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Midwife Crisis

Patients say doctors won't do.


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Three years ago Pat Schneider received one of the highest service awards the University of Chicago Hospitals offers its employees--the Martin Luther King Jr. Humanitarian Award for outstanding public service. Then two months ago the university eliminated the midwife program she's part of.

The university started using nurse-midwives in 1985 to give patients an alternative to conventional birthing methods. Over the years the midwives have proved immensely popular. The current trio--Schneider, Charity Cooper, and Sue Mersch--have developed a long list of patients who praise them for their sensitivity, good humor, and expertise.

According to Dina Weinstein, one of their patients, the midwives' strength lies in the personal touch they offer. "My husband and I moved to Chicago from New Jersey when I was seven months pregnant," she says. "I was going to some hoity-toity ob-gyny service, but they had no bedside manner. It was horrible."

Through a friend's recommendation Weinstein found her way to the midwives. "I met with Charity, and right away I could see the difference," she says. "She was very knowledgeable--she knew as much about birthing as anyone I've met. But it's more than that. The midwives have this salt-of-the-earth warmth. They're happy to see you. They say, 'Take your time.'"

The midwives see themselves as a bridge between the fast-paced, often impersonal world of doctors and their patients, many of whom are intimidated by that world. While doctors might spend five or ten minutes with a pregnant patient per visit, the midwives will spend up to a half hour. Cooper, Mersch, and Schneider work with doctors as backup to offer their patients a full range of services, including episiotomies and C-sections. "We've always been part of a larger team at the university," says Schneider. "We let our patients know all of their options."

Despite their success, the midwives began to worry about their program earlier this year, when the hospital hired a new chairman of its obstetrics and gynecology department, Dr. Arthur Haney. Cooper says, "We heard all sorts of rumors that the university was going to head in a new direction and phase out midwives."

In June the midwives met with Haney. "He was very respectful at the meeting," says Cooper. "But he talked a lot about the rising cost of malpractice insurance, and we didn't know where that was going." Haney told them the hospital was probably going to have to stop offering midwife services. "He felt that he wanted to use us as 'physician extenders,' which is a catchphrase out there. It means you work with the doctors." Period.

Haney did agree to consider changes in accounting procedures that might allow the hospital to retain the midwives, but over the next month the university apparently decided that it had to cut the program anyway. In July, Haney broke the news to them. "He told us to stop taking new prenatal patients. 'Your practice is closed,'" says Cooper. "We would remain on staff as physician extenders." They would be midwives only until the last of their current patients gave birth. Then they would be absorbed as labor and delivery nurses.

But the university had underestimated the amount of support the midwives had in Hyde Park. As news of the program's closing spread, university officials were bombarded with e-mails and phone calls pleading with them to reverse their decision. On August 27 the Hyde Park Herald ran a story headlined "Midwife program serves too few patients." In it Haney told reporter Mema Ayi, "The current economic conditions of health care are forcing us to make difficult decisions," and he pointed to the dramatic rise in medical malpractice rates that had forced the hospital to decrease the number of practitioners it covered for labor and delivery procedures. He also said that the hospital might have continued the midwife program if more privately insured women had used it and that in 2002 the midwives had delivered only 3 percent of the 3,000 or so babies born at the hospital. "The midwives provide a wonderful service that attracts health-conscious patients who want to have a natural and homelike childbirth experience," Haney said. "Unfortunately, the health care system has made that kind of traditional, pure midwifery practice financially untenable in this environment."

Haney's explanations didn't placate the midwives' supporters. As they saw it, the university was following one of the worst trends in modern medicine. Instead of looking for the best treatment for its patients, they said, the university was trying to wring as much money as it could from insurance providers--patients be damned. According to a fact sheet provided by the university, the midwifery program "has required an annual subsidy of $140,000 to $180,000 to survive." But it isn't clear what that figure includes. At any rate, the midwives' supporters say, the central issue is that the hospital can maximize the amount of money it brings in for births by replacing midwives with doctors. In effect, the medicaid and private insurance reimbursement system encourages hospitals to charge more, not less, for basic services such as treating risk-free pregnancies, drawing up the overall cost of health care.

"I've been around long enough to know numbers can be deceiving," says one hospital insider who asked not to be identified. "The deal is that the hospital gets to charge more money from the state and the insurance companies if doctors--as opposed to residents or midwives--are credited with deliveries. Now I'm not going to say that those doctors who supposedly did those 3,000 deliveries weren't in the room when those babies were born. I'm just saying it's in the hospital's financial self-interest to make sure those doctors are credited for doing most of the work. And it has absolutely nothing to do with what's best for the patients or what the patients wanted."

The midwives and their supporters also said that even though malpractice rates were going up, the rates for the midwives were lower. And even though the midwives had delivered only 89 babies last year, that didn't mean more women didn't want to use them. "There's a great demand for our services," says Cooper.

In fact, say the midwives, university officials have been forcing them to turn away patients. "We loved delivering the low-income moms," says Cooper. "But in 2000 we were told by the hospital we couldn't deliver any more of the teen moms."

A follow-up letter from Haney that the Herald printed got the critics even angrier. He wrote, "Our independent midwife practice has always been small with virtually no impact whatsoever on the low-income women in our community since most women served by the practice had private insurance."

The midwives respond that though they no longer serve as midwives to low-income women because they were told they couldn't, they still offer these moms counseling. "Last year," says Cooper, "we did over 4,000 visits with low-income moms."

Many of the midwives' supporters think Haney was belittling the midwives and mocking their patients by writing them off as a fringe group--"hippie airheads," as one woman put it. Weinstein says, "Haney's quotes about 'health-conscious patients' who want to have 'a natural and homelike experience' suggest he doesn't even know what the midwives do. He doesn't understand that if you want an epidural, for instance, or if you need an episiotomy or a C-section, the midwives are there for you. Just as if you want a tub birth they're there for you."

As the e-mail and phone calls poured in, the hospital began extolling the virtues of the midwives. "We want to keep the midwives--we value them as employees," says Karyn Odway, a hospital spokeswoman. "But in these hard economic times we have to make adjustments."

On September 12 the midwives' supporters took their protest to the street, staging a midmorning rally outside the hospital's Duchossois Center for Advanced Medicine, at 58th and Maryland. There must have been 70 or more demonstrators, many of them pregnant women or mothers with infants, on the pedestrian oasis outside the center. They held signs, passed out flyers, and chanted "Midwives go--so do we. Good-bye, U. of C."

Weinstein stood on a wall to deliver a speech, which was largely obliterated by the noise of an earthmover operating on the site of the new children's hospital just across the street.

"Women have been laboring and having babies for countless generations," Weinstein said. "We deserve the fundamental choice of how our children will be brought into the world."

In many ways it was a classic Hyde Park demonstration. The protesters were bright and articulate. One activist, Jack Spicer, warned people to beware the university's spin. "They're going to portray this as a white, middle-class lifestyle choice, but that's really a lot of crap," he said. "This is about providing good health care to women--including black women on the south side."

Many women offered heartfelt testimonies about the care the midwives had provided. "I had one of those V-back babies," said Lisa Snider, a Hyde Park resident. "That means vaginal birth after having a C-section. It was all because the midwives were involved. They got one of those ob-gyny guys to check me out to see if I could deliver. And I could."

Most of the demonstrators seemed to think that axing the midwives' practice signals a larger shift. "I think they got rid of the midwives because they don't fit the image the hospital wants to project," said Noreen McGowan, a north-side midwife. "They don't fit the high-tech image of modern health care, with the new children's hospital and everything."

On hand to offer the hospital's perspective were Odway and John Easton, another university publicist. "Look at this crowd," Easton said, scanning the protesters, almost all of whom were white. "Hyde Park is a wonderful community, but it's isolated. We don't draw outside Hyde Park. The people outside Hyde Park want doctors. They don't want midwives. It's how they look at things."

Then, as if on cue, Moniqua Henderson, one of the midwives' low-income teen patients, walked over. "The midwives are great," she said. "They answer all of my questions. They really care about me and my baby, as opposed to the people at the board of health [clinic] where I used to go. I say the hospital should keep the midwives and just get out the word, 'cause more people would want to use them if they knew they could."

Art accompanying story in printed newspaper (not available in this archive): photos/Jon Randolph.


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