UPDATE: Today, September 13, 2018, Beth Hawver from Friends of Michigan Midwives and I met with Dr. Jennifer Frink, at her invitation. Our goal was to encourage Borgess Medical Center and Ascension administrators to restore full scope of practice to the CNMs, including VBAC. We carried your stories, hopes and concerns with us — supporting families is the entire reason that FoMM and Birth Kalamazoo exist. We’ve also always been supportive of Borgess and their great work with families, as well as their doula-positive approach. We want to see things get back to full, evidence-based status. It was a positive and productive meeting. Dr. Frink shared that revoking these CNM privileges was always meant to be temporary and that the hospital is working toward lifting the restrictions. There is now an off-the-record timeline for the changes, and that timeline felt reasonable to us in terms of making shifts within a big system. We’re so grateful that Dr. Frink reached out to us so quickly and that she truly listened. We agreed to meet again in one month. Our eyes are wide open, and we feel hopeful that Borgess is going to make the right choice to restore full scope for their midwives — quickly. Thank you all for making your voices heard, it’s only together that we can encourage change. If you see or write to Dr. Frink or Tim Stover, please thank them for their openness and let them know that you look forward to the expected announcement that the midwives have had their full scope of practice restored. Because as you have told us again and again, Southwest Michigan families want their midwives. Borgess seems receptive to your concerns, and they are listening. We’re staying on top of this issue and will keep you all in the loop. Watch for an update from us by mid-October, if not sooner, when we meet again with Dr. Frink. If you're not up to date on the full story, read on. -Jessica
In 2015, administrators at Borgess Medical Center, an Ascension Health facility, removed a number of privileges from the Certified Nurse Midwives practicing through Borgess Women's Health. For the past three years, families in Kalamazoo have been denied access to midwifery care at Borgess if they have the following:
• previous shoulder dystocia
• intra-uterine growth restriction (IUGR)
• insulin-dependent gestational diabetes
• previous cesarean birth (VBAC)
These are all within the nurse-midwifery scope of practice. It is safe for midwives to attend these births.
So why are Borgess patients being denied midwifery care? Having a midwife at your birth can mean more personal office visits, more choices, and a provider who is trained to treat pregnancy and birth as a normal, physiologic events — not as medical conditions.
Over these past three years, there have been rumblings at times that the midwives might be getting these privileges back. But it hasn't happened. It's been THREE YEARS. It's time for families to stand up and let Borgess Medical Center and Ascension know that we want our midwives, and we expect our health care systems to follow evidence-based best practices.
(Even if you don't live in Kalamazoo, this is an important issue for you to care about. Acension is a nationwide chain of hospitals. Could this policy be extended to other Ascension facilities? We don't want to risk it!)
Nurse-midwives are licensed health care providers in the state of Michigan, and they deserve to be working within their full scope of practice. Restoring these privileges is a start.
And hey, you know what else? Normal, healthy midwifery patients don't need to see a doctor, either.
Along with these 2015 protocol, Borgess Medical Center also requires that every midwifery patient also see a doctor during her pregnancy — even if the woman is perfectly healthy and low-risk. Also, every midwifery patient is supposed to get a visit from a doctor in the hospital during labor. Why? This practice isn't evidence-based or necessary.
We love doctors (really, they can be so great!), but there's no reason for this dual care, which implies that nurse midwives are somehow not competent to manage our pregnancies and births. Healthy, low-risk women (and even medium-risk patients) do not need to see a physician during their pregnancy or birth, unless they agree with their nurse-midwife that a consult would be helpful for a high-risk situation. Nurse midwives are qualified, competent and capable of managing our care. We're thankful for their collaborative relationships with the physicians, in case there's truly something wrong. But when all is good? Normal? Healthy? Low-risk?
A nurse midwife is everything we need.
So what can you do? The patients have power, so there are a couple of things. Borgess has traditionally been a great place to birth, so we need to advocate together to bring things back to normal. You can do these things even if you didn't have your baby at Borgess. Would you please?
1. First, write to Dr. Jennifer Frink, the overseeing physician at Borgess Women's Health, and to Tim Stover, the interim CEO at Borgess. Respectfully let them know that you want full access to a nurse midwife, in keeping with their licensing and scope of practice, even if you have insulin-dependent gestational diabetes, IUGR, pre-eclampsia, a previous shoulder dystocia, or if you are planning a VBAC. Especially if you are planning a VBAC! Basically, we're asking them to lift these restrictions immediately, because they're not in keeping with best practices, licensing requirements, scope of practice or research. And let them know that there is no need for normal, healthy nurse-midwifery patients to see a doctor during their pregnancy or birth.
If you've had a midwife for a pregnancy or birth, let them know why that was important to you. And if you changed practices from Borgess to Bronson so you could have a nurse midwife, or if you're considering doing that, definitely tell them that as well. Here's their contact info:
Be professional and kind, but clear. These are experienced and talented professionals. We believe if they hear our voices and why this matters to us so much, they will make the right, evidence-based decision.
2. Share this blog post and our memes on social media, using the hashtag #wheresmymidwife and tagging @BorgessMedicalCenter and @Ascension.
3. Keep it up, it's been three years of promises that things will change. We need to show the administration that families truly care about this issue and that we want change now.
4. Hug a midwife. They haven't been treated fairly, and they need our support.
Use your voice. Together, we can make change.
Jessica English, AdvCD/PCD/BDT(DONA), LCCE, FACCE
Jessica English is an advanced certified birth doula, certified postpartum doula, DONA approved birth doula trainer, certified childbirth educator, and Lamaze International program director and trainer. She is the owner of Birth Kalamazoo and Heart Soul Birth Pros, where she trains new doulas and childbirth educators, along with hands-on labor support skills training for nurses.