Ministry providers respond to demand for midwife services

December 15, 2017


Demand for midwifery services has been on the uptick nationwide, and Presence Saints Mary and Elizabeth Medical Center in Chicago and Saint Peter's University Hospital in New Brunswick, N.J., are ministry providers that are responding.

Presence Saints Mary and Elizabeth acquired and expanded a midwifery practice last year; Saint Peter's launched a new midwifery service in the spring and plans to add a birthing center. Clinicians connected with the midwife programs at the two facilities say they made these moves because increasing numbers of expectant moms are interested in the low-intervention and less medicalized birth experiences that midwives tend to support.

"We see demand growing," said Mary Bauer, a certified nurse midwife who heads the service at Presence Saints Mary and Elizabeth. She said women "are looking for unique, customizable alternative birthing plans, and we are happy to be able to meet" those preferences.

Designer care
The number of births attended by a certified nurse midwife or certified midwife has increased every year in the U.S. since 1989, the first year such nationwide statistics were available for U.S. births, according to a May 31, 2014, article in The Online Journal of Issues in Nursing. Information from the American College of Nurse-Midwives indicates that more than 370,000 U.S. births were attended by midwives in 2015. That represents about 9.3 percent of all U.S. births, according to the organization.

Jessica Hembrey enlisted the services of certified nurse midwife Mary Bauer for both of her pregnancies and Bauer delivered the children at Presence Saints Mary and Elizabeth Medical Center in Chicago. Hembrey is shown here with daughter Ada, who was born in 2014.

Presence Saints Mary and Elizabeth's Bauer said the faculty group practice at the University of Illinois College of Nursing had had admitting privileges at the hospital for about 20 years when the Catholic hospital acquired the practice last year.

Bauer said from the outset the midwifery program primarily had treated vulnerable populations, including undocumented immigrants, uninsured women and women insured under Medicaid. She added that Presence Saints Mary and Elizabeth's catchment area has a large Hispanic population that is culturally accustomed to, and comfortable with, midwifery.

While those groups are an ongoing priority for the hospital, it also is marketing midwifery services to a group of health-savvy newcomers. In recent years neighborhoods around the hospital have gentrified. Bauer said, "We're located in a hot area, with hipster professionals moving in, and they are well-informed about their health care, and they are seeking out midwives because the midwives align with their philosophies."

She said these philosophies center on personalized care — the women want to tailor birth plans to their personal preferences, and many of today's expectant moms have done a lot of research on and want more natural, less medicalized options for birth. They are interested in acupuncture, massage, yoga, water births and other low-intervention birthing approaches promoted and supported by midwives.

Bauer said a few years ago the hospital surveyed about 350 women aged 25 to 45 who live in or near its service area. The survey showed the women were interested in learning more about midwifery and about a wide range of birthing options. Presence Saints Mary and Elizabeth marketers thought results confirmed there was a potential to develop the market for midwife services.

Robust expansion
The University of Illinois had decided to end its midwife practice last year after two decades because a federal grant that had supported the practice had expired. Bauer said Presence Saints Mary and Elizabeth acquired the practice because "we thought we could provide a better experience for our patients by bringing the midwives in-house full-time," and because of the evidence of growing local interest in the service.

Bauer was one of the two full-time midwives employed in the University of Illinois practice, and she now heads the service at Presence Saints Mary and Elizabeth. Over the past year-plus, Presence Saints Mary and Elizabeth has hired four additional full-time and five part-time midwives and may expand the service further in the future. Presence Saints Mary and Elizabeth has been using a targeted digital and direct mail campaign since the spring to build awareness of the services in its west-side Chicago catchment area.

Jersey babies
Dr. Edwin Guzman chairs the department of obstetrics and gynecology at Saint Peter's University Hospital. Jennifer Santos is a certified nurse midwife who is part of a newly launched midwifery service at Saint Peter's and Michelle Lazzarotti is Saint Peter's senior director of marketing. The three said the hospital analyzed national trends, researched what local expectant mothers were saying on internet blogs and discussion boards, and studied feedback provided on Press Ganey patient satisfaction surveys. The marketing and clinical folks concluded that there was a demand for midwifery services and for low-intervention birth experiences, and that women found midwife options lacking locally.

The hospital's analysis also revealed that as a perinatal center specializing in care of high-risk moms and babies, Saint Peter's had gotten a reputation for only offering technological birth options, often involving IVs, drugs and fetal monitors, and was not associated with natural birthing options many women with low-risk pregnancies may desire.

Bauer holds Benjamin Hembrey, shortly after she delivered him June 28.

Guzman and Santos said to respond to what they found through the market analysis, Saint Peter's for several years has been offering "OB lite," being intentional to inform women of the many birthing alternatives available and encouraging them to document their preferences.

Options may include bypassing intravenous medications, using preventive techniques to try to avoid Cesarean sections and episiotomies and using birthing tools like birthing balls. The hospital uses a standardized electronic format to document patients' individual birth plans, and shares the women's choices with all members of their birthing team through the electronic medical record.

Saint Peter's built upon this OB lite foundation when it launched its midwife service this year — it now has three full-time midwives. And, plans call for the hospital to add an on-campus birthing center by the spring, for women with low-risk pregnancies who opt for low-intervention births.

That center will be attached to the hospital. Initially it will have two birthing rooms and waiting, consultation and family gathering areas, with room to grow. It will have easy access to an elevator that goes to the inpatient labor and delivery unit, so moms can be transferred quickly into the hospital if complications arise.

Team effort
Publications including TIME magazine have said that as midwife services have increased nationwide, tension between the midwives and obstetricians has arisen.

But, Bauer, Guzman and Santos said their facilities have integrated the midwife practices into the hospitals' service lines, and the hospitals have positioned the traditional providers and the midwives as collaborative team members. They work in the same labor and delivery suites (though that will change at Saint Peter's when the birthing center comes online) and work with the same nursing staff. Both hospitals have protocols in place to ensure that an obstetrician is on call whenever a midwife is delivering a baby, and the protocols specify when that obstetrician will be called in. In most cases, it is when the need arises for a Cesarean section or when complications arise for mother or baby.

Both hospitals are positioning their midwife services as expanded options for moms, not as competition to the care offered by obstetricians.

Santos said of the launch of the midwife services and the other changes happening at Saint Peter's, "I'm very passionate about empowering women so they know there are these safe options available to them and that they can have shared decision-making here. We're lucky to have physicians here that support that philosophy."



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