Where’s My Midwife still pushing for open access to midwives

by Jamie Walker

If you’ve been following the Star News and Wilmington Business journal reporting on the local midwife/birth activist group Where’s My Midwife, then you know that yet another small group of thoughtful people have proved Margaret Meade’s touted theory. In only four months “Where’s My Midwife?” has succeeded in convincing the initially resistant, even adamant administrators at New Hanover County Regional Medical Center to change their policy requiring a supervisory obstetrician to be in the hospital during midwife-attended births. New Hanover County Regional Medical Center was the only hospital in the state operating under such an outdated, restrictive policy.

Kirstin Kreutzer, president of WMM, said that although the elimination of such an antiquated policy will undoubtedly improve access to midwives in Wilmington, debunking it was but the first step in assuring midwifery representation in the Wilmington area.

“We need our midwives back.” Kreutzer said. WMM was formed in August 2009 in reaction to the firing of two midwives employed by the Carolina OBGYN (parent company Wilmington Health Associates). “It was all about money.” Kreutzer said.

Suzanne Wertmann, certified nurse midwife and former employee of Carolina OBGYN agrees. “Although the hospital’s policy needed to go, it was not directly responsible for us leaving. Money was the main reason.” Wertmann said that the group of midwives were given one year prior to August 2009 to formulate a way to make their employment “worth the trouble”.

More and more women were seeking the care of midwives. Although physicians were compensated per midwife-attended birth for “overseeing” the birth (financial penalty to midwives, not felt by the client), it wasn’t enough. WHA’s CEO at the time claimed that the practice made more money per birth on OB-attended births. One would assume this given that C-sections are often twice as expensive as vaginal birth and Carolina’s OB’s were almost twice as likely to perform them. The OB’s c-section rate was 28% as opposed the midwives’ rate of 17%. However, Wertmann claims that the WHA’s current CEO, using a formula based on collection rather than compensation, calculated that the midwives were in fact making the practice money.

After scrambling for an entire year, beyond the demands of their intense workload, to find a way to keep serving the increasingly large number of women seeking midwifery services and to protect their livelihood, the midwives returned to the board and were ultimately defeated. “By the end of that year we realized that no amount of money would have made it worth the trouble. The opposition outnumbered our supporters.”

Eliminating competition is as natural as procreation. And the bigger dog will always win.

A NC law disallowing midwives the “approval to practice” without the signature of a supervising physician, is the mother of the big dog. North Carolina is one of only six states that blocks access to midwives in this way. The law, of course, makes it nearly impossible for midwives to set up private practices in Wilmington.

With Youthful WMM growing in numbers and force, they are not discouraged. One shouldn’t underestimate, Kreutzer says, the power of passion. “We’re asking for the reasonably supportive coexistence of midwives and obstetricians,” she said. “And eventually we’ll get it.”

So, what is WMM’s next step?

“Education,” Kreutzer said. “Education is the key.” Physicians and women, she says, need to be better educated about the benefits of natural childbirth. In doing so WMM hopes to open the doors better wimidwifery representation in Wilmington.

WMM’s ultimate goal is a free-standing birth center. There is currently only one free-standing birth center in the state of North Carolina located in Chapel Hill. There have been several attempts throughout the state to establish birth centers. Largely due to lack of or failing support from once committed Obstetricians, all have ultimately floundered.

“We need to recruit committed Obstetricians who are supportive of midwives, Obstetricians who see birth as a natural process.” Kreutzer said. Although there were several physicians at Carolina OBGYN who were supportive of Carolina’s midwives, no private or group practice has offered to support midwives by way of offering them “approval to practice”.

Local expectant mothers, Kreutzer says, simply deserve better options than Wilmington has to offer.

There are currently two midwives in Wilmington employed by SEAHEC, an organization designed primarily to serve medicaid patients and the under-insured. Their current workload doesn’t allow them to meet the overall demand for midwifery care.

WMM’s supporters plan to fight for the rights of midwives and expectant mothers just as a midwife fights for the healthy birth of a healthy baby. Kreutzer says they will educate, support, and encourage women, expectant mothers, and physicians until birth is finally given back to the women who own it. “This is a women’s rights issue. When women unite, they won’t be ignored.” Kreutzer said.

More to come….