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Hospital loses midwifery birth services.

Byline: Tim Christie The Register-Guard

SPRINGFIELD - McKenzie-Willamette Medical Center has long cultivated a reputation as a place where having a baby was less a routine medical procedure and more a natural and family friendly experience.

But starting Jan. 1, a key element of that environment will be gone when midwives no longer will help with deliveries at the Springfield hospital.

The midwifery practice that worked at McKenzie-Willamette has lost its obstetrical backup, and without a doctor willing to be on call and step in if a birth goes awry, midwives can't practice at the hospital.

Doctors were unwilling to take on the additional workload, liability risk and malpractice premiums associated with supporting midwives, according to Dr. Zena Monji, the hospital's chief of staff, and certified nurse-midwife Michele Bouche.

"It's not because there isn't support for midwifery," said Monji, herself an obstetrician. "Every Ob-Gyn there feels supportive of McKenzie's midwifery practice. It comes down to time and money."

Bouche has been a midwife since 1980 and has practiced at McKenzie-Willamette since 1990.

In 1997, the Center for Women's Health, an Ob-Gyn practice owned by Oregon Medical Group, eliminated its midwifery practice, leaving Bouche and another midwife without a job. So she started her own practice, McKenzie Midwifery and Women's Services.

Now the two other midwives who worked at Bouche's practice have resigned, and she's scrambling to keep her practice alive by moving to Sacred Heart Medical Center in Eugene.

"I worked hard to make a successful business, and to see it disappear because of factors beyond my control is sad," Bouche said.

Until recently, Bouche and her partner midwives were supported by obstetricians Jan Stafl and Byrke Beller, who agreed to be on call in case the midwives needed help with a complicated delivery.

But Stafl said he has decided to stop delivering babies as of Jan. 1, and it's not practical for a single doctor to provide backup for all midwife births at McKenzie-Willamette.

After delivering about 4,000 babies over 25 years, Stafl said he decided to quit obstetrics in part because his children have graduated from high school, allowing him and his wife to travel more. But he also said he recently was sued for malpractice for the first time in his career. Stafl said he believes that the case was defensible but settled out of court rather than go through the time, expense and stress of a trial. He'll continue to practice gynecology, women's care and holistic medicine, he said. He feels bad that midwives no longer will be able to practice at McKenzie-Willamette, he said. But other obstetricians were unwilling to step in to support midwifery.

"Most obstetricians are busy enough with their own patients," he said.

And they're spending enough for insurance. Among all specialities, obstetricians pay the second highest malpractice premiums, after neurosurgeons. And they've faced steep increases in recent years.

In 2001, obstetricians covered by Northwest Physicians Mutual Insurance Co. paid $27,350 a year for malpractice coverage, CEO Jim Dorigan said. In 2005, that same premium cost $79,889, an increase of 192 percent. Northwest Physicians Mutual covers about 2,000 Oregon doctors, or 35 percent of those who purchase insurance.

McKenzie-Willamette CEO Roy Orr said losing midwifery services was a disappointment.

"It just provides another limitation on choices for women who choose to deliver here," he said. "But it doesn't diminish the nurses' role up there and the care they've been known for for many, many years."

Orr declined to provide exact numbers on how many midwife-aided births occur each year at McKenzie-Willamette. Bouche said she and the other two midwives in her practice each participated in about 120 births a year, and Monji said midwife deliveries accounted for about 15 percent of the hospital's births.

Out of about 2,400 births each year at Sacred Heart, about 300 are assisted by midwives employed by PeaceHealth Medical Group, and another 120 or so occur at the Nurse Midwifery Birth Center, a practice located about a block from Sacred Heart Medical Center, hospital spokesman Brian Terrett said.

The Nurse Midwifery Birth Center, owned by PeaceHealth Medical Group, employs five midwives, and another five independent midwives currently practice at Sacred Heart, Terrett said.

"This is going to be a great opportunity for us," he said. "It will be great to have Michele join us."

PeaceHealth is committed to midwifery, but no decisions have been made about whether the Birth Center will relocate when PeaceHealth's new hospital at RiverBend in Springfield opens in 2008, Terrett said.

Orr said he's not overly concerned about losing business to PeaceHealth. The two hospitals have been engaged in a bitter rivalry in recent years over antitrust issues and hospital siting.

"This is not a vote against the services we deliver or the quality of services," Orr said. "It has more to do with the liability environment that Ob-Gyns are living in and the choice of how they practice."

Hospital leaders met with obstetricians in recent months to see if an agreement could be reached to continue providing medical backup to the midwives. Stafl said that in the course of those discussions, hospital officials offered to subsidize any increase in malpractice premiums the doctors might incur for providing support to midwives.

Orr said that's not the case, however. It's true the hospital looked at "any and all options to preserve midwifery," he said, but never got as far as exploring whether it would be legal to underwrite physicians' malpractice premiums.

"We simply found there is no interest in continuing it here from the M.D. community, so we didn't even explore the option you suggested," he said.

Babies have become a key part of McKenzie-Willamette's franchise in recent years as it competed with its larger rival across the river.

In 1997, the Springfield hospital remodeled the fifth floor and called it the Women's Health & Birth Center. The 15 spacious birthing suites are equipped with jetted tubs for mothers to labor in, and equipped so that women labor, deliver and recover in a single room, rather than being shuttled from room to room.

The hospital has long allowed nurse-midwives to practice at the hospital. It even permitted babies to be delivered underwater. That water birth option also will go away with the departure of Bouche and Stafl.

Midwifery has long been an alternative to obstetricians for women who prefer a more natural childbirth. In Europe, 80 percent of births are attended by midwives, compared to about 10 percent in the United States, Stafl said.

"Those women who want to attempt a natural childbirth and have no major complications are going to be served well by a midwife," he said.

"Most of the time birth is a normal biological event," Bouche said. When it's not, midwives call doctors. Bouche estimates that she consults with doctors in 20 percent of her births, and doctors get involved in about 10 percent.

Tracy Goins gave birth Monday to a boy, Colvin Neil Goins, at McKenzie-Willamette with help from Bouche, who was recommended by a friend. Goins said she liked the personalized care she received.

Other women looking forward to a midwife-aided birth at McKenzie-Willamette are disappointed about the loss of the service.

Becky Gee's fourth child is due in February. The 41-year-old Camp Creek woman was planning to give birth at McKenzie-Willamette, but the loss of midwifery services has her contemplating a home birth, she said.

"I feel like my carefully chosen, really good birth plan is not going to be allowed to happen," she said. "It's upsetting. You feel like someone is yanking the rug out from under you."

She said she likes the friendly atmosphere at McKenzie-Willamette, and it's closer to her home than Sacred Heart, which could become an issue because her labor goes fast.

"If I have to drive an additional 15 minutes, I might have this baby on the road," she said.


Michele Bouche, a midwife who has practiced at McKenzie-Willamette since 1990, holds Colvin Goins, whom she helped deliver Monday.
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Title Annotation:Health; As of Jan. 1, the McKenzie-Willamette practice won't have obstetrical backup
Publication:The Register-Guard (Eugene, OR)
Geographic Code:1USA
Date:Dec 9, 2005
Previous Article:BUSINESS BEAT.
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