Coalition to Save Memorial Birthing Center reorganizes

 After the R.I. Department of Health approved Care New England’s request to close Memorial Hospital’s Birthing Center, effective Aug. 1, the Coalition to Save Memorial Birthing Center pivoted to reorganize as the Coalition to Improve Rhode Island Maternity Care.
After the R.I. Department of Health approved Care New England’s request to close Memorial Hospital’s Birthing Center, effective Aug. 1, the Coalition to Save Memorial Birthing Center pivoted to reorganize as the Coalition to Improve Rhode Island Maternity Care.

PROVIDENCE – After the R.I. Department of Health approved Care New England’s request to close Memorial Hospital’s Birthing Center, effective Aug. 1, the Coalition to Save Memorial Birthing Center pivoted to reorganize as the Coalition to Improve Rhode Island Maternity Care. Kaeli Sutton, currently spearheading the new coalition, said it seeks to include a diverse group of perinatal professionals, including midwives, nurses, doctors, mental health workers, doulas and childbirth educators, as well as community advocates and childbearing families.

“The [original] coalition was an attempt to save the Birthing Center, but [we’ve] been trying to push for changes for many years,” said Sutton, who has worked in perinatal education for more than 12 years. The new coalition hopes that Rhode Island hospitals with obstetric services (Landmark, Kent, Newport, South County and Women & Infants hospitals) will adopt family centered, evidence-based maternity care, which facilitates births with the best outcomes.

Sutton wants to clear up common misconceptions about the coalition’s focus. “I’ve heard the term ‘boutique birthing’ for a niche population only looking for unmedicated birth,” she said. “I’m very clear – the coalition is pushing for more evidence-based practices supported by science to have better outcomes for moms and babies and to show families genuine respect and collaboration with the [medical] team.” Having agency over one’s body is better for all birthing women, she said. “This is not a special service; we’re talking about quality health care [for all] … not [something] extra.”

A gentle C-section
The coalition plans to work directly with administrators and practitioners at the Rhode Island obstetrics hospitals and lobby the General Assembly to achieve its goals. The coalition wants these hospitals to adopt a number of practices, including gentle Cesarean sections, as practiced at Memorial, although Sutton said that there is no single definition of a gentle C-section. Spearheaded by Dr. Susanna Magee, a family physician, and Dr. John Morton, an obstetrician, who have received widespread acclaim for their gentle C-section, Memorial’s approach offers these benefits, said Sutton:
• The pregnant woman’s partner and any professional labor support – such as a doula – remain with her in the operating room throughout the epidural and any other pre-labor treatments/medications as well as throughout all post-delivery surgeries and other treatments.
• All extraneous conversations among medical personnel are limited, with a goal of focusing on the family having the baby.
• After a vigorous newborn is delivered, the newborn is put on the mother’s chest for skin-to-skin contact and to initiate breast-feeding.

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Changes to labor and delivery procedures
These and other changes that we want to see implemented during the birthing process, said Sutton, support post-partum healing, not just physically, but psychologically and emotionally, as well.
Although many hospitals have made great strides in supporting post-partum women, the coalition will encourage hospitals to offer additional support for a longer period. Now, a new mother’s first medical visit is typically with her infant’s pediatrician, at six weeks’ post-partum. With breast-feeding problems and/or depression more likely to occur in those first weeks, Sutton said, the coalition, though still in its infancy, wants to ensure that any programs recommended actually meet new families’ needs and are organizationally and fiscally sustainable.

“Our hope would be to set up a program with trained individuals from the community they serve … and would see families … optimally, weekly for the first four to six weeks, with spaced-out visits, thereafter,” said Sutton.

While Sutton calls the DOH’s three evidence-based programs, including those described here “excellent,” the coalition wants to see home visits become standard for all new families, not just for those who are self- or practitioner-referred. Often funded by government and private sector grants, some programs, which have proven to be quite successful, train community health workers in doula and breast-feeding skills, said Sutton.

After Providence Business News contacted Care New England about the new coalition and CNE’s new obligations imposed by DOH, CNE issued the following statement: “As we transition Memorial Hospital’s labor and delivery services to Kent and Women & Infants hospitals, our primary focus remains on ensuring that all pregnant women, their babies and families get the healthiest start together. Throughout this process, we will continue to engage the community as we ensure that we are providing a safe, positive and supportive environment for all birth experiences.”

Breast-feeding
According to the U.S. Centers for Disease Control and Prevention’s 2013 Maternity Practices in Infant Nutrition and Care Survey (the most recent CDC survey available), Rhode Island ranked third in the nation for hospital support for breast-feeding. All six obstetrics hospitals (Landmark, Kent, Newport, South County and Women & Infants hospitals, as well as Memorial Hospital for a few more weeks) from the state participated in the survey, which earned Rhode Island a score of 86 out of 100. Then and now, all of these hospitals provide breast-feeding advice and instructions to patients who are breast-feeding or intend to do so and all include breast-feeding education as a routine component of their prenatal classes.

More recently, Baby-Friendly USA Inc., a nonprofit organization promoting breast-feeding designated these Rhode Island hospitals as Baby-Friendly facilities: Kent Hospital (effective December 2015), Newport Hospital (since 2003, with the latest re-designation effective 2013-18), South County Hospital (since 2000, with the latest re-designation effective 2012-18) and Women & Infants Hospital (effective July 2015).

And, late in 2011, Rhode Island’s obstetrics hospitals were ahead of the curve when they ceased providing free samples of formula in their “goodie bags” distributed to new parents before discharge, except to those individuals who specifically requested formula. Rhode Island was the first such state whose obstetrics hospitals took that action; since then, obstetrics hospitals in Massachusetts, Delaware, Maryland, the District of Columbia and New Hampshire have followed suit, according to a nonprofit advocacy group, banthebags.org.

Easy public access to data on hospital and physician practices
Making hospital-specific data about birth policies and procedures, some of which the Rhode Island Department of Health already collects, should be widely available to the public, such as the frequency of C-sections, vaginal births after C-sections, episiotomies, low-birth rates and more. There are “a number of different practices that midwives and family doctors can employ in births. These are some of the things that we can track to make sure practitioners are using evidence-based medicine,” said Sutton. “Protocols are sometimes [in place] because they’re [always] done that way and not supported by best evidence.” Given that, the coalition hopes to work with DOH to help implement this data collection and dissemination; similar databases exist in some other states, she said, including Massachusetts and Virginia.

Along with providing Memorial Hospital’s local prenatal patients transportation to alternate hospitals, Care New England must also present the DOH with a plan to replicate the model of care currently offered at Memorial’s Birthing Center within six months from May 27, the date of DOH’s decision. Sutton expressed the coalition’s appreciation for DOH Director Dr. Nicole Alexander-Scott’s attention, as well as that of the agency itself, to the impact of the Birth Center’s closing on patients, and Memorial’s special maternity care model. The coalition recognizes that replicating Memorial’s procedures and practices is a multiyear process, if that happens at all; positive changes, however, can be made more rapidly, she said.

To learn more about the model of care followed by Memorial’s Birthing Center, visit the following national birth advocacy organizations: www.motherfriendly.org, choicesinchildbirth.org, www.childbirthconnection.org and www.evidencebasedbirth.com.

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