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Maternity Mergers

Imagine two scenarios for giving birth: In one, you labor, deliver, and go through post-partum/beginning breastfeeding in the same room, baby by your side. You have the same nurse through the process, and no one in the room but your own medical and support team. Your midwives, who consider birth a natural process and know your goals and birth plan, are on hand the whole time. They will offer pain medication if you want it or call in an OB if something is going wrong, but they don’t rush you and won’t push unnecessary interventions they know you’d prefer to avoid.

In the other, after you labor and deliver, while trying to initiate your bonding process, you have to move to a new room and possibly meet a new nurse who knows nothing of the labor you just went through. You may have to constantly be on guard if you don’t want to be separated from the baby during post-partum care. OBs whose training focused on birth as a risky medical event and who are statistically more likely to jump to interventions and surgery are overseeing your care from the beginning.

The former scenario describes the midwives’ practice at St. Mary’s Hospital in the Seton Health Care system in Troy. The other is common at many hospitals in this country, and with the Seton maternity unit closing and reopening in neighboring Samaritan Hospital as the new Burdett Family Care Center, many parents, parents-to-be, birth educators, and doulas are worried about whether the environment at Seton will still be accessible.

Jennifer Fegan-Szalay, a doula with Three Sisters Birth in Troy, says that the majority of the women she’s worked with who have used the Seton practice have chosen it because of the specific midwives there, who are used to working with women’s own birth plans and comfortable with natural birth and minimal intervention.

“I appreciated being treated as a normal, birthing woman and not as an obstetric accident-waiting-to-happen,” wrote mother Melinda Kane on her experience having a VBAC (vaginal birth after cesarean) at Seton.

In 2009, twice as many parents chose Seton as Samaritan for giving birth, but the value of the whole midwifery model of care is not merely about consumer preference. It is considered “evidence-based medicine,” a fancy term for “what the numbers show actually works best.” The Cochrane Database, an independent, well-respected, nonprofit collection of systematic reviews of medical research found in a review of 11 trials covering more than 12,000 births that this model of care in hospitals results in equal rates of neonatal survival, but does so with lower rates of expensive and invasive interventions, lower rates of surgery, shorter hospital stays, and higher rates of breastfeeding initiation and satisfaction with the labor.

Indeed, many who work with parents-to-be told me parents have been choosing Seton in large part based on these kinds of statistics. In 2008, 55 percent of Seton’s births were attended by midwives, compared to Samaritan’s 27 percent (which is still better than many U.S. hospitals). Samaritan’s c-section rate was 80 percent higher than Seton’s (37.2 percent vs. 20.7 percent), but its VBAC rate was 84 percent lower. Controversial interventions (episiotomies, inductions by membrane rupture) were also much more common at Samaritan.

Marisa Christiano, a doula and childbirth educator from Schenectady County who sees many clients choosing Seton for this reason, says she fears that with the merger, the practices and attitudes leading to the “good stats” of Seton might get lost.

It’s hard to predict such things ahead of time, but one small concrete thing that is being seen as a possible indicator is the physical layout, which will involve separate rooms for labor/delivery/recovery and post-partum (Samaritan’s “LDR” model instead of Seton’s “LDRP” model), requiring at least one transition for the family during the birth experience. Marylin Morgan, vice president of corporate marketing and communications for Northeast Health, Samaritan’s parent company, says that the layout plans are “not a closed book” and they are looking into a hybrid model with some LDR and some LDRP, but since they are renovating within an existing building, there are some physical limitations. She says in any case that in the future other space in Samaritan may be considered for LDRP.

And, she emphasizes, Burdett will “absolutely” want to be working with more midwives, including the midwives currently at Seton.

Those raising the concerns are clear that they don’t yet know how Burdett will operate, and say that their goal is to get some answers and to work with Burdett to encourage it to offer the birthing options so many women seek, with not only midwives, but the whole midwifery model of care. To that end, they have launched Friends of the Burdett Care Center (friends and are planning to show up at a meeting of the Establishment Committee of the Public Health Council on Jan. 12 at 10 AM to offer comments on the plans.

Their message is that evidence-based care is the way to achieve the goal as phrased by Morgan, who says the bottom line is: “We want moms who deliver to have the best possible birthing experience.”

—Miriam Axel-Lute

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