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Ann Arbor midwives react to elimination of Ascension hospital midwives in Michigan

Lee Roosevelt, PhD, MPH, CNM, midwife in Ann Arbor
IHA Cares
Lee Roosevelt, PhD, MPH, CNM, midwife in Ann Arbor

Cathy Shafran: This is 89.1 WEMU FM. I'm Cathy Shafran. Across Michigan, the past few months, one hospital system has begun the process of eliminating midwives from their birthing centers. The Ascension chain of hospitals began the move late last year to Ascension Borgess in Kalamazoo and then Ascension River District in East China Township. And just yesterday, Ascension announced effective March 1st that midwives will no longer staff the birth center at Providence Southfield Hospital, a facility where the majority of births were supervised by midwives. So why is this trend happening and what's the likelihood it could grow? In Washtenaw County area medical facilities. We pose those questions now to Lee Roosevelt, a certified nurse-midwife participant at IHA in Washtenaw County and president of Michigan, affiliate of American College of Nurse-Midwives and a clinical assistant professor at U of M. Lee, thanks for joining us.

Lee Roosevelt: Thanks so much for having me.

Cathy Shafran: I know that Ascension is saying, and they quoted this yesterday, as saying all deliveries at Providence will be supervised by highly qualified obstetric physicians who specialize in low intervention births. Does this help with the explanation of what's going on?

Lee Roosevelt: Not at all. And to say the physicians are experts in normal or low technological birth is just a misnomer. That's not what they're trained in. Their expertise is in risk disease, surgery. Midwives are really the experts in normal births.

Cathy Shafran: So, what's your explanation of what's actually going on?

Lee Roosevelt: You know, I think ascension is really sort of an outlier in the field of midwifery. Right now, we, especially in Washtenaw County, University of Michigan and IHS, has been dramatically expanding their midwifery practices because what they're seeing is that midwives have terrific outcomes for low risk, normal birth. I think ascension has sort of taken a different perspective and that they are more concerned with profit than they are with patient outcomes, low technological, upper hand to not earn as much money for a hospital system. People aren't necessarily utilizing epidurals. They have lower rates of infections, lower C-sections. And these are the things that bring in capital for health care systems. So, I think that they have really sort of taken this position that their priority is money and profit over the well-being of patients and providers.

Cathy Shafran: Now, I know that you used to work there at Southfield—Providence Southfield. What rate of midwives were used in births while you were there?

Lee Roosevelt: So, the midwifery practice at Providence, Southfield has fluctuated over time, but is generally doing between 20 and 30 per month. One of the very, very unique things that Providence Southfield has is what is called the alternative birthing center, which is a birth center that is separate from a labor delivery floor, but in a hospital and people choose. It's known as the ABC because they want very low-tech safe birth that take place in a hospital with, you know, physician backup and access to hearing delivery if needed. But that as long as things are going normally, they stay in the birth center where they receive specialized, high quality nursing care and midwifery care. Assumption is saying that people can now have physician deliveries in the ABC at Providence Southfield. And that's that is the case. But a physician has to be willing to do a delivery in the ABC. When I worked there, physicians did maybe 2 to 5 or so months in the ABC, and the rest of the births in the birth center were attended by midwives.

Cathy Shafran: I'm curious if you see these cuts that are being made by ascension as a larger issue nationwide where obstetrics and gynecology is is being cut back because it's not profitable.

Lee Roosevelt: I think that it's interesting, right? I think we are definitely trending towards moving towards more high-tech births because that's what made hospital systems money. And what the evidence shows us is that while it makes the hospital system money. It actually is not great for patient outcomes. And I think in the current context of thinking about racial disparities in health care, one of the consistent mechanisms that has been shown to improve those health care disparities is midwifery led care. And I think that's particularly relevant for Southfield, where 60 to 70% of the population in Southfield are people of color. And these midwives were doing incredible work to equalize care and make sure that women in this area were receiving safe care that decreased their risk overall.

Cathy Shafran: And now those services are being taken away.

Lee Roosevelt: Right. Right.

Cathy Shafran: Where do they go now?

Lee Roosevelt: That's a good question. I think, you know, ones with means what we're seeing, I know what we've seen a big influx of patients on the ascension midwifery practice. Henry Ford, West Bloomfield has seen a big influx, as has Oakland Nicole Nurse midwifery practice. The problem is, is that work for people that have transportation and means to get to these other practices in hospitals. What it doesn't address is the large portion of Medicaid patients that those that that practice was serving that is local to the Providence, Southfield area that doesn't have the ability to then find other midwifery services. So, they're being seen by resident physicians who are physicians who are completing a training and specialty in a big way. And it's a very different model of care.

Cathy Shafran: Many of us would be wondering as we sit here in Washtenaw County. Do you see this trend coming this way as well, or is this something that is specific to Ascension?

Lee Roosevelt: I think it's very specific to Ascension University of Michigan and Trinity Health and which is a practice I'm part of in Washtenaw County, has been putting incredible resources into expanding access to midwifery care, where, you know, in Saint Joe's in Ann Arbor, most of the people that are seen in the obstetric triage, or the obstetric emergency department are triaged by midwives. And that practice model really works, and it leads to great outcomes. And I think the hospitals in Washtenaw County realize that and are placing that value on outcomes and patient satisfaction over profit.

Cathy Shafran: And if you were to look at the difference between an ascension and what's going on in Washtenaw County, why do they go in one direction while locally they go in a different direction?

Lee Roosevelt: You know, I don't think it's just local, but Washtenaw County, I think nationally we're seeing expansion of midwifery services, especially in the context of talking about health care disparities, that hospital systems have really realized that if they are going to make a dent in negative patient outcomes that Black women are particularly vulnerable to, that they need to employ midwives in midwifery led care. So, I actually don't think this is specific to Washtenaw County. I think Ascension is very much the outlier in cutting midwifery services where nationally we're seeing growth expansion of midwives.

Cathy Shafran: So, if there's any impact from this move, then in Washtenaw County, it would be seeing those patients coming this way.

Lee Roosevelt: Yes. And we're happy to take care of them and pick up where they were left off. But it's devastating for like the practice was given a month notice. So you have people that are due in four weeks that have established a really deep and meaningful relationship with these midwives and are then suddenly that's pulled out from under them for weeks from their delivery, you know, without even thinking about also the impact to the midwives themselves who, you know, some of which are single parents or the main income earner for their families and have now been told they have a month of salary left. And even if they do find new jobs, it takes months for credentialing. So, these midwives who have, you know, poured, you know, blood, sweat and tears into the care of people at Providence are now within a month without an income. I mean, to the midwives, to the pregnant people that they take care of. It's just it's an incredible loss to the whole community. And it's a loss to the culture at Providence, too, that public health field has always been sort of a higher intervention hospital, which, you know, from my experience working there. And I think the having a thriving midwifery practice has really impacted the overall culture in terms of how even obstetricians are approaching labor and birth at Providence Southfield. And without that cultural influence of the midwives, I think it's going to have very negative impact for outcome at Providence Health Field.

Cathy Shafran: We've been speaking with Lee Roosevelt, a certified nurse, midwife practitioner at IHA in Washtenaw County and president of the Michigan affiliate of American College of Nurse-Midwives. Thank you so much for joining us.

Lee Roosevelt: Thanks for having me.

Cathy Shafran: In a statement, Ascension Providence said that Ascension Providence Hospital continues to offer obstetric services to ensure a high quality, safe experience for expectant parents throughout their pregnancy and the birth of their child. They also say families who wish to utilize a private practice certified nurse midwife are welcome to include them in the birthing experience, provided they have the necessary privileges at Ascension Providence Hospital. I'm Cathy Shafran, and this is 89.1 WEMU FM, Ypsilanti.


American College of Nurse-Midwives

Trinity Health IHA Medical Group, Nurse Midwives - Domino's Farms

Ascension Midwife Care

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Cathy Shafran was WEMU's afternoon news anchor and local host during WEMU's broadcast of NPR's All Things Considered.
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