Every morning at Watsonville Community Hospital in Northern California, the labor and supply group divvies up its sufferers — low-risk ones go to the midwives and high-risk ones to the physicians. Then, all through the day, the medical doctors and midwives work collectively to make sure the births go easily.
“We kind of divide and conquer,” stated Dr. Julia Burke, chair of the hospital’s obstetrics and gynecology division.
The hospital started permitting licensed nurse midwives to ship infants in 2017, a part of an effort to lower cesarean sections and make moms happier.
It wasn’t a simple transition, Burke stated. Some medical doctors, for instance, had been working towards for 30 years and by no means labored with nurse midwives, who’re registered nurses with a graduate diploma. Pharmacy, medical billing and different departments additionally had been hesitant in regards to the change, not sure of what it could take to combine nurse midwives, she stated. “It took a lot of convincing,” she stated.
Throughout the nation, hospitals and medical practices are battling outdated stereotypes and generally their very own suppliers and employees to convey on licensed nurse midwives. To achieve this, they’ve to beat a lack of understanding in regards to the security and advantages of midwifery care and the legal guidelines and insurance policies that prohibit using nurse midwives.
Certified nurse midwives are educated to offer girls’s well being care, together with household planning companies and maternity care. As for childbirth, they usually deal with regular births and go away extra difficult instances to physicians. There are greater than 11,200 licensed nurse midwives across the nation, together with about 1,200 in California.
Women cared for by licensed nurse midwives have fewer C-sections, analysis reveals, which may enhance start outcomes and produce important cost savings for hospitals. A 2017 study, as an illustration, additionally discovered fewer epidurals and fewer use of anesthesia amongst low-risk girls with care led by licensed nurse midwives, in contrast with care led by physicians.
Despite the information supporting using nurse midwives, they attend fewer than 9 p.c of births within the United States. That’s far decrease than in some European international locations, the place greater than two-thirds of births are attended by midwives, stated Laura Attanasio, assistant professor of well being coverage and administration on the University of Massachusetts-Amherst.
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Lack of consciousness amongst sufferers and different suppliers is a key cause, Attanasio stated. “When people hear the term ‘midwives,’ people think you are really talking about home births,” she stated. In truth, she stated, most midwife-attended births happen in hospitals.
Attanasio stated that to considerably improve the variety of births attended by midwives, physicians and hospitals have to be keen to convey them on board, and extra nurse midwifery coaching packages have to be created. “Our maternity care workforce reflects the way it’s been for the last 100 years,” she stated.
Administrative hurdles pose one other problem in some areas. Six states, together with California, require nurse midwives to apply beneath the supervision of a doctor, stated Kim Dau, affiliate professor at University of California-San Francisco. Yet medical doctors could also be reluctant to imagine these supervisory duties as a result of they’re anxious about malpractice legal responsibility or a much bigger workload.
Attempts to alter the regulation in California have to this point failed because of infighting between the state’s medical affiliation and hospital affiliation.
To assist overcome the obstacles, the Pacific Business Group on Health, a California nonprofit well being group representing employers, is making an attempt to broaden the variety of hospitals and doctor practices that use midwives. They have created guidelines for the way to combine them, and are laying out a enterprise case to persuade medical doctors and hospitals.
They argue, as an illustration, that midwives may help scale back OB-GYN burnout and scale back malpractice instances related to pointless C-sections.
Bringing midwives into hospitals and doctor practices additionally may help improve their clientele, stated Brynn Rubinstein, affiliate director of the group’s maternity care program. “Women are really hungry for lower intervention in birth,” she stated. “Midwives are a great option for them.”
More girls would use midwives if given the choice, in accordance with a latest survey by the California Health Care Foundation. Seventeen p.c of ladies surveyed stated they might undoubtedly wish to be cared for by a midwife in a future start, and 37 p.c stated they might think about it. (Kaiser Health News produces California Healthline, an editorially unbiased publication of the California Health Care Foundation.)
But girls can’t all the time discover them, or they could harbor misconceptions in regards to the security of midwife-led care, interviews carried out by the Pacific Business Group on Health reveal.
Lauren Lockwood, a midwife in Walnut Creek, stated among the medical doctors she works with at John Muir Medical Center additionally had misconceptions about midwives: “Most OB-GYN physicians don’t know what education I have gone through, what my experience is and what I am qualified to do.”
Lockwood stated some physicians additionally might really feel “a little threatened” by competitors from midwives, however others see the worth.
Some hospitals, together with Highland Hospital in Oakland, have used midwives for no less than 20 years, stated Katie McKee, interim nurse supervisor of the midwifery program. There, the OB-GYN medical doctors work collaboratively with the midwives, who deal with a lot of the prenatal care, triage and about 70 p.c of deliveries, McKee stated.
McKee stated there may be all the time no less than one doctor and one midwife on the hospital, they usually talk continuously. “We are always working as a team,” McKee stated.
At Watsonville Community Hospital, about 15 miles south of Santa Cruz, directors knew they needed to do one thing to convey down their C-section fee for low-risk births, which was larger than the state common. In 2016, Burke, the OB-GYN, helped begin a hospitalist program there so physicians would all the time be on-site. That allowed girls to be in labor longer with out medical doctors intervening with medicine to induce labor.
Then Burke, who additionally directs OB-GYN companies on the clinic community Salud Para La Gente, labored to herald the nurse midwives from the clinic. They’re now on the hospital each weekday from 7 a.m. to 7 p.m.
It’s too early to inform if the nurse midwives have helped scale back the C-section fee, which is now 24.9 p.c, however Burke stated she expects it to say no.
Now Burke and lead midwife Sarah Levitan wish to broaden this system so midwives are all the time on the hospital. “To truly see the value of midwifery, we need to be there 24/7,” Levitan stated.
