Tuesday, March 16, 2010

Midwifery Advocates Protest Seemingly Illogical Hospital Decision

by Candace Curlee, CNM, MS, ACNM Region VI Representative

A curious thing happened last month in Ventura County, CA. St. John’s Pleasant Valley Hospital in Camarillo decided that midwives can no longer practice at their facility. Midwives have been practicing at St. John’s for the past 30 years. Evidently, the pediatrics and obstetrics committees along with the board of directors made the decision for “safety reasons.” Midwives were not included in the discussion.

One would assume this was related to bad outcomes; however, no peer review on the midwives’ quality of care occurred prior to the decision. In fact, the letter notifying staff midwives, three days prior to their effective dismissal, said that the loss of hospital privileges was not a reflection upon the care provided. The letter also stated that there was no allowance for a hearing or review.

The odd part of this whole situation is the board and committees’ reasoning. They say that because the hospital does not have a neonatal intensive care unit (NICU), it is unsafe for midwives to attend birth on the premises. However, physicians continue to deliver babies at St. John’s Pleasant Valley, including cesarean births, which statistically have more risk for a newborn to be admitted to NICU. Officials at the hospital have been mute, except to insist that this new policy is all about patient safety without further explanation. They declined to respond when asked to release statistics of babies admitted to NICU whose birth was attended by midwives as opposed to those attended by physicians.

In general, midwives care for women who are at low risk for complications. Numerous studies, including a recent Cochrane Review, testify to the high quality and safety of midwifery care. In fact, research indicates that midwifery care may reduce the risk of neonatal morbidity and mortality and therefore the need for NICU admission. Birth Action Coalition, is spearheading a campaign to force the hospital to rescind this unjust and unsubstantiated policy. If you live in the area, please join them at their next rally Friday, March 19, 11am to 1pm.


Anonymous said...

I had a similar thing happen to me. I wrote the board of directors as well as JCAHO. The patients started writing letters; the main newspaper got involved. The hosital even went so far as to writing a complaint to the state board of nursing which they had no documented evidence. Four months later I was let back into the hospital but because I didn't have "a supervising MD" I could only function as a family member. Isn't ACNM organized to take on these cases?

I'm sorry this has happened. Don't stop fighting for what is right.

Melissa Garvey said...

Thanks for sharing, anonymous. ACNM is in the process of organizing into state affiliates as I type, and this is a perfect example of why we're so excited about it. A strong state structure is critical to our ability to respond to these types of situations timely and effectively. If you're curious about what exactly a state affiliate is, visit http://www.midwife.org/siteFiles/education/State_Affiliates_8_09_000.pdf.

pinky said...

Their is more here than meets the eye. It just makes no sense to say a midwife cannot practice because the hospital does not have a nicu. If not nice, then the patients presumably are low risk. Low risk patients are fine for a CNM to take care of everywhere else on the planet? The line of reasoning is flawed.

Anonymous said...

Thanks for sharing Candace. I hope the midwife client population also get involved. How many births were the midwives attending there?

Joyce Weckl CNM said...

Thanks to all for comments and to Candace for the article. I am one of the two CNMs involved. You're right, there is more than what meets the eye. We (CNMs) are being used as political pawns between battling MDs and it's a rotten place to be. Please note our community coalition's web site and the attached petition. Yes, moms, the newspaper, nurses, etc. are all involved but the hospital is not budging yet. We continue the fight (after 14 years of excellent care)!