Guest columnist Vanessa Ross: Midwives, staff express ‘tragedy’ of birthing center closure

  • Holyoke Medical Center, Wednesday, June 3. Gazette file photo

Published: 6/9/2020 2:28:33 PM

As former midwives, nurses, staff and physicians of Midwifery Care of Holyoke and the Holyoke Medical Center (HMC) Birthing Center who dedicated decades of our lives to the families of Holyoke, we want to thank you for shining a light on the dismantling of critical obstetric services in Holyoke. (“Hospital birth center closing,” June 6)

We echo the sadness and frustration of those quoted in the article at this devastating loss. We would like to clarify and give more context for some of the issues raised in the article.

1. The description of the case of the midwife who was disciplined for raising concerns about inadequate anesthesia of a patient failed to capture the egregiousness of this event. Being encouraged to state concerns is a cornerstone of ensuring safe patient care and enables every member of the health care team to look out for the best interests of the people they are serving.

This warning was given in spite of the statements of two nurses who witnessed the event and agreed the midwife had appropriately advocated for the patient. Two other midwives with no history of disciplinary action had also been given similar warnings over the course of only a few months.

The result was an increasingly hostile workplace environment in which midwives and nurses did not feel safe to speak up without fear of retaliation and which put the safety of patients at risk.

2. At the meeting referred to in the article, CEO Spiros Hatiras did not only “yell” at the midwives — he called us a “cabal.” He told us we either had to be “team players” by ceasing to complain about the treatment of our colleague or should find work elsewhere. The entire senior leadership team of HMC was present at this meeting, including the vice president of human resources.

3. Massachusetts has no law against workplace bullying. The Healthy Workplace Bill has been introduced three times without passing in the state Legislature. It was reintroduced in the current session and was referred on Oct. 17, 2019, to the Senate Ways and Means Committee, where no further action has been taken.

There is no legal recourse for employees experiencing workplace bullying in the commonwealth. The behavior described above meets the criteria for workplace bullying in this bill.

4. Despite a steadily decreasing birth rate in Massachusetts, Midwifery Care of Holyoke had maintained a volume of just under 500 births a year up until the dismissal or resignation of the providers mentioned in the article, many of whom have signed below. The practice enjoyed a stellar reputation in the community for over 30 years and drew patients to Holyoke from as far away as the Berkshires and surrounding states.

5. Certified nurse midwives (CNMs) are independent licensed providers in Massachusetts and do not require physician supervision to practice. CNMs maintain consultative relationships with physicians and refer patients in need of higher risk care. The “micromanagement” mentioned in the article was in direct contrast to our legal scope of practice in the commonwealth, yet the administration at HMC took no action to support the midwives.

6. Midwifery care is backed by decades of research showing that it results in better obstetric outcomes with less intervention than care by physicians. Nevertheless, in Massachusetts, CNMs are reimbursed at a lower rate than our physician colleagues for the same services. This inequity puts hospitals in the position of preferring to bill for physician services, which essentially limits CNM practice in the state.

7. CNMs in the U.S. largely work in underserved communities facing a long history of systemic racism, such as the one in Holyoke. Unequal reimbursement results in financial losses to the hospitals providing obstetric services to these communities.

Equitable reimbursement for the same services needs to be addressed by state legislatures. An Act to Increase Access to Nurse-Midwifery Services has been introduced in Massachusetts twice, most recently this spring. The Massachusetts Affiliate of the American College of Nurse Midwives plans to reintroduce this bill again in the next session that starts in January.

The loss of midwifery and obstetric services reinforces the role of racism and subsequent disparities in the health delivery system and leads to more mothers and babies dying in these communities.

Community hospitals are critical to providing health care to those who most need to access services in their community. Both the larger context of unequal reimbursement and the specific issues of decreasing respect and autonomy for the midwives and workplace bullying resulted in the loss of midwifery care in Holyoke.

The complete dissolution of obstetric services in Holyoke will be a tragedy which we hope can be averted by the coming together of concerned members of the larger community.

Vanessa Ross, a Certified Nurse Midwife, worked at Midwifery Care of Holyoke for nearly 13 years. This guest column was also signed by Christina Krutsky, CNM, MSN; Jane Frey, CNM, MSN; Joan Wiener, CNM; Nina Kleinberg MSN, CNM (ret.); Jennifer Whitman Foster, CNM (ret.), PhD, MPH, FACNM, FAAN; Damaris Ramirez, RN, BSN; Luz Pacheco, former MCH Office Manager; Lisa Pack Kirschenbaum, RN, BS; Gretchen Loebel, MD; Anne Fine, CNM, FNP, MSN; Virginia Miller, CNM, MSN; Liza Winston, CNM, MSN; Rachel Graber, CNM, MSN; Sara Eggemeier, CNM, MSN; Rochelly Maldonado, CNM, MSN; Fedelma McKenna, CNM, MSN; Chalimar Sanchez, RN; Karen Kennedy Sheedy, LPN/PNT; P.M. LaValley, CST/PNT; Zuleyka Otero, RMA; Wilmairy Burgos, RMA; Jacqueline Cruz, MA; Natalie Sanchez, MA; Monica Willemain, RN, BSN; Nicole Kent, MS, RN; Brianne DeFlumeri, LPN/PNT; and Mary Phillips, MSN, RN.

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