Midwives Barred From California Hospital


Back in February, without evidence or reasonable cause, hospital administrators at St. John’s Pleasant Valley Hospital in Camarillo, California made the decision to ban Certified Nurse Midwives from continuing to facilitate births at the center.

Midwives say they were told by hospital heads that they would no longer be allowed to deliver – or even assist in – births at the hospital.

According to the Ventura County Star, midwives are still able to practice at St. John’s sister hospital – St. John’s Regional Medical Center – in Oxnard, 11 miles away, because the hospital has a NICU (neonatal intensive care unit) in case of emergencies.

Photo courtesy of Birth Action CoalitionPhoto courtesy of Birth Action Coalition

Clearly, some very serious safety issues must have arisen at the Pleasant Valley Hospital in order for the hospital to take such drastic measures.

Only, that’s not the case. While hospital administrators say the reason for the ban is rooted in concern for the safety of their patients, they haven’t – as of this writing – provided any actual evidence to back up the statement.

According to the article,

The two midwives who deliver at least 60 babies a year at the Camarillo hospital said they don’t understand the reasoning because they rarely have complications.

“Midwives only see and deliver normal and healthy patients,” said Lynn Olson, who commutes to The Woman’s Place for Health in Camarillo from Agoura Hills. “In the two-and-a-half years I’ve been working here I believe I’ve had one NICU (neonatal intensive care unit) patient.”

Midwives at the hospital and those who oppose the decision are asking key questions about why, if administrators are concerned about patient safety, they aren’t concerned about the fact that doctors are the providers who deal with high-risk pregnancy and births. If the hospital does not have a NICU, why would it be the midwives, those who deal with low-risk, healthy pregnancies, who place womens’ and newborns’ health in jeopardy?

There is no answer. Instead there is only the fear and worry from doctors, including Dr. Stephen Carter, an ob-gyn, involved with both hospitals:

There were “too many situations where the nursing staff and the pediatric staff got sucked into bad situations they weren’t comfortable with,” he said.

Carter said doctors worry most about midwives who specialize in home births and rely on hospitals for backup when complications arise.

This reasoning does not sit well with midwives in California and around the country. On the American College of Nurse Midwives blog, Midwife Connection, Candace Curlee, a CNM herself, writes:

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.

Until the midwives are reinstated, the Birth Action Coalition will gather in front of St. John’s Regional Medical Center to protest the action. On the organization’s Facebook page, the coalition says it will continue to protest:

“… until they either: reinstate the midwives at Pleasant Valley; show records of birth outcomes for CNMs and obstetricians which support their claim that it is safer for “low risk” birthing women and babies to labor in Oxnard; or retract their claim that the midwifery ban is due to patient safety.”

It is curious, as we sit with the most recent report from Amnesty, International, which calls our maternal health statistics in this country a crisis, nothing less than a human rights violation, why hospital administrators are taking action to actually curb women’s access to safe childbirth care?

In fact, expanded access to skilled practitioners like Certified Nurse Midwives, is precisely what we need to focus on in order to ensure that women with healthy pregnancies are not subject to unnecessary interventions – interventions that can lead to severe complications or maternal death in some instances.

For more information, visit Birth Action Coalition’s Facebook page and read Candace Curlee’s post on Midwife Connection.

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  • melgarvey

    I don’t understand how banning all midwives from practicing at the hospital will get them out of having to serve women who need emergency transfers from planned home births. The law requires them to treat any patient who shows up in an emergency situation…at least that’s my understanding.

  • amie-newman

    What do home birth transfers have to do with the services CNMs are providing in the hospital? Still and all, they haven’t provided evidence to suggest that these home birth transfers are resulting in negative outcomes for mothers and babies, have they? And if they don’t have a NICU, they don’t have a NICU. So where do midwives come into play?

    You’re right – it’s fishy down to the core.

    Thanks for alerting me, Melissa!

  • kerewin21

    In the medical culture, transfers and admissions are actually politically quite complicated.  Yes, the hospital must accept anybody who needs emergent care, but it is very poor quality care for a medical professional to transfer a patient to a hospital with which they are not affiliated in some way, and most professionals wouldn’t do it unless they had no other choice.  For instance, the midwife in this situation would not have anyone to call at the hospital to ensure a smooth transfer of care, and there could be a delay in necessary care due to poor communication.  Unfortunately, there are a lot of turf wars within the medical field that could also get in the way of a patient accessing timely care.

     

    In addition, most states require that women laboring at home be able to be transferred within a certain amount of time to a facility that can provide a higher level of care.  This would mean that some women’s homes would be out of range.

  • aria

    There were “too many situations where the nursing staff and the pediatric staff got sucked into bad situations they weren’t comfortable with,” [Dr. Carter] said.


    Oh…does he mean these nurses?  The 15 out of 16 nurses there who SUPPORT the midwives?  (The remaining 1 nurse was on vacation when the letter was written, and the 15 didn’t want to spak for her without her consent.)

     

    http://www.vcstar.com/news/2010/feb/13/15-of-16-rns-in-womens-unit-at-st-johns-oppose/

     

     

    Carter said doctors worry most about midwives who specialize in home births and rely on hospitals for backup when complications arise.


    I had a homebirth.  My baby came out at an angle, sunny-side-up, chin-first.  A doctor couldn’t have handled it.  I would have had a c-section.  My wonderful midwife was able to help me deliver my baby safely, without drugs, at home.  I doubt doctors are worried about mother-safety.  Each birth with a midwife is less money for them to make.

     

     

    Look, even among same-risk-level mothers, hospitals’ c-sections are ~1/3.  The complicaton rate with midwives is a third of that c-sections rate, and most complications are very very minor.  My birth can be considered a complication, but in the end, I had not even a minor tear.  At a hospital, it would have been…a c-section.

     

    No matter what, birth comes with risk.  There’s created-risk in an unnecessary c-section, and there’s risk in a vaginal delivery.  The medical industry does a damned good job of creating fear, in making us women doubt our abilities, teaching us to ignore our instincts in favor of letting a doctor okay when to push (I was watching an infuriating episode of A Baby Story the other day with the mother literally begging the doctor to let her push while the doctor said it wasn’t time, and she was in tears trying to not push – I felt sick to my stomach for her), but yet not telling us that they’re making more money the more we listen without questioning.

     

    We are not stupid creatures, and doctors are not gods.  Pregnancy isn’t a medical condition, a problem needing micromanagement, and childbirth isn’t an emergency that needs to be treated as if a c-section is right around the corner (the excuse for not allowing food or water dring the most hysically exhausting times in our lives is what if a c-section is needed, though the resulting exhaustion from deprivation causes the need for c-sections!!).

     

    If it’s really my body, that needs to go for my right to choose how to deliver my baby out of my body.

  • aria

    Dr. Stuart Fischbein is a rare doctor in complete support of midwifery.  He’s associated with St. John’s at this time, and has been out there protesting with us.  While the overwhelming majority of doctors are against us women having any rights and being treated like human beings capable of makn medical decsions, Dr. Fischbein speaks out for our rights.

     

    http://www.supportdrfischbein.com 

     

    He also maintains a blog, linked on his page.