Each morning at Watsonville Group Hospital in Northern California, the labor and supply crew divvies up its sufferers — low-risk ones go to the midwives and high-risk ones to the physicians. Then, all through the day, the docs and midwives work collectively to make sure the births go easily.
“We form 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 docs, 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 might take to combine nurse midwives, she stated. “It took loads of convincing,” she stated.
All through the nation, hospitals and medical practices are battling outdated stereotypes and generally their very own suppliers and employees to carry on licensed nurse midwives. To take action, they’ve to beat a lack of awareness in regards to the security and advantages of midwifery care and the legal guidelines and insurance policies that limit using nurse midwives.
Licensed nurse midwives are skilled to offer girls’s well being care, together with household planning companies and maternity care. As for childbirth, they sometimes deal with regular births and depart extra sophisticated circumstances to physicians. There are greater than 11,200 licensed nurse midwives across the nation, together with about 1,200 in California.
Girls cared for by licensed nurse midwives have fewer C-sections, analysis reveals, which might enhance start outcomes and produce important cost savings for hospitals. A 2017 study, as an example, 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.
Regardless of the information supporting using nurse midwives, they attend fewer than 9 p.c of births in the US. That’s far decrease than in some European nations, 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 College of Massachusetts-Amherst.
Lack of information amongst sufferers and different suppliers is a key purpose, Attanasio stated. “When individuals hear the time period ‘midwives,’ individuals assume you might be actually speaking about dwelling births,” she stated. Actually, 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 should be keen to carry them on board, and extra nurse midwifery coaching packages should be created. “Our maternity care workforce displays the way in which it’s been for the final 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 College of California-San Francisco. But docs could also be reluctant to imagine these supervisory duties as a result of they’re fearful about malpractice legal responsibility or an even bigger workload.
Makes an attempt 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 Enterprise Group on Well being, a California nonprofit well being group representing employers, is attempting to broaden the variety of hospitals and doctor practices that use midwives. They’ve created guidelines for combine them, and are laying out a enterprise case to persuade docs and hospitals.
They argue, as an example, that midwives can assist cut back OB-GYN burnout and cut back malpractice circumstances related to pointless C-sections.
Bringing midwives into hospitals and doctor practices additionally can assist improve their clientele, stated Brynn Rubinstein, affiliate director of the group’s maternity care program. “Girls are actually hungry for decrease intervention in start,” she stated. “Midwives are a terrific possibility for them.”
Extra girls would use midwives if given the choice, in keeping with a current survey by the California Health Care Foundation. Seventeen p.c of girls surveyed stated they might undoubtedly need to be cared for by a midwife in a future start, and 37 p.c stated they might take into account it. (Kaiser Well being Information produces California Healthline, an editorially unbiased publication of the California Well being Care Basis.)
However girls can’t all the time discover them, or they might harbor misconceptions in regards to the security of midwife-led care, interviews carried out by the Pacific Enterprise Group on Well being reveal.
Lauren Lockwood, a midwife in Walnut Creek, stated among the docs she works with at John Muir Medical Heart additionally had misconceptions about midwives: “Most OB-GYN physicians don’t know what schooling I’ve gone by way of, what my expertise is and what I’m certified to do.”
Lockwood stated some physicians additionally might really feel “a bit of 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 docs 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 continually. “We’re all the time working as a crew,” McKee stated.
At Watsonville Group Hospital, about 15 miles south of Santa Cruz, directors knew they needed to do one thing to carry down their C-section price for low-risk births, which was increased 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 docs 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 cut back the C-section price, which is now 24.9 p.c, however Burke stated she expects it to say no.
Now Burke and lead midwife Sarah Levitan need to broaden this system so midwives are all the time on the hospital. “To really see the worth of midwifery, we should be there 24/7,” Levitan stated.