oregon women are very likely to have a safe delivery in any setting." The authors of the study also acknowledge that a major limitation of their research was that the data did not distinguish between types of out-of-hospital birth (including birth center births, home births, and births unattended by any health care professional). Nor did the data distinguish between the varied levels of training among out-of-hospital providers. To improve safety further, the authors of the study do not propose moving all births to a hospital labor and delivery unit, but rather encourage better collaboration and communication between all types of providers. They also recommend looking to countries with better integrated maternity care systems, like the Netherlands or the United Kingdom, where midwives are the lead care providers for healthy women.
“Beyond preventing maternal and newborn deaths, quality midwifery care improves over 50 other health-related outcomes, including in sexual and reproductive health, immunization, breastfeeding, tobacco cessation in pregnancy, malaria, TB, HIV and obesity in pregnancy, early childhood development and postpartum depression.”
Sincerely,
The Lane County Friends of the Birth Center
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
COO, Inpria Corporation
Co-Chair, Lane County Friends of the Birth Center
Mother of two birth center babies (born 2012, 2015)
Katharine Gallagher, MPP
Founding member & Former Chair, Lane County Friends of the Birth Center
Former Commissioner, Commission for the Accreditation of Birth Centers
Centro Latino Americano, Social Services
Mother of two babies, one VBAC baby at hospital cared for by the birth center midwives (born 2005, 2007)
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, 2019)
Emeritus Board
Katharine Gallagher
Eleanor Vandegrift
Karen Guillemin
Kathy Lynn
Renee Bailey
Anna Chorlton
Maria Blum
Jennifer Rinner
Sara Starlin
Matt Huston
