Tuesday, April 24, 2012

Friends requests re-evaluation of policy barring women from laboring at birth center at or past 41 wks pregnancy

In its capacity as the consumer advisory group to the PeaceHealth Nurse Midwifery Birth Center, Lane County Friends of the Birth Center recently sent the following letter. It expresses concern over and requests a re-evaluation of the new policy barring women from laboring at the birth center at or past 41 weeks pregnancy. 

Ms. Michele Peters-Carr, CNM
PeaceHeatlh Nurse Midwifery Birth Center
353 Deadmond Ferry Road
Springfield, OR  97477

April 12, 2012

Dear Michele:

On behalf of the Friends of the Birth Center consumer advisory group, I am writing to express concern about the new policy prohibiting pregnant women at or past 41 weeks from laboring at the Nurse Midwifery Birth Center. Since May 2011, several families have expressed their surprise and displeasure at losing access to a much-anticipated and planned-for out-of-hospital birth.

As a consumer advisory group, Friends of the Birth Center has the following specific concerns regarding the development and implementation of this new policy.
  • We have the impression that the decision-making process resulting in this change was set not by Birth Center midwives but rather for them. The Commission for the Accreditation of Birth Center requires that birth centers operate as independent practices with the necessary autonomy and authority to develop evidence-based standards for care.
  • The new policy runs counter to the 42-week standard (with increased surveillance) for out-of-hospital birth set by the Commission for the Accreditation of Birth Centers.
  • The Birth Center already has a thorough surveillance protocol for monitoring women at and beyond 41 weeks to identify risks making a birth center birth unwise. This protocol is consistent with evidence-based practice.
  •  The policy is not supported by the literature. All the references in the attached review confirm that risk rises with advancing gestational age. The issue that arises is not risk but rather how much risk is too much for out-of-hospital birth. The risk at 41 weeks is less than the risk of many other complications occurring in normal pregnancy.  Almost all of the referenced studies endorse expectant management with antenatal testing. This was the policy employed by the Nurse Midwifery Birth Center before May 2011.
In the more than 25 years since its inception, the Birth Center has developed a well-deserved reputation for excellence in practice. Its outcomes meet and exceed state, national and international standards and benchmarks. In light of this, we would like to encourage a re-evaluation of the current policy.

We encourage a return to a decision-making process that both respects the authority of the midwives, as providers, to oversee the development of standards of care and facilitates collaboration between them and  specialists. Such a policy would incorporate rather than override the preferences and values of pregnant women. If there is relevant new information, this can be incorporated into the decision-making and consent process already in place to support and aid women in making decisions about their care.

We appreciate the opportunity to share our concerns. We are optimistic that a review of the above items will facilitate a worthwhile discussion resulting in a satisfactory conclusion for all involved. Having the opportunity to be included would be most welcome by the Friends of the Birth Center

Katharine Gallagher, Chair 

Consumer Advisory Group Members
Maria Alisa Blum
Anna Chorlton Connelly
Katharine Gallagher
Lynn Kane

Emeritus Members
Eleanor Vandegrift
Karen Guillemin
Kathy Lynn
Renee Bailey

Kathi Levell, PHMG Executive Director, Planning
John Wire, PHMG Manager of Women's Services
Lane County Friends of the Birth Center blog (www.lanecofbc.blogspot.com)

encl: Post-date literature review

Post-date literature review
  • The American College of Obstetricians and Gynecologists (green journal) June 2003  Labor Induction Versus Expectant Management for Postterm Pregnancies: A Systematic Review With Meta-analysis
  •  American Family Physician May 15 2005 volume 71, number 10  Management of Pregnancy Beyond 40 Weeks' Gestation
  •  Journal of Midwifery and Women's Health Sept/Oct 2009  Comparison of Induction of labour and Expectant Management in Postterm pregnancy: A Matched Cohort Study
  • Journal of Perinatal medicine 38 (2010)  Recommendations and guidelines for perinatal practice  Guidelines for the Management of Postterm Pregnancy
  • Medscape reference 3/25/2011 author Aaron Caughey MD  Postterm Pregnancy
  • SOGC Clinical Practice Guideline  No. 214, September 2008  Guidelines for the Management of Pregnancy at 41+0 to 42+0 Weeks

Saturday, April 14, 2012

Miriam Rosenberg, CNM joins the Nurse Midwifery Birth Center

Friends of the Birth Center is pleased to welcome and introduce the Birth Center's newest staff member:

Midwife Miriam Rosenberg joined the PeaceHealth Nurse Midwifery Birth Center in 2011.

Originally from Washington, DC, Miriam received her bachelor's degree in nursing and master's degree in midwifery from Oregon Health & Sciences University.  Prior to becoming a nurse-midwife, she worked as a doula at San Francisco General Hospital and at a birth center in Chiapas, Mexico.  She is fluent in Spanish. Outside of work, Miriam enjoys cooking, hiking, and pottery.

Be sure to come to the Birth Center's second annual birthday party on May 5 from 2 - 4 pm. You might have the opportunity to meet Miriam. You will definitely have the opportunity to re-connect with Birth Center midwives, lactation staff, nurses and staff and families. And, of course, to eat a Divine Cupcake treat..... See you there. 

Spread the word via Facebook invite:

Monday, November 7, 2011

Friends of the Birth Center meets with new PeaceHealth Oregon CEO

This morning members of the Lane County Friends of the Birth Center met with Mr. Tom Reitinger - PeaceHealth Oregon’s new CEO and Chief Mission Officer.

We shared our history as a grassroots advocate for funding and building the new PeaceHealth Nurse Midwifery Birth Center near the Sacred Heart Medical Center at RiverBend. (Click here to take a virtual tour.) We also discussed our groups’ continued activity as a consumer advisory group for the practice.

Meeting with Mr. Reitinger provided an opportunity for our group to highlight the many features and characteristics that make the PeaceHealth Nurse Midwifery Birth Center such an important asset and resource for Lane County. Among many topics discussed,  we touched on its status as a Baby Friendly facility and its provision of Lane County’s only Centering Pregnancy Program (group prenatal care). We also spoke to the power and efficacy of the birth center model and independent midwifery.

Before we could invite him, Mr. Reitinger expressed interest in visiting the Birth Center and we look forward to this happening!

-- Katharine Gallagher 

Thursday, September 29, 2011

New Members for the Consumer Advisory Group & a Fond Farewell to Outgoing Members

The Lane County Friends of the Birth Center consumer advisory group is pleased to announce we have new members – Maria Blum, Anna Connelly and Lynn Kane. We also bid a fond farewell and many thanks for their hard work and commitment to our outgoing and founding members – Renee Bailey, Karen Guillemin, Kathy Lynn and Eleanor Vandegrift. Katharine Gallagher will remain an active member. Incoming and outgoing members look forward to being in touch for a smooth transition. Learn more about these founding and incoming consumer advocates below. 

About LaneCoFBC…
LaneCoFBC is the PeaceHealth Nurse Midwifery Birth Center’s volunteer-led consumer advisory panel. Our existence and activities meet the Commission for the Accreditation of Birth Centersrequirement that accredited birth centers (1) have effective mechanisms for receiving advice and information from consumers and (2) demonstrate the effect of this input on the policy and operation of the center. Toward these ends, the LaneCoFBC has quarterly board meetings, in addition to biannual meetings with Birth Center staff and PeaceHealth leadership. We maintain an email account, blog and a Facebook page:

o    lanecofbc@gmail.com

Be sure to “like” our Facebook page as this is where we make announcements and post fun, interesting and informative items.

Incoming Members

      Maria Blum
When was your baby (babies) born using NMBC services at the Birth Center or hospital?
My son was born at the old birth center in 2006.  If I can't live in an Arts and Crafts house, at least I got to have a baby in one!

What's your favorite thing about the Nurse Midwifery Birth Center?
I loved the client centered service, the view of birth as a normal process rather than a disease or illness, and the home like atmosphere of the birth center.  To me, consumer advocacy means viewing individuals as the experts in their own lives, and valuing that expertise.

A personal detail - examples: profession, hobby, dream for the future
The first half of my pregnancy was in the UK, where midwife care is the standard, not the exception.  I'm a social worker and like to knit and read in what little spare time I have. 

      Anna Chorlton Connelly
When was your baby (babies) born using NMBC services at the Birth Center or hospital?
Iris was born at the birth center in May of 2008.

What's your favorite thing about the Nurse Midwifery Birth Center?
The amount of time given by midwives and staff during appointments and not feeling rushed, but rather feeling their concern that all my questions were addressed. It was a level of caring attention that I had not before experienced from the medical field.

Why is consumer advocacy important?
Ordinary people need a voice. Not simply to make a choice between what is presently offered, but to actually have a say in which services or products are offered. We can all make our own choices, but is it a truly free choice if we have no say in what our options are and are forced to pick from a limited line up of services or products? Especially if there's more services or products that could be available, but they're just not being offered. 

A personal detail - examples: profession, hobby, dream for the future
Hmm... before becoming a mama to Iris, I was a legal assistant for 8 years and, even after 3 years away from it, I still identify with that profession- to an extent. Presently I'm in flux and feeling my way around for the various directions my life is taking. However, there are three prime areas of self-education and interest that occupy my mind and time. First and foremost, I'm in the process of healing myself internally primarily in order to be the parent I want to be to my daughter, so I've been studying gentle parenting and non-violent communication. Tied into parenting is a leaning toward homeschooling/unschooling with my daughter, which I'm also researching. Second, I feel compelled toward breastfeeding and birth advocacy, but have yet to see exactly what my role will be- that is, whether it takes on any sort of profession or moves more toward activism and advocacy. Last, I will soon (after my small studio area in my house is complete) get back to my painting. I haven't painted a single thing in over 7 years, but have never stopped 'seeing' paintings in my mind that I want to put to canvas or board. I'm increasingly anxious to have this particular creative outlet again, and also to share it with my daughter.

Katharine Gallagher
When was your baby (babies) born using NMBC services at the Birth Center or hospital?
I have two boys – Eitan (6) and Zev (4). I discovered the Birth Center during my pregnancy with Zev in 2007. 

What's your favorite thing about the Nurse Midwifery Birth Center?
I love that the Birth Center’s model of care yields optimal outcomes for mothers, babies and families and by extension the community as a whole. Its seamless maternity care follows women, babies and families from the prenatal period well through the postpartum period. After birth, families are provided coherent infant feeding services including drop-in access to Baby Clinic where they can talk with lactation consultants as well as with other mothers. Supportive friendships frequently form at Baby Clinic.

Why is consumer advocacy important?
As the receivers of care, consumers have a unique perspective to offer on practice and policy. Making this perspective part of on ongoing feedback loop takes advantage of this insightful and beneficial information

A personal detail - examples: profession, hobby, dream for the future
I recently joined the Commission for the Accreditation of Birth Centers as a consumer advocate. I also blog at motherbabynetwork.wordpress.com and teach independent childbirth education. 

Lynn Kane
When was your baby (babies) born using NMBC services at the Birth Center or hospital?
Our daughter Lydia was born in February 2010 at the hospital (before the new birth center was open)

What's your favorite thing about the Nurse Midwifery Birth Center?
There are many things I love about the NMBC, but overall it was the positive and holistic approach to pregnancy, birth and postpartum. More specifically I really appreciated our Centering group. It was so fantastic to have so much time with the midwives, so much invaluable information, and the support of other wonderful parents throughout the whole nine months (and beyond--we still get together for regular potlucks!).

A personal detail - examples: profession, hobby, dream for the future
I am a classical pianist and spend much of my "free" time collaborating with other musicians at the University and around town. We love having lots of music around our home!

Outgoing Members

 Renee Bailey
When was your baby (babies) born using NMBC services at the Birth Center or hospital?
Charlotte 1/2/08, Penelope 10/24/09

What's your favorite thing about the Nurse Midwifery Birth Center?
My favorite thing about the birth center is how much I feel apart of my own care there. I really enjoyed weighing myself at each appointment. It might seem a small thing, but this simple act made me feel like they trusted me and because they trusted me I felt I could trust them.

A personal detail - examples: profession, hobby, dream for the future
I'm enjoying the new hobbies that have popped into my life post-motherhood: cooking and baking, blogging (about cooking and baking), and running.

      Karen Guillemin
When was your baby (babies) born using NMBC services at the Birth Center or hospital?
My older daughter was born in May 2003 at the old Hilyard Street hospital with midwife Sue Armstrong, who was then at Women's Care but subsequently joined the NMBC.  My younger son was born in December 2007 with Chris at the old Birth Center.

What's your favorite thing about the Nurse Midwifery Birth Center?
My favorite thing about the Birth Center is the sense of partnership and camaraderie that one develops with all of the staff.  The whole prenatal care process allows you to build up close relationships with the staff and confidence in your own knowledge and intuition for the birthing process. I also really appreciated how much they include the whole family. It was incredible for my four year old daughter to hear her future brother's heart beat and to follow my pregnancy through regular Birth Center visits.

A personal detail - examples: profession, hobby, dream for the future
Although I'm rotating off the board, I'm looking forward to continue working with the Birth Center in a research project I'm conducting with Dr. Rebecca Bent at PeaceHealth (http://www.peacehealth.org/about-peacehealth/medical-professionals/eugene-springfield-cottage-grove/Pages/TRAP-Research.aspx). It's very exciting for me that my research interests in the biology of animal development and interactions with microbes has some possible implications for neonatal health. We discovered than an enzyme in the digestive tract, alkaline phosphatase, confers protection against bacteria. We are testing whether this enzyme is present at lower levels in premature infants (by measuring its level in meconium) as compared to full term babies. If we find this to be the case, this could be a new explanation for certain digestive tract complications experienced by premature infants, including necrotizing enterocolitis (NEC). Because breastfeeding is the best treatment against NEC in premature infants, we are also interested in determining whether this enzyme is present in breast milk and especially in colostrum. Birth Center clients are a perfect group to study this possibility because they have such a high rate of breastfeeding and work closely with the lactation consultants.

      Kathy Lynn
When was your baby (babies) born using NMBC services at the Birth Center or hospital?
Aria was born October 17, 2006 at the Birth Center. Jasmine was born on August 12, 2009 in Houston, TX but the midwives and nurses played a significant role in helping me to induce lactation and provided support to us during baby clinic. 

What's your favorite thing about the Nurse Midwifery Birth Center?
My favorite thing about the Birth Center is having a resource that provides such exemplary pre-natal, childbirth and post-natal support to women, babies and families. 

A personal detail - examples: profession, hobby, dream for the future
A person detail:  I have a deep interest in talking with others about adoption as way to build a family, as well as the possibilities that exist related to milk-sharing and induced lactation. 

Eleanor Vandegrift
When was your baby (babies) born using NMBC services at the Birth Center or hospital?
My first baby was born in November 2007 at the Birth Center in Eugene and my second baby was born in July 2011 at the new Birth Center in Springfield.

What's your favorite thing about the Nurse Midwifery Birth Center?
I love that the staff of the Birth Center care about me as an individual and care about my family as well.  Even when they are busy, everyone always takes time to stop, look me in the eyes, and discuss whatever is on my mind.  I have received this type of care throughout my prenatal appointments, labor/delivery, postpartum recovery, and on going lactation support. It's amazing to receive such support during this time of major life change surrounding the birth of a child.

A personal detail - examples: profession, hobby, dream for the future
In addition to being a mom, I am an instructor in the Teaching and Learning Center at the UO, and I love my work helping students to succeed academically.


Monday, May 2, 2011

Giving Thanks for the New PeaceHealth Nurse Midwifery Birth Center

The new PeaceHealth Nurse Midwifery Birth Center (Birth Center) turns one this week! On this occasion, the first anniversary of the 2010 grand opening, Lane County Friends of the Birth Center would like to thank and express deep appreciation to PeaceHealth, the Sacred Heart Medical Center Foundation, donors, community leaders and families for making this new facility a reality.

Don’t forget to come to the Birth Center’s 1st birthday cupcake party! 
RSVP here 
Because of this shared leadership, collaboration and support, local families are continuing to enjoy the benefits of a more than 25-year local tradition of accessing midwifery care in a freestanding birth center. Since the 2010 grand opening and as of April 18, 120 babies have been born at the Birth Center! Even more babies and families have also enjoyed prenatal and postnatal support at the Birth Center. It’s been a great first year.

The Birth Center provides a compelling local example of cost-effective and excellent maternity, breastfeeding and well-woman services consistent with and frequently exceeding international maternal and infant standards for wellbeing. Women and families regularly describe this care as uniquely supportive and empowering.

Families also consistently highlight the Birth Center’s Baby-Friendly designated lactation services which include regular, drop-in access to lactation experts as well as peer support from other Birth Center families during the year following the births of their children. The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by WHO and UNICEF to promote, protect and support breastfeeding through the Ten Steps for Successful Breastfeeding; evidence-based practices that help mothers reach their breastfeeding goals. Read what Birth Center families have to say – read Friends’ recent breastfeeding survey here.

Friends’ appreciation for the new Nurse Midwifery Birth Center is deepened by the knowledge of Sacred Heart Medical Center’s plans to become a Baby Friendly-designated hospital (see page 10 of Cornerstone Spring 2011). As consumers, we know first-hand the critical importance of initiating infant feeding in an evidence-based model and are pleased to know that more Lane County families will enjoy the Baby Friendly standard of care. Thank you PeaceHealth and Sacred Heart Medical Center for making this commitment!

Please join us for a week-long Facebook birthday celebration beginning today. “Like” us at facebook.com/lanecofbc.

Tuesday, January 25, 2011

Lane County Taking Over PeaceHealth Prenatal Clinic

As of Feb 1, services currently offered at the PeaceHealth Prenatal Clinic will be transferred to the Lane County Charnelton Community Clinic at 151 W. 7th Avenue.

Lane County is joining six other counties to provide prenatal care for women who would be OHP-eligible except for immigration status. This new coverage expands the “Citizen / Alien Waived Emergency Medical” (CAWEM) and is made possible through the federal Children’s Health Insurance Program (CHIP). CHIP allows states to serve the unborn children of women who would be Medicaid(OHP)-eligible except for immigration status. Learn more at MotherBaby Network

Long before CAWEM Plus, PeaceHealth undertook and underwrote maternity services through its Prenatal Clinic. The same Certified Nurse-Midwives who staff the Nurse Midwifery Birth Center staffed the Prenatal Clinic. The Prenatal Clinic ensured pregnant women, regardless of immigration status and/or ability to pay, received the excellent, continuous midwifery care associated with positive birth outcomes. Services included prenatal care, birth attendance, lactation support, postpartum care, well-woman visits and birth control.

CAWEM Plus expansion into Lane County prompted Public Health and PeaceHealth to negotiate the transfer of the Prental Clinic services to the Charnelton Community  Clinic. Lane County will contract with PeaceHealth to have Prenatal Clinic midwives and staff continue providing maternity services at the community clinic.

Births will continue to occur at RiverBend. PeaceHealth obstetricians will continue to collaborate with the midwives. While the six-week post-partum appointment will still be available, coverage for the mother ends with the conclusion of her pregnancy. Newborns will be enrolled in OHP Plus for one year of automatic eligibility.

As we understand it, CAWEM Plus does not cover birth control but there are other accessible programs available to women who desire it. We do not know the degree to which lactation support will be available.  

Friends of the Birth Center has followed the status of the Prenatal Clinic with great concern. We are pleased that the Prenatal Clinic midwives and staff will continue providing quality, continuous midwifery care that many of the most vulnerable women and babies in our community have come to trust and rely on. We hope this care will continue to include lactation support.