My friend and colleague, Molly Remer, recently wrote an article that is featured on eHow.com. “How to Choose the Right Doula” is a great step-by-step guide. It also has a picture of yours truly. 🙂
I ran across this article in the Springfield News-Leader, written by Deborah Smithey, CPM. She makes some excellent points that we can all appreciate about how much money midwives are saving state. While money may not be a big deal to those of us who know the excellent care midwives give, it makes a huge difference when discussions come up in the legislature….it is, after all, about the bottom line. If you’re the blogging/commenting sort, post your thoughts on how midwives have helped you, saved you money, been efficient, etc.
The current economic situation and resulting budget crunch are causing major cuts in Missouri’s budget. With unemployment and underemployment rates climbing, people are looking for ways to save money without compromising quality. Missouri’s midwives are already saving the state millions by attending low-risk homebirths, with excellent outcomes.
Midwives charge less than doctors and hospitals. Midwives’ clients spend 70 to 90 percent less than they would spend for uncomplicated vaginal delivery in the hospital. Missouri saves money when parents who are eligible for Medicaid choose to pay for homebirth themselves. The passage of the new health care bill does not affect homebirth families in Missouri. As always, these parents carefully weigh their options; considering safety, cost, privacy and personal preferences.
Missouri’s population (5,800,310) is similar to Washington State (6,287,759). One percent of Missouri’s babies and two percent of Washington’s are born at home. Washington underwrites the expense of licensing and regulating midwives, and its Medicaid program pays for midwife-attended home birth.
Washington commissioned a study to determine the economic costs and benefits of its midwifery program. The two-year total savings was $488,147 for Washington Medicaid and $2,713,072 for all payors combined. (1) The study admits these numbers are significantly underestimated because they do not include associated costs, including differential intervention rates between planned home and hospital births.
Certified Professional Midwives (CPMs) have low rates of expensive medical interventions, including induction, epidural, anesthesia, IVs, forceps, vacuum delivery and cesarean surgery. Only 3.7 percent of CPM clients transfer to the hospital for a Caesarean section (2) while Missouri’s statewide c-section rate was 30.2 percent in 2006. (3)
Babies born by C-section, premature babies and babies born with a low birth weight are more likely to be admitted to the Neonatal Intensive Care Unit (NICU). At an average of $3,000 a day, care for infants in NICU accounts for 75 percent of all dollars spent for newborn care. (4) Care for infants with a moderately low birth weight can cost 46 percent more than infants born at normal weight, and the cost to care for a baby born at 26 weeks can quickly rise to $250,000 or more. (5) These factors can be reduced by midwifery care. Preventing even one premature birth could save Medicaid more than a quarter of a million dollars.
The CDC reports Missouri’s homebirth rate was “significantly higher than the US average” from 1990-2006. (6) Increased public awareness, media attention to the rising C-section rate and women’s desire for a better and safer birth experience fuels the increase. Because of this rise in homebirths, the savings to the state is climbing.
Missouri’s midwifery law is working great for families and saving the state millions. Midwifery care costs less; has lower rates of costly intervention; lower rates of C-section, prematurity and low birth weight; reduces the number of newborns admitted to NICU; and costs the state nothing to implement.
Midwives in Missouri are helping improve the health of mothers and babies.
The number of CPMs in Missouri is rapidly increasing, as is the percentage of homebirths. That’s good for families and for Missouri’s bottom line.
Deborah Smithey, CPM, is a former president of Missouri Midwives Association.
References: 1) Health Management Associates. (2007). Midwifery licensure and discipline program in Washington State: Economic costs and benefits. Retrieved March 22, 2010 from http://www.macpm.org/Washington_Midwifery_Cost_Study_10-31-07__1_.pdf 2) Johnson, K.C., & Daviss, B.A. (2005). Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America. British Medical Journal, 330(1416). Retrieved March 22, 2008 from http://www.bmj. com/cgi/content/full/330/7505/1416 3) Martin, J.A., Hamilton, B.E., Sutton, P.D., Ventura, S.J., Menacker, F., Kirmeyer, S., & and Mathews, T.J. (2009). Births: Final Data for 2006. National Vital Statistics Reports, 57(7), 70. Retrieved March 22, 2010 from http:// www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf 4,5) Kornhauser, M., & Schneiderman, R. (2010, January). How plans can improve outcomes and cut costs for preterm infant care. Managed Care. Retrieved March 22, 2010 from http://www.managedcaremag.com/archives/1001/1001.preterm.html 6) MacDorman, M.F., Menacker, F., & Declercq, E. (2010). Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990-2006. National Vital Statistics Reports, 58(11), 4. Retrieved March 22, 2010 from http://www.cdc.gov/nchs/data/ nvsr/nvsr58/nvsr58_11.pdf.
Many families who would like to have the option of a birth center lost were disappointed when the state’s only birth center, in Columbia, closed recently. Thanks to two hard-working and inspiring women, Missourians will now have another option! Genevieve Calkins and Jessica Henman are opening The Birth and Wellness Center this summer in O’Fallon.
See article below or click here to read it on the St. Louis Today website:
Certified nurse midwife Jessica Henman and Genevieve Calkins expect to open the Birth and Wellness Center in June. They are waiting for approval of their lease application before announcing the location.
Henman, 35, of Wright City, will care for pregnant and laboring women while Calkins, 30, of St. Peters, will serve as the business manager. They will work with a doctor who will handle patients whose pregnancies become high-risk or need to be transferred to a hospital.
Birth centers serve healthy women with low-risk pregnancies who desire a birth with little medical intervention. Birth centers are commonly staffed by nationally certified and trained midwives, who focus on education and care that promotes physiologic birth. The centers are home-like environments with private rooms, each with a birthing tub.
Even before the doors have opened, Henman said nearly a dozen pregnant women have planned to deliver their babies at the center; and another group is willing to fund an effort for her to open a second center in St. Louis County.
“There is a wave coming across Missouri. Women are searching for more options and more say in their health care,” Henman said. “Hospital care isn’t the only care that should be available.”
The wave mirrors a nationwide desire for more birthing choices. A federal report released last week found that after a gradual decline from 1990 to 2004, out-of-hospital births increased more than 3 percent from 2004 to 2006. States with increasing access to birth centers and midwives saw steep increases of 15 percent or more, while other states saw declines.
“When it is an option, women will choose it,” said Kate Bauer, director of the American Association of Birth Centers.
More birthing choices is one of several key recommendations for maternity care that were recently released by Childbirth Connection, a 92-year-old nonprofit that works to improve maternity care through research. More than 100 stakeholders representing providers, hospitals, health plans, educators and consumers worked for two years on the recommendations after agreeing on some serious shortcomings in care.
Several challenges remain, however, for out-of-hospital providers. Missouri’s only other birth center, in Columbia, closed at the end of last year.. Groups wanting to open birth centers in other parts of the state and in Illinois face hurdles. For Henman and Calkins, the road wasn’t easy.
One of Henman’s first patients will be Joanna Sargent of Maplewood, who came across the center’s website while searching for midwifery care. She is due in September with her fourth child.
Sargent delivered her other children in hospitals, but she has since learned more about the midwifery model and risks associated with interventions commonplace in hospitals.
“I feel more educated about the birthing process; and I feel, for me, the better choice is away from the hospital,” said Sargent, 35. “I had considered home birth, but it wasn’t something my husband was totally set on. The birthing center was a good compromise for the both of us,”
Sargent is the typical demographic of women seeking out-of-hospital birth, which is a woman who is white, married, over the age of 25 and has previous children, according to the report released by Centers for Disease Control and Prevention.
The authors stated women may choose home birth for a variety of cultural, religious and economical reasons; or like Sargent, they share a desire for a low-intervention birth.
Women stand to make significant gains in the quality and value of their maternity care, says Childbirth Connection director Maureen Corry. While most women and their babies are healthy and low-risk, routine care is technology-intensive, she said. Risky procedures are overused and wasteful, while proven ones are under utilized and generally less expensive. Wide variations in use of interventions and outcomes can be seen across regions, facilities and providers.
Six of the 10 most common hospital procedures in 2007 were maternity related, and cesarean section was the top operating procedure, according to last year’s report by the Agency for Healthcare Research and Quality. Maternal and newborn hospital charges exceeded $86 billion in 2007, with Medicaid paying for 42 percent.
Medically induced labor has more than doubled since 1990 to 22.5 percent of births in 2006 (some studies suggest the number is closer to 34 percent). The cesarean rate has hit an all-time high — 31.8 percent.
‘BLUEPRINT FOR ACTION’
Recommendations developed by the stakeholder groups called upon by Childbirth Connection include everything from payment reform to promoting a cultural shift in fear-based attitudes about childbearing. Their “Blueprint for Action” was printed in January’s Women’s Health Issues medical journal,
One key action step is implementing policies that foster physiologic childbirth and decrease excessive use of elective procedures. This would include changing state laws and insurance regulations to promote access to midwives and birth centers and providing more training options for midwives. Ideally, midwives and obstetricians would collaborate to create a continuum of care.
“Most U.S. births are attended by specialists trained in high-risk pregnancy and disease management, a large number who have little training or experience in protecting, promoting and supporting physiologic birth — the most appropriate care for most of the population,” the report stated.
Dr. Tina Foster, an obstetrician at Dartmouth-Hitchcock Medical Center who contributed to the blueprint, said whatever choice a woman makes should be informed and supported in the safest way possible.
“We need to support the woman who wants an unmedicated physiologic birth, and the other woman who knows she wants an epidural,” she said. “We need to understand what people want and be willing to provide it.”
Henman became a registered nurse in 1996 and worked in cardiology before becoming a childbirth educator and labor coach. Helping women through labor sparked her desire to be a midwife, she said.
At the time, certified professional midwives (who have no nursing degree) were illegal in Missouri. Henman set out to get her advanced nursing degree in midwifery through the distance learning program at Frontier School of Midwifery and Family Nursing in Kentucky. She and her family had to move to Pennsylvania last fall to cram in her clinical requirements at a busy birthing center.
Her biggest challenge in opening a birth center, however, has been finding a doctor to sign a “collaborative practice agreement,” a legal document outlining their responsibilities. Missouri law requires nurse midwives to have the written agreement in order to practice. While national standards for nurse midwives require collaboration with physicians much like primary doctors and specialists, the requirement of a legal document scares off many doctors in today’s litigious atmosphere, she said.
Henman said she contacted more than 50 doctors before finally finding one willing to work with her. He asked not to be identified until the document is finalized.
Finding a collaborating doctor is what caused the state’s only birth center in Columbia, Mo., to close at the end of December after the physician left for a career change. The center is staffed by certified professional midwives, who can practice without a written agreement, but need a doctor in order to get reimbursed by insurance.
“There’s a lot of people willing to support it (out-of-hospital birth), but the laws are still funky; and until it gets straightened out, it’s going to be a struggle” said Ivy White, a midwife at the Columbia center.
Another challenge in Missouri is the state’s licensing requirements for birth centers, which Henman and others are trying to change, Birth centers are licensed as ambulatory surgical centers even though no surgeries take place. Many of the requirements are expensive and unnecessary, says nurse midwife Rachel Williston, 34, who wants to open a birth center in Independence, Mo.
Difficult legal requirements in Illinois for birth centers are also holding up groups in Illinois who want to open the state’s first centers.
While many barriers still remain, efforts to provide more birthing choices for women are clearly on the rise, said Corry at Childbirth Connection. “It’s not revolutionary, it’s evolutionary.”