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Outraged families to rally, urge Evergreen Hospital to restore private-practice cuts to midwifery services

Bothell resident Oesa Hauch and daughter, Olivia, who was delivered by a midwife at Evergreen Hospital in 2004. Hauch is helping to organize a rally to urge the hospital to restore midwifery services that were recently cut.  - Contributed
Bothell resident Oesa Hauch and daughter, Olivia, who was delivered by a midwife at Evergreen Hospital in 2004. Hauch is helping to organize a rally to urge the hospital to restore midwifery services that were recently cut.
— image credit: Contributed

A group of families, mothers and midwives outraged by recent drastic cuts that were made to the midwifery program at Evergreen Hospital plan to rally in front of the Evergreen Family Maternity Center on Nov. 15.

The Center for Women's Health at Evergreen (CFWH), a private practice that has offered a full-service midwifery option for prenatal care and delivery at Evergreen since 1997, will reduce its midwifery staffing by 60 percent, effective Nov. 17.

The decision was made following an alleged embezzlement scheme that involved nearly $500,000 in theft from the practice in 2009-2010, according to a Kirkland Police report.

In response to the program cuts, a group of patients, professionals and other midwifery supporters have created a Facebook page, "Support Midwifery at Evergreen Hospital," urging the hospital to employ a team of midwives directly to maintain 24-hour midwifery care at the hospital. The website has already garnered more than 500 supporters.

The group also launched an online petition on Sunday that nearly 200 people have signed.

They will urge the hospital to reconsider its decision not to directly hire the midwives during the rally, set for 4 p.m. Nov. 15 at the Family Maternity Center.

The five obstetricians who own CFWH and the midwives previously negotiated this option with Evergreen, but officials decided against the option.

However, hospital officials now say the deal is still on the table.

Midwifery service

Every year, about 4,500 babies are delivered at Evergreen Hospital, which ranks in the top 10 percent of hospitals nationwide for providing the best maternity care, according to HealthGrades.

The Center for Women's Health at Evergreen employs five certified nurse midwives who deliver 280 of those babies each year. Currently, the midwives attend approximately 40 births per month at Evergreen.

“Midwife means ‘with women’ and many patients come to us because they want a more patient-center approach, with more hands on care to their pregnancy and birth,” said Heather Bradford, a certified nurse midwife at the clinic who works per diem. She has delivered 350 babies at Evergreen since 2002. “We stay with women during their whole labor and consequently, women need less intervention and are less likely to need a cesarean section.”

Bradford personally understands the importance of midwifery services. A midwife provided her with prenatal care for all three of her children, including a twin pregnancy, and attended their deliveries at Evergreen Hospital.

But now, Bradford is concerned that the recent cuts will mean less birthing options for women on the Eastside.

“The midwifery program as we knew it has essentially dissolved,” she said. “It’s a truncated service at this point, which is a disservice for our patients because they won’t have a full midwifery service available to them.”

Effective Nov. 17, CFWH will reduce its midwives from five to two. This means 24-hour midwifery care will no longer be available to Evergreen patients.

“It’s a tragedy,” said Bradford, noting that many patients have already left CFWH to find better midwifery services elsewhere. “I think it’s a huge mistake on Evergreen’s part to have let this happen.”

She added that hospital officials could have handled the situation better and thinks the hospital should create an in-house midwifery service.

“That would be a very easy solution to employ the midwives to provide 24-hour service,” Bradford noted.

Bothell resident Oesa Hauch, who is helping to organize the rally, said CFWH midwives were very supportive during her pregnancy and birth of her daughter Olivia, now 7.

“I had a wonderful birth experience. The midwives were also very gracious to my husband so he could be involved in the process as well,” recalled Hauch, who is the owner of Amazing Mama Birth Services, which offers birth and postpartum doula services on the Eastside. “I’ve seen the wonderful care they’ve given to families, so it’s just shocking what’s going on here.”

She said part of the benefit of midwifery care is the midwives spend more time with their patients and are often able to be in the delivery room longer than an obstetrician.

“Midwives are also more supportive of physiological birth. They honor the natural birth process and are not as prone to using pain interventions,” said Hauch, noting the CFWH’s low rate of cesarean sections at 15 percent, compared to the national rate of 32 percent.

With the new changes, she said a woman in labor could “show up at Evergreen and be seen by an obstetrician she’s never met before. Her birth plan may not be honored.”

The CFWH can no longer guarantee that a midwife will attend their patients’ birth because midwives will now be expected to share on-call duties with six other obstetricians.

Midwives will also no longer be able to support patients who wish to have a Vaginal Birth after Cesarean (VBAC) because there is no longer a dedicated backup for the obstetricians, which is essential for the process.

Hauch, who will also attend the rally, said the group hopes to raise public awareness about the state of midwifery services at Evergreen.

“We also want to let Evergreen know that midwifery is an important option for people,” she said, adding the hospital should hire the midwives directly.

For Sharon Hammond, any future decision the hospital could make will not come soon enough. The nurse-midwife has already taken another job with Swedish Issaquah.

“I’m very sad to be leaving, but I certainly understand the reasons,” said Hammond, who was with CFWH for four years. "I think it's going to be a substantial loss to women in this area because two midwives won't be able to do 24-7 care our patients have come to expect.  It’s going to be a little tougher for women in the community."

Sachiko Oshio, a certified nurse-midwife who has already left the Evergreen clinic to work at the Northwest Hospital, said more than half of her patients are following her to Seattle.

“For a lot of my patients, it’s a hardship to travel across the bridge from Redmond, Duvall and Maple Valley,” said Oshio, who was with CFWH since 1998. “It’s a loss to the Eastside.”

She said she does not blame the center for its decision to make the cuts.

"I am sad, but in the current economic crisis, it's understandable,” said Oshio. “What I'm most unhappy about is Evergreen Hospital didn't make more of an effort to make the midwifery program more viable at the hospital.”

Embezzlement

The clinic’s decision to cut services was precipitated by an embezzlement scheme that caused CFWH officials to do an extensive audit, said Karen Wells, one of the obstetricians who owns the center.

In January, the company fired its administrator after she allegedly opened at least six business credit cards without the company’s knowledge in 2009-2010, according to a Kirkland Police report filed on Jan. 22.

The Everett woman, who has not yet been charged in the case, allegedly used the cards to pay for family vacations, food, entertainment and even personal dry cleaning and cell phone expenses, the report continued. The amount of embezzlement was more than $475,000, according to police documents.

The Reporter does not name anyone involved in a crime unless they are charged.

The woman later admitted to CFWH officials that she spent the company’s money for personal use and said she was seeing a therapist for a gambling and shopping problem, the report continued.

The former administrator settled with CFWH in June to pay the company $475,000.

However, she was arrested on Aug. 11 for embezzlement and financial fraud and a criminal case against her is currently under review, said Dan Donahoe with the King County Prosecutor’s Office.

"That is what made us discover the inequity between production and salary,” said Wells, noting that the company stabilized following the embezzlement, but still couldn’t keep up with the acceptable midwife salaries in the Puget Sound area. “We had to make a business decision. So we did not fire anybody, but the midwives who are leaving have elected to work in a different setting that can pay them better than we can.”

Wells said the hospital administration has been “very supportive” of helping to maintain a midwifery program.

“It wasn’t the hospital’s job to all of a sudden make this work in an instant, so I really don’t think the hospital is the bad guy,” she said. “They did look into as many avenues as they could and I think it's going to take another several months to figure that out. So they need to develop a program from the base. They can't just take these midwives on and make it work all of a sudden. It was too tricky.”

During previous negotiations, the hospital looked at ways to employ the midwives directly, said Kay Taylor, vice president of Communications.

State law mandates that midwives be associated with a practicing physician to be able to deliver services at hospitals. One of the options the hospital looked at was to have its on-staff obstetrical hospitalist provide backup to the midwives.

However, there are Stark laws that prohibit hospitals from favoring one practice over another, said Wells. Evergreen has five private-practice groups, including CFWH.

"The last we talked to the practice, they were confident that they could effectively continue the employment relationship with the midwives. We're disappointed to learn from the practice and midwives that that was not successful,” said Taylor. "Given that the decision was very recent, we have started a process to determine how we can best continue midwife services.”

She said it could take a couple of months for the hospital to reach a decision, but the hospital welcomes the community’s feedback.

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