Kalamazoos Borgess hospital cut its midwife staff. Now its reconsidering. – MLive.com

Ashley Daniels has worked in labor and delivery for Ascension Borgess hospital in Kalamazoo for more than a decade.

The Kalamazoo nurse was born in that hospital. Its where she delivered her four children. But the way its staffed now, she wouldnt recommend her loved ones go into labor there.

In August, Borgess took steps to cut its nurse midwife staff from seven full-time caregivers down to three. But the move, which was explained to staff as a financial COVID-19 recovery effort, resulted in all but one midwife leaving, Daniels explained.

This used to be a unit I encouraged my friends and family to deliver at, and now I cant say that, she said. Midwifery care is the gold standard. That is a term thats used all over the place because you get that bedside, emotional and physical support that physicians arent trained to give.

The decisions being made are completely opposite of what benefits the community and our birthing mothers.

Six months later, the health system may be reversing its decision. Daniels said she and her colleagues were told last week the hospital would be looking to bring its midwife staff back up to six personnel.

Hospital representatives didnt return messages from MLive seeking comment. There is, however, an online job posting by Ascension to hire at least one certified nurse midwife in Kalamazoo.

Jessica English is an advanced certified birth doula and owner of Birth Kalamazoo, a doula and childbirth education agency. She heard about Borgess re-expanding its midwifery staff from a hospital nurse, and called it a great move.

Weve been vocal about what a loss this is, English said regarding the previous cuts. There is really robust research that shows having a nurse midwife improves outcomes. Thats the No. 1 reason why people want midwives.

Its better for the community if we can get Borgess back in the swing of offering midwives to their patients.

Theres a misconception by some that midwives simply assist in homebirths. While thats within their skillset, its only a fraction of the job.

In hospital settings, midwives are registered nurses who have additional training to specialize in womens reproductive health, from adolescence through menopause, including pregnancy, labor and childbirth. They do everything a doctor can do leading up to and during childbirth, except for surgery when complications necessitate it. Then, midwives turn to partner physicians.

There are also certified professional midwives, who are licensed and trained in community-based births. They typically work in homes or birth centers rather than hospital settings, but offer similar individualized care focused on patients ideal birthing scenario.

One thing that sets us apart (from labor and delivery physicians) is the way we match client goals with the type of care they want instead of telling them the way well do things, said Emily Dove-Medows, president of the Michigan chapter of the American College of Nurse-Midwives. Its a more bi-directional model of care.

A 2018 study published in the Journal of Midwifery & Womens Health found that among women with low-risk pregnancies, midwifery care was associated with substantially fewer preterm births and labor interventions with no increased odds of neonatal deaths or intensive care admissions.

Months after Borgess cut back on its midwifery services, another Ascension hospital across the state announced cuts of its own. Providence Southfield Hospital said its midwives would no longer staff its birthing center as of March 1.

Dove-Medows, who previously worked at the Southfield birthing center, said the reduction leaves a huge gap in midwifery access in Metro Detroit. Hospital-based midwife practices can accept a wider range of insurance types, while private practices may be more limited in payer types.

Were at a point in our health care system where people want more access to information, support and choices in their care, Dove-Medows said. Having that option of having a midwife participate in your pregnancy care is really important to have.

But the reductions dont appear to be part of a larger Michigan trend. Most of the states large health systems have maintained or grown their programs.

At Michigan Medicine, Joanne Bailey, director of Nurse Midwifery Services, said shes watched the program expand over the last 20 years, from about eight full-time nurse midwives to about 30 full-time positions.

In Southeast Michigan, Henry Ford Health staffs 12 midwives each at its main campus in Detroit and its West Bloomfield hospital. They typically divide time between seeing patients in clinic and at the hospital, explained Homa Wemah, the systems lead midwife.

Corewell Health East, formerly known as Beaumont Health, employs 12 midwives at its Family Birth Center, and system leadership said they are actively working to expand access to (certified nurse midwife) care for patients who are seeking the CNM experience.

Theyre also looking to open a pair of off-campus clinics for hospital-employed nurse midwives to provide prenatal care. Dr. Kurt Wharton, an obstetrician, gynecologist and chief of the systems womens clinical care programs, said this is a top priority for our team as demand for (certified nurse midwife) service increases.

Corewell Health West, previously known as Spectrum Health, has 30 midwives, most of whom work out of Butterworth hospital or South Pavilion medical center in greater Grand Rapids. The system is looking to onboard two more midwives in Ludington.

If you look at the long arc or the last 20 years of my career, there are certainly way more midwife positions and practices than there were 20 years ago, Bailey said. In general, its increasing and there are in general more opportunities for people to receive midwife care.

When English, the Kalamazoo-area doula, heard about the midwife staff cuts at Borgess last fall, she wrote a blog post on her business website explaining why it was a mistake.

This is a frustrating, troubling change for our community, and it will limit midwifery options for area families, setting us back in decades of progress in Southwest Michigan, she wrote.

She said doulas act as consumer advocates, including making referrals to medical practices based on what their clients are looking for in their pregnancy journey. In recent months, its been difficult to refer patients to Borgess knowing their chances of seeing the hospitals lone midwife would be low.

While the health system has reportedly reversed direction regarding its midwife staff, it could take months to get new team members back in the fold. At least some of the midwives they cut in the fall have taken midwife jobs elsewhere.

Amanda Ezekiel, a midwife who left Borgess and now has a new position outside Ascension, said she probably wont ever work for them again after what happened.

She hopes the hospital is adding positions. It would mean a lot for Borgess to acknowledge it made a mistake, to show its commitment to patient outcomes and satisfaction, and to the midwives like her who thought theyd be in that job forever, she said.

In the meantime, the one staff midwife has been forced to spend most of her time since August in clinic visits rather than delivery rooms, according to Daniels. Thats put more deliveries on the shoulders of remaining physicians.

Seeing the level of care and how it drastically changed, has been infuriating for us nurses, Daniels said. It takes a long time to hire and credential before providers can practice. Itll probably be about a year before we go back to anything close to what we used to be.