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
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.
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
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