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.

Birth Doula

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We work hard to ensure safe and satisfying birth experiences for our clients. We have experience and training in providing labor support for vaginal birth, cesarean and VBAC (Vaginal Birth After Cesarean). We support women who choose midwives or doctors as their birth attendants.  We can provide support for home births, birth center and hospital births.

We meet with clients and their support team prenatally to become acquainted, explore and discuss their values and establish their expectations of a doula. We use this as any opportunity to learn more about them and their partner/support team to build upon what already works for them in challenging situations and the resources that they have in place. For clients who choose a package with multiple prenatal visits, one visit can be with the client’s healthcare provider. In addition, clients have access to our book and video library, as well as referral sources for a variety of needs.  We are also available for questions or concerns at any point after we are hired before birth via phone/text, email or Facebook.  During the on-call period, we respond right away. For all other times, we will respond as soon as possible.

As doula partners, Faith Groesbeck and Beth Singleton work together to provide back-up for times when we are on-call for more than one birth, in the event of illness or other personal emergency, or when relief is needed in the event of a very long labor.

After delivery, we remain with clients until they are comfortable and their family is ready for quiet time together. We can also help to get breastfeeding off to a good start.

We are available to answer questions about the birth or your baby and would like to get together with you within a week to see how you and your baby are doing, to process the birth experience and get feedback from you about our role. Postpartum doula services can be arranged through a separate contract and fee schedule.

Basic Birth Doula Package (all-inclusive): $450

This includes the services described above, provided by Beth Singleton, DONA-trained birth doula.

Deluxe Birth Doula Package (all-inclusive): $600

This includes the services described above and includes customized herbal tea blends, as appropriate and desired, and the option of discounted add-ons, such as private childbirth education and birth photography. Clients choosing this package will work with Faith Groesbeck, DONA-trained and BAI-certified birth doula.

Premium Birth Doula Package (all-inclusive): $900

This includes services described in the Deluxe Birth Doula package, plus two private in-home childbirth education classes, birth photography, and 10 hours of postpartum doula support within first month after delivery. A $1,060 value: save $160! Doula services provided by Faith Groesbeck and birth photography provided Beth Singleton.

Planned Cesarean: $300

Birth Quest offers a package for when a cesarean is planned at the time a doula is hired. Whether or not the doula is allowed in the room is subject to hospital policy and staff permission. This package includes one prenatal visit, continuous support during preparation for, surgery and postpartum, and eight hours of postpartum doula support within the first month after delivery.  This package may be provided by either Birth Quest doula.

Last-Minute Doula: $300

This package is for those who, due to special circumstances that come up while they are due (i.e. their support person is no longer able to make it or a medical complication has caused a change in the birth plan), they have decided to hire a doula last minute. This package includes continuous support during labor, delivery and the first hour postpartum and one postpartum visit.  Last minute doula services are subject to availability. This package may be provided by either Birth Quest doula.

Options for Families with Financial Hardships

Families who are unable to afford these fees may have other options. We are committed to helping make doula services affordable for all families by offering barters and payment plans.  Doulamatch.net is a database of doulas, some of whom have sliding-fee scales or charge reduced rates while pursuing certification. I would also be happy to refer you to other area doulas who may charge less. Please contact me for more information.

 

Postpartum Doula

smarrowPostpartum doula and breasteeding support is available to provide an extra set of hands and information that can help clients and their families transition into life with a newborn well-supported, with confidence and in good health. In this role, we will listen, ask questions, and help problem solve.

More specifically, services may include:

  • Nurturing for the mother’s postpartum recovery
  • Support for adoptive and surrogate parents
  • Providing opportunities for rest and family bonding
  • Support and inclusion of partner and/or other family members
  • Parenting information, including newborn care, baby-wearing and feeding support
  • Attention for older siblings
  • Light housework (e.g. grocery shopping, laundry, and dishwashing)
  • Basic meal preparation
  • Answering the phone and taking care of guests
  • Referrals to community resources

Postpartum Doula & Breastfeeding Support: $20/hr within 30 miles of downtown Muskegon; $25/hr between 30 and 75 miles of downtown Muskegon