North Ottawa Community Hospital

Questions and Answers from NOCH Hospital Tour with Laura on 2-24-14 

Classes and Other Support Services

Does the hospital offer classes in childbirth education? Newborn care? Breastfeeding? Postpartum adjustment?

Laura teaches childbirth preparation. She is trained through Prepared Childbirth Educators.  She teaches a 3 class (2 ½ hours per class – 7 ½ hours total) series and an all day (9 AM – 4 PM) Saturday class.  They have a breastfeeding support group that meets 2x/mo.  They also have infant/child CPR, Postpartum adjustment group, a refresher class, and a sibling class.  They do not have any IBCLCs, but Laurie McCabe is their certified breastfeeding counselor who teaches their breastfeeding preparation and breastfeeding and beyond classes.

Care During labor and birth – Organization of Care

Is there a birth center in the hospital? How does care in the birth center differ from “regular” hospital labor and delivery care?

 There is a separate area within the hospital that is for labor and delivery. It was private and when I was there at least, very quiet.  The nurses do work 12-hr shifts, so you may have the same nurse for your entire stay (depending on how long you are there).  They also strive for one-on-one care, when possible, so moms get a lot of personalized attention.

Would I labor and give birth in one room, or would I be required to move just before the birth? Would I stay in the same room after I give birth?

Women deliver and recover in the same room. There is an operating room on the unit just for c-sections.

Care during labor and birth – companions

Do you have any policies that limit the number of people who may be with me during labor and birth? Can the baby’s siblings be present?  Is there an age restriction?

I didn’t ask and it didn’t come up.

Do you have experience with trained labor support (doulas) during labor and birth? Do you encourage use of doula care?

Laura said they see a doula at a birth about every four months or so.

Care During Labor and Birth – interventions

Do you monitor the well-being of the baby during labor? Do you use occasional or continuous electronic fetal monitoring?  Is a Doppler or fetoscope an option?

It’s up to the provider and really depends on how well the baby is doing. They do use the wireless, which can pick up the heartbeat at long distances (mom can walk the perimeter of the ward without a problem) and are waterproof.

What are your usual policies and practices about:

  •  IVs in labor

I didn’t ask and it didn’t come up.

  • Freedom to be active and move about in labor

This is very much supported. They have three sizes of birth balls that Laura described using in a variety of ways.  As mentioned before, moms are encouraged to walk, as well.

  • Eating and drinking in labor

Laura said that it’s up to the provider, but they have juice, jello and other “clear fluids” on hand.

  • Positions for birth

She described many different births using the stool, squat bar and hands and knees. Hands and knees and the stool seemed to be her favorite.  She said she sees more intact perineums with the stool, too.

What is the usual care if a labor is progressing slowly?

If a mom comes in, she is monitored for two hours. If, during that time, there is no cervical change, they will send her home.  Laura encouraged labor support people or moms themselves to call the hospital to inform staff of their progress.  She said to just call straight to labor and delivery.  She said that 4-1-1 is the rule: contractions four minutes apart, lasting 1 minute each, continuing for at least an hour, but it’s usually OK to wait a little longer.

What percent of the time do women giving birth here get an episiotomy?

She had stats, but didn’t want to give them out without asking permission first.

Care during labor and birth – help with pain

How would you recommend that I prepare for managing pain during labor and birth?

I didn’t ask this question, but they do have a high percentage of parents that attend their childbirth preparation classes.

What drug-free measures for pain relief are available in this hospital?

They have birth balls, as mentioned above. For comfort, they are cool with aromatherapy and have a CD player families can use.  Their Jacuzzi can be used for pain relief, but there isn’t enough space to deliver in there.  Some of the providers are pushing for a portable birth tubs, but it is still uncertain.

What would happen if I decided that I wanted an epidural?

I didn’t ask this question.

Are other pain medications an option?

I didn’t ask this question.

Care during labor and birth – complications

What percentage of women who give birth here have cesarean sections?

She had stats, but had to ask permission before disseminating. She did say their overall c-section rate was lower than the national average and primary c-section rate was only 19%.

Are there any situations (such as cesareans or other procedures, tests, treatments) that would require me to be separated from my partner and/or doula during labor or birth?

Only 1 person is allowed to be in with the mom during a cesarean.

Postpartum and newborn care

What newborn care is routinely provided or offered if a baby is healthy?

Hep B shot, Vit K shot and Erythromycin eye drops. Baby is weighed and measured.

Would my baby be separated from me immediately or shortly after birth? For what purpose and how long?

Early skin-to-skin is encouraged. Most procedures take but a few minutes to complete.  The baby can stay with mom until she’s ready to hand him/her off and then he/she can go back to her quickly afterward.

Are there any policies regarding use of hospital nursery care by healthy newborns? Do you have a “rooming in” option, where my baby could stay in the room with me instead of being cared for in the nursery?

I didn’t ask this question.

Is there a newborn intensive care unit on site? Is there any situation in which my baby would need to be transferred to another facility?

There is no NICU on site.

What breastfeeding resources are available? Does the hospital have a lactation consultant on staff?  How would I ensure that my breastfed baby would not be given bottles of water or formula?  Do you pass out formula samples?

They have a certified breastfeeding counselor, Laurie McCabe, who serves all of their patients, but most staff nurses have some training. There are no IBCLCs on staff.

Could my partner stay with me throughout my stay after the baby is born? What accommodations are available?

The rooms have a pull out love seat that looks pretty comfortable.

Leaving the hospital

How long do women usually stay after a vaginal birth? Are shorter or longer stays acceptable to the staff?

I didn’t ask this question.

What follow-up care would you provide after I go home? Does the hospital have a nurse available for home visits?  Do you provide information or give breastfeeding or emotional support over the phone?

About 45% or more of the moms who deliver there have a positive perinatal risk assessment screen. Laura attributes this to the very personalized care she gives and the multiple contacts which build trust with moms to be honest about their experience.  They have a support group for postpartum adjustment and are dedicated to providing emotional support.

According to North Ottawa Community Hospital Officials, Grand Haven Moms aren’t Trendy

 

North Ottawa Community Hospital (NOCH) recently announced that they were eliminating their midwifery program. Public outcry ensued. Without producing any evidence, the administration blamed patients choosing obstetricians over midwives and economics as driving factors. The situation at NOCH is a continuation of the medical industry historically dominating obstetrics at the expense of midwives and patient care.

In order to get my women’s studies degree in 1998, I completed an internship at Elizabeth Seton Childbearing Center in Manhattan. I was interested in learning more about how race and class impacted childbearing decisions. In my paper for class, I wrote about how, historically, traditional birth attendants were systematically ousted from the hierarchy of male obstetrics. As historians Barbara Ehrenreich and Deidre English wrote in their pamphlet, “Witches, Midwives and Nurses” in 1973

“[T]he sexism of the health system is not incidental […]. It is historically older than medical science itself; it is deep-rooted institutional sexism [that] is sustained by a class system which supports male power (41 – 42).”

I was shocked to find out that 20 years later in some of NYC’s public hospitals serving the city’s poorest women, obstetric care was dominated by midwives (Baquet & Fritsch). Far from representing a reversal of power, the economically-driven shift was linked to substandard care when doctors were not available and midwives were forced to care for women with high-risk pregnancies and medical emergencies.

In Grand Haven, the loss of midwifery care affects primarily Ottawa County women who enjoy a higher socioeconomic status than in the rest of the state. In 2012, the median household income for Ottawa County was $55,158 compared to the state average of $46,793 (United States Census Bureau). Ottawa County moms are also more likely to be married and older than statewide (2012 Michigan Resident Geocoded Birth Files). Finally, Ottawa County is one of the whitest counties in the state, 93.1% of their residents are white compared with 80.1% statewide (United States Census Bureau).

Is there a national trend toward women, particularly higher-income white women choosing doctors over midwives, resulting in midwives being pushed out of obstetric and hospital practices? Not hardly. In 2009, births attended by midwives reached an all-time high of 8.1% (Declercq, E.).

When Time Magazine and the New York Times reported on this trend, both cited the greater acceptance among white women as a driving factor. Time pointed out that, in 1990, more nonwhite mothers used midwives whereas in 2009, they gave birth with midwives at the same rate as women of color (Rochman, B.). The New York Times reported that midwives were becoming a status symbol among Manhattan’s elite, with some popular practices booked solid. “It sounds bizarre,” they quoted Ms. Sylvie Blaustein, the Founder of Midwifery of Manhattan as saying, “but midwifery has become quote-unquote trendy” (Pergament, D.).

While I could find no basis for a trend toward less midwifery preference among white, middle-class women as NOCH administrators suggest, evidence for an economic motivation abounds. Obstetricians only compete for low-risk patients with midwives when reimbursement rates are high and birth rates are low. At NOCH, both of these criteria exist: only 32% of births to Ottawa County moms were publically funded in 2012 compared to 44% statewide (Kids Count Data Center) and birth rates (the number of lives births per 1,000 women) have declined during the last decade for which data is available, from 14.1 in 2002 to 12.3 in 2012 (2002 – 2012 Michigan Residents Birth Files). When you look north to Muskegon County, birth rates have also declined, but less dramatically and a whopping 62.7% of births are covered by Medicaid (Kids Count Data Center).

Unlike in Grand Haven, where midwifery hospital care has now become extinct, Muskegon County supports two busy midwifery clinics that almost exclusively serve women on Medicaid – Hackley Community Care and Muskegon Family Care. While any woman can seek care at a federally qualified health center, as NOCH administrator Barbara Nyblade, Director of Physician Practices at NOCH, pointed out, few from Grand Haven will cross the bridge to do so.

In this twist of fate, we find childbearing choices favoring the poor. In the meantime, NOCH has hired three new obstetricians to replace the midwives who have been moved to other positions. While natural childbirth advocates continue to make their voices heard on the streets and in the media, we can all find comfort in the one thing that hasn’t changed when it comes to obstetrical choices in the U.S. in recent decades: the former NOCH midwives can always find work serving the poor.

Words Cited:

2002 – 2012 Michigan Residents Birth Files, Division for Vital Records & Health Statistics, Michigan Department of Community Health; Population Estimate (latest update 9/2012), National Center for Health Statistics, U.S. Census Populations With Bridged Race Categories. Accessed online @ http://www.mdch.state.mi.us/pha/osr/Natality/BirthRateTrends.asp on 10/20/14.

2012 Michigan Geocoded Resident Birth files, Division for Vital Records & Health Statistics, Michigan Department of Community Health. Accessed online @ http://www.mdch.state.mi.us/pha/osr/chi/births/Birthchar/BxChar.asp?DxId=1&CoCode=70&CoName=Ottawa on 10/20/14.

Baquet, D. & J. Fritsch.  “Lack of Oversight Takes Delivery-Room Toll.”  New York Times.  March 6, 1995.

Declercq, Eugene. “Trends in Midwife‐Attended Births in the United States, 1989‐2009.” Journal of Midwifery & Women’s Health 57.4 (2012): 321-326.

Ehrenreich, Barbara, and Deirdre English. Witches, Midwives, and Nurses: A History of Women Healers (Contemporary Classics). Feminist Press at CUNY, 2010.

Kids Count Data Center. Medicaid Paid Births – Single Year. Accessed online @ http://datacenter.kidscount.org/data/tables/1716-medicaid-paid-births–single-year?loc=24&loct=2#detailed/5/3804,3813/true/868,867,133,38,35/any/3639,13078 on 10-20-14.

Pergament, Danielle. “The Midwife as Status Symbol.” New York Times. June 15th, 2012. Accessed online @ http://www.nytimes.com/2012/06/17/fashion/the-midwife-becomes-a-status-symbol-for-the-hip.html?_r=1& on 10/20/14.

Rochman, Bonnie. “Midwife Mania? More U.S. Babies than Ever Are Delivered by Midwives.” Time. June 25th, 2012. Accessed online @ http://healthland.time.com/2012/06/25/midwife-mania-more-u-s-babies-than-ever-are-delivered-by-midwives/ on 10/20/14.

United States Census Bureau. State & County Quick Facts. Ottawa County, Michigan Accessed online @ http://quickfacts.census.gov/qfd/states/26/26139.html on 10/20/14.