Naked City

For more than a year, local midwives have lobbied the city to allow them to practice at the new Austin Women's Hospital -- the city-owned hospital-within-a-hospital at Brackenridge, scheduled to open late this year. But with a University of Texas Medical Branch proposal to operate the new facility headed for City Council action, possibly next month, midwifery representatives say they still have no definitive answers from the city. Members of the Austin chapter of Texans for Midwifery voiced their frustrations Monday in East Austin during a public meeting to review the UTMB proposal. "They said they will consider it, but there is a general sense [among midwives] that no one is willing to go to the mat to get us in the hospital," said Libba Letton, a chapter member.

The midwives' frustrations first surfaced when Brackenridge and Seton Healthcare Network (which operates Brack) suspended their midwifery programs after doctors decided to drop their sponsorship of the midwives. The midwifery group then appealed to the city to let them practice at the new Women's Hospital, which will primarily serve low-income women. Most of the deliveries at the new hospital will be paid for by Medicaid, and the midwifery group asserts they could actually save taxpayers money: certified nurse-midwives are reimbursed at 85% of the rates paid to obstetricians, and midwives' clients require fewer high-cost interventions, such as cesarean deliveries. "The women of Austin want the option of using nurse-midwives in hospitals," said chapter president Amy Chamberlain. "Since UTMB is likely to manage this hospital and already uses nurse-midwives at its other facilities in Texas, nurse-midwives should be an option at this facility as well."

Midwifery representatives had initially lobbied to be allowed to practice without the sponsorship of a physician. Now, they say, their first goal is to gain entry into the new hospital. Still, said Letton, "We recognize that if it's up to the doctor, many of them won't want the competition -- and that's not what anyone is willing to say." The Austin group will take its message to the steps of the Capitol on Thursday, Oct. 30, where a rally will be held in conjunction with a national convention of the Midwives Alliance of North America.