Friday, August 29, 2003
Changes in Practice As We Move from ESCbC to the Hospital Birth Center
I'm posting this on behalf of the ESCbC midwives:
First, we'd just like to say that the St. Vincent's administration has done a tremendous amount of work in a extremely short amount of time. The letter of employment came through. The construction began 2 days ago on the tubs (8/27/03). The move will happen on 9/2/03.It's important to note that we will not be bringing all of the protocols (ways of practicing) from Elizabeth Seton. We are now employees of the faculty practice at St. Vincent's, and therefore under the direction of the Director of the OB department. While we don't have a complete list of changes for the practice, these are some of the protocols that differ from your previous expectations from an out of hospital birth center:
- All clients must be seen by a doctor in the faculty practice during their pregnancy.
- Upon admission, all clients must have a period of 20-30 minutes on the electronic fetal monitor demonstrating fetal well being. This will determine whether the client will be admitted to the birth center with intermittent monitoring or the labor and delivery floor with continuous monitoring.
- If your water breaks before labor starts, you will be asked to come to the hospital immediately. If labor does not start within 6 hours, you must be transferred to labor and delivery for induction.
- The progress of labor will be evaluated with vaginal exams every 2 - 3 hours.
- There can be no births in the water at this time. However, labor in the tub is permitted.
- Current hospital policy only permits 2 support persons in the labor room or birth center (excluding nurse and midwife). Siblings are allowed if they have had a class and have a support person. These policies may change.
- You will be expected to stay at least 12 hours post partum. A pediatrician must examine and discharge the baby. Because the pediatricians usually examine the babies in the morning, depending on the time of the birth, you may need to stay more than 12 hours.
Posted by kstehle at 08:06 AM in Transition of Care | Permalink
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Comments
This is absolutely horrible. The whole point of having a birth center is for women and their newborns not to be in a the medicalized environment of a hospital.
Now is the time to have your clients write out a BIRTH PLAN. They need to meet this hospital staff, get to know the doctors but more importantly, make sure that the hsopital does not impose upon their relationship with all of the midwives.
That is the problem. Once inside the hospital, hospital management can have more to say about a woman's birth experience than all the midwives and birthing women combined.
It is a sad day indeed.
Posted by: liza at Aug 29, 2003 10:29:38 AM
What a disappointment. I was very happy with my experience at the Maternity Center Association in 1994, but I urge low-risk ESCBC clients to seek homebirth instead of St Vincent's. As a doula, I can say that the autonomy of women and even midwives is severely curtailed in a hospital setting, no matter how many compromises that hospital may appear to be making. The requirement of EFM at admission is a good example. Homebirth is the only way clients can maintain the control of their birth experience that they sought when they came to ESCBC, and be treated with the same level of compassion and respect. I say this meaning no offense to those midwives who choose to work in a hospital setting, but the difference is night and day.
Posted by: Elizabeth at Aug 29, 2003 2:14:11 PM
I congratulate and thank St Vincent's for setting up the new facility in the hospital. I am very grateful that I will be able to continue to see the extraordinarily gifted midwives from the ESCbC. But I strongly urge the hospital to consult with us (the pregnant women) en masse or individually to gain an understanding of the expectations of a woman seeking an out-of-hospital style birth.
Women whose water has broken but who have not gone into labor will very likely choose not to report their situation in order to avoid or delay induction. I urge the hospital to change the six hour requirement to the ESCbC standard of 24 hours.
Births into water are perfecty safe given intact connection with the umbilical cord. Contact with air is the trigger for the first breath. Water births are a beautiful and gentle introduction to the world. This is of paramount importance to the many women like me.
Fetal monitoring is unnecessary in low risk births and is restricting during labor; a time when women must be kept walking and moving. Freedom from the confines of a hospital bed is a critical factor in the choice for out-of-hospital births. I ask that where monitoring is required, dopplers be used instead.
This fine hospital will benefit enormously financially if it can form a facility which is in stark contrast to its also excellent labor and delivery floor. The challenge should be to explore the boundaries of differentiation rather than degree of similarity that can be attained. If women feel that they are going to be giving birth in a hospital, albeit an excellent one, and that the only real difference between that and giving birth down the hall is that there's a nice quilt on the bed, they will opt for home births.
Respectfully yours,
Ann Cecil-Sterman, MS(Chinese Medicine) L.Ac.
Posted by: Ann Cecil-Sterman at Aug 29, 2003 5:45:12 PM
I am very sorry to hear That ESCBC will, in essence, be moving its practice to St Vincent's as I was fully expecting to have my second birth there. While St Vincent's is a fine facility, women need to take the Hospitals "concessions" at face value. First, there seems to be little difference between the new midwifery practice guidelines of the former ESCBC and the restrictive regulations that St Vincent's will impose. Second, All hospitals, no matter how progressive they claim to be, will ultimately cow tow to the pressure of cost-effectiveness and liability pressure. However, I wish the outstanding staff of ESCBC all the best.
Posted by: Valerie Valentine Herron at Aug 30, 2003 12:53:08 PM
So basically, the birth center in St. Vincent's is hospital rooms with slightly better decor. All of these protocols being forced upon the midwives are going to mean a lot more early intervention bringing their induction, c-section, and episiotimy rates much closer to the national averages. This is exactly what birth center clients are so desperate to avoid! Being forced to treat their current clients so aggressively must be a very bitter pill for these magnificent women to swallow. I honestly feel sorry for them. I can't imagine having to compromise my belief in the process of labor so extremely. Perhaps if St. Vincents really is interested in making money this way, which they definitely could, they should provide a greater difference between the birth center setting and their normal LD ward.
I'm sad that the birth center choice has not been preserved in this instance. I know the midwives were very optimistic about being able to care for their clients in the way that they are accustomed to in their practice. I only hope that the quick and excellent work done by St. Vincent's to provide this alternative will ripen over time. Perhaps they can still provide a setting where labor is not managed and treated like a disease. Good luck to all you pregnant gals having to make this choice so late in your terms. Let's all get to work on making society more hospitable to a birth center setting!
Posted by: Elizabeth Howell at Aug 30, 2003 4:26:48 PM
What a sad state of affairs. Induction 6 hours after water breaks is crazy and not indicated by any medical information I could find. I don't see any difference between the "new birth center" and a regular St. Vincents delivery. Since this is about money, St. Vincents would be wise to listen to the desires of pregnant women. Otherwise, we will go elsewhere, and we are a large and lucrative group of consumers. I was scheduled to have my child at E.S. but will now have a homebirth instead. I urge all other women wanting to keep their power and choices to do the same. My sympathies to the midwives who are now being forced to work within this unhealthy system. Women have been having babies far longer than men have been making up rules about it!
Posted by: Alison at Aug 31, 2003 9:56:10 AM
I am devastated by the closing of ESCB after having a beautiful, natural birth there last fall. I found it to be such a supportive and nurturing environment that let me feel safe and cared for during labor and delivery. As we think about having a second child, my (very conservative) husband is strongly encouraging having a home birth insead of being in a hospital environment.
Posted by: Beth Hooper at Sep 2, 2003 2:21:07 PM
Looking through these new sets of rules, it was what we were afraid of happening when ESC went under the wing of a major hospital. Again, the rules seem to have a lot more to do with insurance liability than medical reality. Each of the responses above expressed some of our views as new - soon - to - be - parents. E.g. attaching a fetal monitor restricts the laboring women from moving around. The movements help to facilitate flow through the body, providing energy to the fetus and the mother. Not to mention, gravity pulls things down. It would make more sense moving about than lying down flat. Physics and human physiology tell otherwise about restricting movement. We are very sad to see these rules impose .... at the same time, we hope that the St. Vincent's administration takes a better look at studies and change their policies in lieu of clear evidence and statistics on natural birth centers (as in Holland for example).
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