Midwives on the Move

Local midwives pressure hospitals to continue midwifery programs.

Texans for Midwifery crowded the BHOC Thursday night.
Texans for Midwifery crowded the BHOC Thursday night. (Photo By John Anderson)

A standing-room only crowd -- including many babes-in-arms wearing stickers reading "I Midwives" -- showed up to the Brackenridge Hospital Oversight Council's meeting June 20 to urge the council to prevent the complete disappearance of midwifery services from Austin hospitals. Faced with service cancellations at Brack and Seton Medical Center, local midwives and their supporters worry that Austin women are losing birthing options at a time when the number of available doctors is decreasing and the birth rate is rising.

"Why is Austin's only public hospital cutting yet another service to Austin women?" midwife consumer Amy Chamberlain asked. Along with other Austin mothers, midwives, and midwifery supporters, Chamberlain has formed a local chapter of the statewide Texans for Midwifery, a consumers support group. Chapter members coalesced in the wake of last month's announcement by Capital Obstetrics and Gynecology Associates -- the faculty physician practice that sponsored three certified nurse-midwives at Brackenridge during an 20-month trial period -- that it wouldn't renew its sponsorship. According to officials at Seton Healthcare Network, the Catholic nonprofit that manages Brack and runs several other local hospitals, the program was losing money. And Women Partners in Health will end its six-year-old program at Seton Medical Center in December, also due to financial reasons.

The midwives at Brack will remain on staff until July 15 to provide prenatal care; their attorney, Susan Jenkins, says negotiations with Seton are ongoing, and no lawsuits have been filed. Last month, Jenkins released a statement on behalf of the midwives indicating their "complete surprise" at the doctors' decision to end sponsorship. The doctors took over all deliveries immediately upon announcing their decision, and although the midwives -- who delivered 475 babies during their tenure -- hastened to notify their patients of the policy change, they missed one pregnant woman. "We wish that hadn't happened," said Seton's Ed Berger, apologizing to BHOC Chair Dr. Jim Brand and Donna Ammons, the only members at the meeting. Berger and other Seton officials reiterated that it wasn't Seton's decision to end midwifery services, but that of the doctors themselves -- yet Capital Ob/Gyn is part of Seton's own medical and education program.

The Brack midwives could have their clinical privileges renewed if they find new physician-sponsors, says Michael Regier, Seton's vice-president for legal affairs and general counsel. "I think we're supportive of midwifery," he said. Finding sponsoring physicians, however, is the midwives' responsibility, and TfM believes "there's little if no chance" that will happen, in part due to a Seton policy requiring a doctor to be present when a midwife's patient goes into labor or delivers. If the midwife program at Brack was losing money, says TfM, it may be because of this rule, which makes it economically unfeasible for physicians even to collaborate with the midwives.

"Midwifery isn't a money-making proposition, but it's not a money-losing proposition, either," Chamberlain said. TfM believes doctors should serve as backup for midwives on an as-needed basis, and wants Seton to change its in-house doctor requirement; the group says 23 other major hospitals in Texas have no such policy. They also want Seton to let midwives practice as non-sponsored, or independent, Allied Health Professionals under its medical staff bylaws. The group is in the process of acquiring bylaws from other hospitals, Chamberlain says, "to make it easier for Seton to change theirs. They won't have to invent new language -- other hospitals will provide the models."

Many TfM members who spoke Thursday clearly doubt Seton's overall commitment to women's reproductive health -- and not only because of the midwifery issue. Fresh in their minds is the recent ordeal regarding the city's new "hospital within a hospital" on Brack's fifth floor. The hospital, eventually approved by the City Council, is the city's response to Seton's announcement last summer that it could no longer permit common reproductive services prohibited by Catholic Ethical and Religious Directives. "Who decided this [for] the citizens?" asked local midwife consumer Natalie Uzoff-Galletti about the cancellation of midwifery at Brack. "Brackenridge is my hospital -- the city's hospital. Citizens should have a say in what gets added or subtracted."

Dr. Brand recommended that midwife supporters express their concerns to City Council. TfM hopes that bylaws written for the new "hospital within a hospital," due to open next year, will recognize midwives as licensed independent practitioners. But John Gilvar of the Austin/Travis County Community Health Centers says midwifery at the new hospital hasn't been discussed, and whether it's feasible remains uncertain. "The ability of some hospitals to provide certain services depends to an extent on being subsidized by insurance," he said. "Since the new hospital would be treating uninsured patients, we wouldn't have the advantage of private insurers taking over some of the load."

While the number of deliveries at Brackenridge is growing rapidly, so is the crisis in providers for patients without private insurance. Not only are fewer ob/gyns delivering babies in public hospitals because of malpractice insurance rates, but more doctors are limiting the number of publicly insured patients they can afford to accept. Yet studies by the Centers for Disease Control and the National Center for Health Statistics show that deliveries by nurse-midwives result in fewer malpractice suits, as well as lower costs, lower infant mortality and caesarian rates, and higher birth-weights. Says Chamberlain, "It is a bad time to be discriminating against midwives."

TfM will hold a picnic and rally on Saturday, July 13, 10am-noon at Waterloo Park, to support midwifery in Austin. For info, call 419-7406.

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midwives, midwifery, Brackenridge Hospital Oversight Committee, Seton Medical Center, Amy Chamberlain, Texans for Midwifery, Capital Area Obstetrics / Gynecologists Associates, Seton Healthcare Network, Women Partners in Health, Susan Jenkins, Ed Berger, Jim Brand, D

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