[FNLBeInformed] Midwives Popular, But Forced Out of Business

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Midwives Popular, But More Forced out of Business

 

By Asjylyn Loder - WeNews correspondent

 

(WOMENSENEWS)--The birth of Miriam Singer's fourth child was tinged

with a sense of loss for the mother, who knew that she was among the

last few who would deliver a baby at the midwifery center at the

University of Chicago Hospitals and Health System, where Singer had

delivered all of four of her children.

 

The hospital stopped accepting new midwifery patients in early

October after 18 years, and will soon close its doors despite an

outpouring of community support from loyalists such as Singer.

 

The demand for midwifery care has more than tripled in the last

decade, but rising insurance costs have made it difficult for

midwives to stay in business. Midwives spend more time getting to

know patients throughout their pregnancy and are less likely to

intervene by inducing labor or performing Caesarean sections. For

those reasons, many women favor midwifery care. But midwives earn

substantially less than obstetricians and hospitals and independent

midwives alike are finding it hard to shoulder skyrocketing

malpractice premiums.

 

Midwives attended 305,606 births in the United States in 2001, or

nearly 10 percent of vaginal births, a 100 percent increase from

1990, according to the National Vital Statistics Report by the

Centers for Disease Control and Prevention. Studies have shown

midwife deliveries to be as safe as physician-assisted deliveries.

Of births attended by midwives, 97 percent take place in hospitals,

where an obstetrician is on call to handle complications.

 

Singer, for example, suffered serious postpartum bleeding after the

birth of her third child. Her midwife called in a physician to

handle the bleeding, but stayed by Singer's side. Singer had a high

risk of bleeding with the next delivery, but the midwife brought

Singer safely through without complications while a physician

remained on-call for emergencies.

 

Certified nurse midwives are typically registered nurses who have

completed a Bachelor's degree, often in nursing, and earned advanced

certification in the care of pregnant women.

 

Closures, Protests Around U.S.

 

There are no statistics on how many midwifery practices across the

country have closed recently but several prominent midwifery

services have been scaled back or closed since August.

 

On Sept. 29, Full Circle Women's Health, a nonprofit midwifery

practice in Tallahassee, Fla., closed its doors after 20 years due

to a rent hike and doubled malpractice insurance rates. In Des

Moines, Iowa, a hospital that handles most midwife assisted births

in the area cannot find enough physicians to meet the requirement

that midwives work with two attending physicians and has let go four

midwives as a result. In New Jersey, the last of three independent

midwifery birthing centers closed in 2002.

 

New York saw an escalation of this trend this year. In August, the

Brooklyn Birthing Center announced that its malpractice insurance

had stopped covering midwives. Then, on Sept. 1, the prestigious

Elizabeth Seton Birthing Center announced the closure of its

Manhattan birthing rooms due to a 400 percent hike in malpractice

insurance rates. In early October, New York Presbyterian Hospital

initiated cutbacks in midwifery services at its Allen Pavilion

branch.

 

Midwives displaced by the string of closings have found it hard to

find a home elsewhere. In late November, four former Seton midwives

quit St. Vincent's Hospital, complaining that hospital regulations--

including a policy that advised recommending inducing labor six

hours after membrane rupture--made it impossible for them to

practice the methods of natural, noninterventionist childbirth that

defines midwifery care.

 

As several high-profile midwifery services were forced to close

their doors this year, women have rallied together to demand the

greater continuity of care and attention that midwives provide.

 

In Austin, Texas, where hospital-based midwifery care was

discontinued last year, midwives and former midwifery patients

demonstrated in October to bring the midwives back, which may happen

under new hospital managers. And in Chicago, midwifery patients

marched on the University of Chicago Hospitals after it announced

the closure of its midwifery practice.

 

Record-High Insurance Pinches Midwives, Doctors

 

Hospitals across the country are going through painful cost-cutting

due to the rising costs of care associated with record-high

insurance premiums. Even though midwives usually earn less than

obstetricians, in lean economic times hospitals can be tempted to

cut back on them and direct patients instead to obstetricians,

because obstetricians are fundamental medical personnel. In

addition, insurance companies often have lower reimbursement

rates for midwives than obstetricians.

 

" The midwives are getting caught in the squeeze, " said Deanne

Williams, executive director of the Washington-Based American

College of Nurse-Midwives.

 

Midwives earn on average $41,500 to $52,000 annually, topping out at

$65,000, according to the University of Missouri Career Center--less

than half of the $133,450 earned by obstetricians, according to the

Bureau of Labor Statistics. The insurance plan endorsed by the

American College of Nurse-Midwives costs from $7,000 to $32,000 per

year, depending on experience, education and location. New York, and

Florida are two of the priciest states to practice.

 

Obstetricians are also feeling the pinch with median premiums that

increased 167 percent between 1982 and 1998, and rising steadily

each year since. Last year, saw a 15 percent increase. Many doctors

are choosing to close their practices. The upshot is what many see

as a triple negative for health-care participants.

 

" The loser is the physician who is overburdened, the woman who does

not want to receive that kind of care and the midwife who is out of

a job, " said Williams.

 

Singer agreed. " Their availability is second to none. In terms of

pre-natal care, I was able to call the midwives any time, the whole

nine months, " she said. Singer was able to see the same midwives

through the births of all four of her children and the midwives

stayed by her side throughout the duration of her labor, following

her wishes to have a low-intervention delivery, qualities Singer

doubts she could have found from a busy obstetrician.

 

" If I were to have delivered with an obstetrician, my delivery would

mostly be attended by labor nurses that I didn't know and by

residents, " she said.

 

In scaling back its midwifery service, New York Presbyterian

Hospital cited concerns over the safety of their patients,

reclassifying " low risk " patients as " at risk, " thus disqualifying

them from midwifery care. Midwives counter that they have safely

managed high-risk deliveries for years and that the maneuver is

designed to force midwives out.

 

" We traditionally work with high risk populations and decrease the

bad outcomes, " argued Janet Brooks, who has been a midwife at Allen

Pavilion for 14 years. " What they are saying is that they are

changing to a medical model of care, " she said. " A medical model of

care means that there will be more interventions and the more

interventions, the more money you can charge. "

 

There is speculation that the change in policy is related to a $5.1

million Medicaid fraud settlement agreed to by the hospital earlier

this year. The lawsuit alleged that doctors had fraudulently billed

Medicaid for services performed by midwives.

 

Hospital spokesperson Bryan Dotson says patient safety, and not

financial considerations, was the primary concern. He added that no

midwives have been let go as a result of the new policy.

 

A late November study by American Baby magazine found that women

attended by midwives were less likely to have a Caesarean and

received less medication than women attended by an obstetrician.

Statistics this year showed that 26 percent of babies in the United

States are now delivered by Caesarean, in part because of guidelines

by the American College of Obstetricians and Gynecologists that

allow for elective Caesarean. The World Health Organization

recommends a national Caesarean rate of 15 percent.

 

Asjylyn Loder is a freelance writer in New York.

 

For more information:

 

American College of Nurse Midwives: - http://www.acnm.org/

 

American College of Obstetricians and Gynecologists: -

http://www.acog.org/

 

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