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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 oftheburdettcarecenter.org)
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
www.mjoy.org
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