West Michigan VBAC Access Update

Source: 2015 Geocoded Michigan Birth Certificate Registry.
Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services

A year ago, I wrote a blog about how hospital bans against vaginal birth after cesarean (VBAC) limit options for Muskegon families. I used birth data from the Michigan Department of Health and Human Services to compare percentages of people with low-risk pregnancies who have a cesarean after a prior cesarean in Muskegon and surrounding counties. Not surprisingly, VBACs are more common where hospitals support them.

The data available that I used was from 2008 to 2014. Since then, 2015 data has been released. I wanted to update this information to see if there were any changes, explore what might be impacting this change and predict how this situation might change in coming years based on current developments in healthcare policy and services.

Statewide, there has been improvement. In 2015, a total of 2,006 people had VBACs, compared to 1,882 in 2014, an increase of 124. When we look at West Michigan counties, however, only Muskegon County and District Health Department #10, which includes Oceana, Newaygo and eight other counties, saw an increase. Kent county births included 40 fewer VBACs and Ottawa county had 3 fewer than the year before.

There are a few issues with this data and that make it difficult to draw conclusions from. First, the two-to-three-year lag time from when the year ends until the data becomes available makes it less useful. We can reflect on what may have happened two years ago to impact these changes, but it is less relevant than being able to access real-time data. Secondly, the online database only provides this particular piece of information by county. In a large county, like Kent, it would be interesting to see how being in an urban, suburban or rural area or proximity to a specific hospital may impact access.

When applying this information to our doula practice, we see clients make a lot of different choices when it comes to choosing a provider and location for their planned VBAC. While some Muskegon area families are happy to travel to Spectrum Health Butterworth in Grand Rapids to deliver, others prefer the intimacy of the small practice at Gerber Memorial Women’s Health, also under Spectrum, in Fremont. Still others have decided to stay in Muskegon and show up in labor at Mercy Health Hackley, while home birth after cesarean (HBAC) is a clear choice for others.

Things may change in 2018. Dr. Tami Michele, who has practiced at Spectrum Health Gerber Memorial for many years, is switching over to Spectrum Health Medical Group Ob/Gyn, with locations on 68th St. and on Mid Towne in Grand Rapids. Some say the move is to help increase the access to VBACs at Butterworth, which serves more patients. Dr. Michele is former doula, whose advocacy for those who wish to plan a VBAC has earned her a national reputation. What is less known at this time is how her moving from a small, rural hospital to a large metropolitan one will impact access to VBACs for those outside of Grand Rapids. Some will surely follow her, while others may feel that they lost a resource.

Another recent change on the national landscape was the publication of the American Congress of Obstetricians and Gynecologists updated guidelines on VBAC, which appeared in the November issue of Obstetrics and Gynecology. According to Mark Turrentine, MD, chair of ACOG’s Committee on Practice Bulletins-Obstetrics, the guidelines are meant to ensure delivery at the safest facility, “However, this absolutely should not result in women having limited access to VBAC.”

According to Jen Kamel, founder of VBACFacts.com, the guidelines are an improvement over those released in 2010. She quotes the new guidelines, “Available data confirm that TOLAC [trial of labor after cesarean] may be safely attempted in both university and community hospitals and in facilities with or without residency programs.” She interprets this to mean that if a hospital can handle deliveries, they should offer VBAC, because an emergency cesarean may be required in any birth, even a low-risk one.

How local staff changes and changes in the ACOG guidelines will impact local access remains to be seen. Will more people be able to access VBACs at Butterworth, or will support at Gerber decline? Will the 2017 ACOG guidelines result in a reversal of bans at Mercy Health Hackley, North Ottawa Community Hospital and Spectrum Health Gerber Memorial, or will the liability concerns prevail? Time will tell, but we won’t be able to see the data until 2020!

In the meantime, we will continue to support families in all their choices, whether they choose a repeat cesarean, a VBAC at a hospital or birth center of their choice, or at home.

Black Infant Mortality in Muskegon More than Doubles in Eight Year Span

Available here: http://www.mlpp.org/wp-content/uploads/2017/08/Muskegon-2017-Right-Start.pdf

Source: Michigan League for Public Policy, 2017 Right Start Annual Report on Maternal and Child Health, Muskegon Community Report

According to Kids Count data, released August 9th, 2017, the Black infant mortality rate, or B-IMR, in the City of Muskegon has more than doubled in an 8-year time span. The infant mortality rate measures the number of infants who died per 1,000 infants born. This makes it possible to compare places with different population sizes, or groups within a population. The data in the report compares a “rolling average” or the average of a 3-year time span, 2008 – 2010 and 2013 – 2015. For a relatively rare event like an infant death, years are combined to get enough numbers to make sure the statistics are not related to chance.

The community report for Muskegon points to the Maternal Infant Health Programs (MIHP) at Muskegon County’s two Federally Qualified Health Centers, Muskegon Family Care (MFC) and Hackley Community Care (HCC) and several programs through Catholic Charities of West MI as examples of efforts. Policy recommendations in the full report include:

  • Reducing disparities by race and ethnicity
  • Protecting the Affordable Care Act and the Healthy Michigan Plan
  • Expanding home visiting programs to support vulnerable women and infants
  • Addressing the social determinants of health

Here is a timeline of some significant events that impacted reproductive, maternal and infant healthcare services in Muskegon during the time covered in the report:

Important Events Impacting Reproductive Health in Muskegon County from 2008 to 2016

Muskegon County experienced a 131% increase in infant mortality during the time these events occurred. Did they have an impact?

These events may impact infant mortality in the following ways:

Despite promises by administrators that reproductive health services would not be impacted, the hospital system, now operating under the Ethical and Religious Directives for Catholic Health Systems (ERDs), eliminated insurance coverage for family planning under its health insurance plans. Although some providers violate the ERDs by prescribing birth control for preventing pregnancy, there is now institutional support for providers who, because of their own religious beliefs, refuse to insert an IUD immediately postpartum, prescribe hormonal contraceptives, or emergency contraception; or perform a tubal ligation during a cesarean, for example. The merger also meant an end to all abortions, except to save the life of the mother, which, as the court case Means vs. the US Conference of Catholic Bishops shows, is up for interpretation by the local Bishop. The ban on abortions includes terminations for fetuses known to have birth defects incompatible with life, even when the pregnant person has health conditions that can make pregnancy dangerous for them.

As I stated this past May, when I was invited to speak to congressional staffers by the National Women’s Law Center (NWLC) on the impact of religious restrictions in healthcare in Washington, DC, unenforceable policies open the floodgates to discrimination based on provider biases.

Muskegon’s Fetal Infant Mortality Review (FIMR) findings showed an increase in both unintended pregnancies among women experiencing an infant or fetal loss and a sharp increase in Black infant mortality following the loss of Title X family planning services.

The new Muskegon Planned Parenthood clinic reopens inside of Public Health – Muskegon County , providing services in Muskegon for the first time since the Peck St. clinic shut down in 2007. Title X – funded clinics are unique in that federal guidelines prohibit discrimination, religious refusals on the part of the provider and can provide more confidential services to minors than state law requires.

The Birthing Center at the former Mercy Hospital was a favorite among local women. As an in-hospital birthing center, it was physically detached from the hospital, but still run by it. During construction, some women who gave birth complained to me of noise and crowding. Some women who had given birth prior at the Mercy facility and then had to deliver subsequently at the new facility, preferred the later.

Centering Pregnancy is an evidence-based group prenatal care model shown to decrease the incidence of preterm births, with the best improvements among African American women.

Regardless of the reasons of the clinic’s closing, Muskegon County women now must drive to Grand Rapids’ Heritage Clinic, currently the closest abortion clinic, to obtain an elective abortion. For those who lack transportation to Grand Rapids or the addition time for travel, this clinic closure creates an additional barrier to obtaining services. Research has linked increases in abortion access to declines infant mortality rates.

  • Oct 2013: Public Health – Muskegon County (PHMC) Eliminates the FIMR Program

Despite successfully reducing the B-IMR in Muskegon County, PHMC eliminates the FIMR program after a “Know Your Rights” event is held at Muskegon Community College. The event, co-sponsored by the ACLU of Michigan was held to educate local women about how other communities had been impacted by mergers with Catholic healthcare systems.

Planned Parenthood takes over the job of STD testing, despite being open fewer hours, when PHMC decides to focus on partner notification. At the time, we had the third highest rate of Chlamydia among all counties in the state of Michigan. Chlamydia and Gonorrhea are major contributors to prematurity and infant mortality.

Now, both of the FQHCs offer Centering Pregnancy group prenatal care, although the midwives at HCC stopped catching babies that same year, leaving MFC the only place in Muskegon to receive continuous care from a Certified Nurse Midwife throughout labor and birth.

Research shows that racially inequities in incarceration rates are directly related to racial inequities in STD rates. When the former jail was being used, the racial disparities was 5.9, meaning an African American in Muskegon County was nearly 6 times more likely to be in jail than a White resident. Muskegon County FIMR participated in at least two efforts to address this injustice: The Disproportionate Minority Contact (DMC) Coalition and a Health Impact Assessment (HIA) on the funding of the new jail. The DMC Coalition, which was making some progress in collecting data to identify key points in the juvenile detention system where discrimination occurred, had its leadership derailed by a vote electing Judge Pittman as the new president and never again convened. The HIA was sabotaged by inadequate funding and refusal to approve a research project initiated by a professor at Grand Valley State University to inform service providers of the unmet psychosocial needs of current inmates.

Muskegon is about to have its second birthing unit in five years built away from the city center to be more convenient to out-of-town patients. According to the head of obstetric nursing, community input for the birthing unit was obtained, although the public was not invited.

While the causes of infant mortality and the inequalities expressed in rates are complex, one thing is clear, Muskegon stands out in Michigan as having the largest increase, 131%, in an eight-year time span at the same time as infant mortality statewide is decreasing. This is not an accident, nor are the multiple contributing factors a mystery. What remains unasked is why aren’t the home visiting and other programs in place not making more of a difference? And moving forward, if Public Health and Mercy Health aren’t doing a good job of ensuring the survival of our county’s Black infants, is anyone paying attention and will anyone be held accountable? Who will spearhead our efforts toward improvement? Whoever that is, I wish them the best of luck in their endeavors, will follow their lead and hope that they don’t become demoralized and without a job. The needed change will not come without stepping on a few toes.

Muskegon Momma Shares her VBAC Birth Story

Adorable VBA1C baby!

My VBA1C Story.

So here it goes! I am a little late but I just finished up with school and having a newborn baby, and her being baby number two with a 5 year old boy at home has been quite the adjustment for me, but things are really coming along great and he is an amazing big brother to her!!! I had my amazing VBAC! I gotta say, my story is one of these stories you mommas trying for a VBAC MUST READ. I read stories like mine everyday during my pregnancy and they gave me so much encouragement. Because after what I had been through with my son, I honestly had a lot of doubt deep down. I was 17 when I got pregnant with him. I did not educate myself, I thought having a baby was nothin! I figured everyone else seemed to have a baby no problem, so why can’t I!? But as we all know birth can be very unpredictable. So as far as what happened with my son I will try to make a long story short, I went in for my last OB check up, which was a day before my due date and my blood pressure was extremely high so I got an ultra sound to check my fluids, everything seemed fine, but they did schedule me to be induced for June 13th. Hours after pitocin started I was making little progress even after they broke my water, ended up getting the epidural and after 24 hours of labor and 4 hours of pushing I ended up with a c-section. My son was posterior and was showing signs of stress. I just remember, after being told that I was going to be having a c-section, all I kept telling my sons father is “I feel like a failure, why can’t I do it!?” It was all very traumatizing. The anesthesiologist was a complete smart ass when came time to bring me in for the c-section, cuz I mean there was so much to joke about, right!? Afterward I was shaking so bad, I couldn’t hold my baby for nearly a half an hour after the c-section, not to mention I was so doped up on morphine and whatever else, I could barely function. I will say my son was absolutely perfect. 8 pounds 2 ounces and 21 ½ inches long, and very healthy. When the surgeon paid me a visit in the recovery room he informed be that I would HAVE to have the rest of my children a c-section in the future. I was highly upset. I was upset about the outcome of my birth, I felt everything had went wrong, and that I failed. Recovery was also very painful and lengthy!! But, my recent experience with my daughter was very healing. I feel empowered, strong, hopeful, blessed and so many other beautiful things that birth can possibly make you feel, but most importantly, I got my baby girl, who arrived healthy! And I was healthy! But enough rambling and on to the best part!

Ok, so I found out I was pregnant March 1st of this year. I guess I wouldn’t say it was planned, but we weren’t necessarily trying to prevent it. At first I was just like ok, I guess I’m going to have another c-section, that really sucks. But then my stubborn bitch side kicked in and I was like wait, no, they can’t make me do s***! I mean they can’t really force me to have surgery, I’m not doing it, I refuse. Most people thought I was crazy and I heard a lot of “oh but you have to” and “you’re not allowed” but I was determined. I was also determined to breastfeed which I was unsuccessful with my son as well. (which has been going great as well ) But anyway, I told my midwives that I really wanted to have this one natural and they told me I better go in when time to push or the more safer route would be to go to Spectrum, so that is what I planned to do. But then I was actually talking to my stepmom and I was explaining to her that I really wanted to have this one natural and she told me to look into hiring a doula. I heard of a doula, but didn’t really know what they did or anything about them. And then a few different people referred me to Faith Groesbeck. What a real kind hearted, and genuinely beautiful soul she is. So explaining to Faith what I wanted as far as birth and telling her about my first experience she suggested I go to Gerber Hospital in Fremont. I made my appointment to meet with the VBAC supportive provider for the first time and when I got there I couldn’t meet with her because she was in delivery with one of her patients. I could have rescheduled but I wasn’t going to be able to meet with her until closer to the end of my pregnancy. I was a little frustrated, understanding that things happen and it wasn’t her fault, I just decided I would go to Hackley. It’s right down the street from my house, yes they are not as VBAC supportive as I would like, but I just kept in mind that they can’t force me to do anything and that I CAN DO THIS. And I did eventually accept that, if I HAD to, if there were extenuating circumstances that required me a c-section, than I would because my daughter and my safety was number 1. But unless it came to that, I was determined to have my VBAC, at Hackley Hospital. No matter the risks (because I did an extensive amount of research and there were risks, yes, but very unlikely considering my circumstances. I was not high risk.), the paperwork I had to sign or the attitude that was given, because honestly, no one’s attitude was going to be bigger than mine, and paperwork..??? Give it here!

Other than all of the morning sickness I had at the beginning of my pregnancy, it went really well. I had a little bit of preterm labor scare at about 25 weeks, but was most likely due to lack of water. After that I would have Braxton-Hicks here and there but nothing to get to excited about. I was very patient up until the last 3 weeks of course. The anticipation really started killing me. On Halloween though, I lost part of my mucus plug. I did feel some excitement because I knew my body was making changes, but my due date was in 10 days so I also knew that it didn’t necessarily mean anything. I could have been pregnant for another 10 days, or longer!! So I went about my week as normal, but was definitely trying to get last few things done around the house in case she decided to come a little early. I was supposed to go visit my grandma in Grand Rapids that Saturday but I called her Friday because I was having Braxton-Hicks very consistently and had a feeling the baby would be here soon so I wanted to spend my weekend doing the final last touches to the house and the kids room. So Friday morning I woke up feeling fine, I had sex about 11 am-ish I think it was and about noon I started having the Braxton-Hicks. I went to the grocery store, came home and was hanging out with my son for a bit. He was supposed to spend that whole weekend with his dad but I didn’t want him to because I knew when the baby came he was going to go with his dad for about a week or so so I could recover a bit (my kids have different fathers, so you’re not confused lol) I didn’t want him to go though because I was sad that it was my last little bit of time left with him being my only child. So I told his dad that he could go that night but I wanted him back Saturday if I could so that I could soak up the time with him. So anyway, my son went with his father that evening and I got this huge burst of energy and cleaned everything. I mean everything. I also cooked dinner and made brownies! Meanwhile the contractions were starting to be more consistent and somewhat uncomfortable, they weren’t anything unbearable. It was about 9 pm when I noticed they were at about 10 minutes apart. I was not concerned though because I was still in minimal amount of pain. At 10:30 I lost the rest of my mucus plug and then I thought, ok my body is making more changes, GREAT! I think I may have somewhat been in denial. As I’m communicating with a good friend of mine, she’s all like “baby time, you’re going to have her tonight watch” and I’m all like yeah right, I wish! Although I did feel she was going to come soon I just didn’t think it was going to be that night or anything in the near-near future. Lol. Anyway I decided that jusssst in cassse the baby came that night I decided I Should take a shower and do my eyebrows lol. So it was about midnight and my daughter’s father showed up, he works second shift and gets out of work at 11. I told him I wasn’t sure, but I thought labor may be on its way. Lol denial at its finest…and at 12:30 I crashed really hard, so I laid down. I woke up at 2am from the sharp pain of a contraction. It wasn’t anything excruciating, but enough to wake me out of my sleep. I sat up and just dealt with them as they were a little uncomfortable. I texted my grandma and told her I thought I might be in labor. She called me immediately and asked me how far apart my contractions were and I told her about 3-4 minutes apart. She told me to go in, I told her that i didn’t want to go in because they would send me home. Yeah my contractions were close together but I wasn’t in that much pain yet. You would think if you were in real labor you would be in a great deal of pain right? So I called a close friend of mine and asked her how much pain she was in when she decided to go in and she said she was in so much pain but they kept sending her home. So Brandon, (my daughter’s father) said we should go in, and here I am like no I just don’t really want to get sent home… but with him and my grandma hounding me I said okay, I’ll go in, but watch me get sent home. Right before I left my house the heat turned up a notch! It was about 2:45 when we arrived to the hospital and when I got out of my truck I knew then it was real labor because I couldn’t walk through the contractions anymore. I could still talk, and was breathing through them, but they had me hunched over. They got me checked in and the Nurse checked me and said “okay they will probably be keeping you but the Doctor will be coming in shortly to check you again, now I understand you had a c-section with your first” I told her I wasn’t having a c-section and she says “Well, do you know our policy here at Hackley on VBAC’s?” Of course I went in there with my diehard attitude and I said, I know you guys are going to try to make me have a c-section and its not going to happen. She says “Well we aren’t going to make you do anything, but we do have to let you know the risks” Her name was Lauren, She was awesome and I will never forget her. I won’t forget any of those residents there that night. I also reminded all of the residents that I did not want an epidural or any other form of pain medication. The Doctor that came in, his name was Dr. Thomas Duncan, and right away he checked me and told me that they were going to do what they could to help me have a successful VBAC and went through the ricks with me and that it was going to be either him or Dr. Gale-Butto that would be helping me deliver. So wait am I dilated though? I asked him. “Yes, you’re dilated to 9, your water is bulging and I can feel baby’s head” he says. I got scared. It was really happening, I was about to have this baby, SOON! I was in a good amount of pain by this time but was breathing through the contractions and felt I was doing okay. I was scared mainly of what was going to come when my water broke. As they moved me to the room where things were getting much more intense I suddenly felt the urge to push and my water broke. They wanted me to hold off a little bit because I tested positive for group b strep but its kind of hard to hold off when your body is taking over. At one point i asked if it was too late for the epidural, and Lauren the sweet nurse I will never forget, encouraged me that i was so close and she believed i could do it without, along with my daughter’s father and one of my Doulas Elizabeth (Unfortunately Faith was not able to make it due to important life events in which I do not hold against her for we were communication the entire time, and she was very encouraging as well) . You can do it they kept telling me. One of the other nurses came in and wanted to check me again but I refused firmly. I was in so much pain by this point, hands feeling in my vagina is the last thing I wanted! And besides when they checked me last i was at a 9, what do you need to check again for!! I thought. I told them I wanted to push when I felt ready and that I wanted to listen to my body. So after my water broke I could not fight the urge to push any longer. It was time to start working that baby out! I would say when I first started pushing I didn’t feel like anything was happening but i was in all this pain and i felt like I was trying my hardest. So after a number of pushes and feeling like it would never end I got fed up with the pain and decided I would take in that deep breath and push with all my might. The harder I worked, the sooner I could hold my baby girl in my arms. It’s truly amazing what you body can do. When she was crowning I reached down and felt all of hair and it was almost relieving and it made me so happy to just be able to touch her and know it was almost over. Unfortunately there is no picture of me touching her head, but Brandon, her father did say the look on my face was priceless and he will never forget it. What’s also crazy is pushing your baby out, and wanting the pain to end so badly, but having the doctors tell you to push, but don’t push so hard, because they were working her head out and her shoulders. Lol That took some control, but had I not listened I may have tore worse than I did. But after pushing for an hour and enduring that great amount of pain that I had no idea I could handle, my beautiful baby girl arrived at 6:12 am weighing 6 pounds 8 ounces and 19 inches long, HEALTHY and PERFECT. It was instant relief and all I could think about was how perfect and beautiful she was and that I DID IT. She came out eyes wide open and sucking on the back of her hand. She was ready to nurse and latched on right away, no problem! I feel like a momma lion!!! I knew I could do it, and the encouragement i received from those around me helped so much!!! I will never forget the residents that helped me deliver at Hackley hospital. I am truly blessed and I hope you mommas who are trying for a VBAC get some encouragement from this, you CAN do it!!

Childbirth After Cesarean: Lakeshore Women Have Options

From module 12 of the VBAC Education Project (VEP).

From module 12 of the VBAC Education Project (VEP).

Women in Muskegon and elsewhere along the West Michigan lakeshore have several options for childbirth after cesarean. What are some of these options?

Repeat Cesarean

The majority of women in Muskegon County who have a prior cesarean have a repeat cesarean section (RCS). This may be because they decide this is the safest option for them based on their medical history, while others prefer the certainty and convenience of scheduling their birth. Other times, women don’t realize that they have other options or don’t have the support to access them.

Vaginal Birth After Cesarean (VBAC)

I’ve heard Muskegon birthing people being prepped for surgery be told that they can deliver vaginally in the future, but that they would have to go to a Grand Rapids hospital. That’s only part of the story. While currently, all three of the hospitals in Grand Rapids, Spectrum Health Butterworth, Metro and Mercy Health St. Mary’s, offer VBAC, distance makes this option a challenge for many people. Holland Hospital also offers VBAC as an option.  Others are intimidated by the prospect of receiving prenatal care and delivering with a large practice and facility, which feels impersonal compared to the care they are accustomed to in their community. Despite the challenges, some Muskegon people will travel out-of-county for their VBAC.

Another option that appeals to some families is to deliver in a community hospital that has a VBAC ban, or policies that discourage VBAC, but is known to have supportive providers. Dr. Michele and her colleagues at Spectrum Health Gerber Memorial have an excellent reputation for supporting those who choose to have a VBAC. Others receive their prenatal care locally, put off scheduling a RCS or do not show to appointments, with the plan to show up in labor at their local hospital. Local community hospitals include Mercy Health Hackley in Muskegon and North Ottawa Community Hospital (NOCH) in Grand Haven. I have heard of people having VBACs at Hackley, despite the ban, but not at NOCH.

Free-standing birth centers are an option for women who want to deliver with a midwife in a home-like atmosphere outside of, but close to, a hospital. There is some evidence that choosing midwifery care through a free-standing birth center increases VBAC success rates. Simply Born Birth House is the only free-standing birth center in West Michigan. Sara Badger, a Certified Professional Midwife (CPM) is the provider there. Birth centers have criteria they use to screen women to see if they are good candidates for this type of care. If this is something you are considering, I recommend scheduling a consultation before pregnancy to learn more.

The final option is to plan a home birth after cesarean, or HBAC. In the event of a rare complication, like a uterine rupture, this may not be the safest option, but some people are willing to take the risk to birth on their terms, in the privacy of their own home, with a provider who believes in their body’s ability to birth. As with birth centers, home birth midwives have criteria for screening clients who are candidates for HBAC. You may have to interview several in order to find the right one for you.

As with any birth, there are many decisions to be made. Since providers vary a great deal in their support of VBAC, it isn’t a bad idea to do some research prior to your next pregnancy. A provider may also have good advice to increase your chance of having a successful VBAC, like the amount of time to wait between pregnancies and how to optimize your health.

While those in Muskegon and along the lakeshore may not have all of the options available to birthing people in large, metropolitan areas, they do have possibilities. Knowing what those are is the first step to choosing the course of care best for you and your family.

Hospital Midwives on the Lakeshore – Remaining Options

Having a midwife attend your labor and birth increases the chance of having your baby naturally and without drugs!

Having a midwife attend your labor and birth increases the chance of having your baby naturally and without drugs!

In a prior blog, I wrote about how North Ottawa Community Hospital (NOCH) closed their midwifery practice in 2014. At that time, I contacted both federally qualified health centers (FQHCs) in Muskegon to ask them if they would be willing to have me interview them to help spread the word to expectant women in the area about their remaining options. Hackley Community Care (HCC) got back with me and we were able to videotape an interview with their collaborating physician, Dr. Danielle Koestner.

I have been at several births with the HCC midwives and have always been impressed by the way they respected and supported the wishes of my clients. The good relationship we had benefited our mutual clients because we were able to communicate concerns to better coordinate care.

When I learned that the HCC midwives were going to stop catching babies, my initial response was, “Not again!” Like others, I am still upset about losing the option of midwife-attended deliveries at NOCH. Still, I wanted to wait and find out more information. Earlier this week, I received the official letter from HCC, stating that the midwives were going to continue to provide pre- and post-natal care and that they were officially certified as a Centering Pregnancy site. Now, however, the obstetric laborist and residents at Mercy Health Hackley would be in charge of their pregnant patients’ labor and deliveries.

The laborist comes with a wealth of knowledge and experience. While many women include avoiding residents in their birth plans, I have found them to be on top of the latest research, open to patient preferences and supportive of evidence-based care. For some women, this will be an acceptable option. During their prenatal care, they will benefit from an evidence-based group prenatal care model, the individualized care characteristic of midwives and access to a host of other services offered on-site.  However, for women specifically looking to benefit from the better outcomes research shows continuous care from a midwife during labor and delivery offers, this change will be unacceptable. The research shows that interventions are lower and outcomes improve when midwives provide care throughout the pregnancy, labor and delivery.

For women who seek a midwife to provide their prenatal care and attend their birth, Muskegon Family Care (MFC), Muskegon’s other FQHC with a midwifery program, recently hired new midwives and are now fully staffed. In July, I had the pleasure of meeting with one of them, Katie Van Heck, CNM, to discuss how to improve their services by increasing their patients’ access to doulas. I now have a couple of clients who are seeing the midwives there for care and I am excited to work more with this practice in the future!

If you live along the West Michigan lakeshore and you wish to deliver in a hospital, with a Certified Nurse Midwife (CNM), the only midwives who can practice in Michigan hospitals at this time, these are some of your remaining options:

  • Muskegon Family Care – With three midwives on staff, this practice is located in a federally qualified health center in Muskegon Heights. This means they primarily serve low-income people, but they can serve anyone.
  • Midwifery Services at Advanced Women’s Ob/Gyn – If Muskegon-area women are willing to travel to Spectrum Health Butterworth in Grand Rapids to deliver, this private midwifery practice has an 6% c-section rate, which speaks for itself.

What will be the next news for midwifery options along the lakeshore? Hopefully, something positive, like a new private practice or free-standing birth center opening up!

Did you have your baby with a midwife in a hospital? Please share your experiences in the comments!


Sandall, Jane, et al. “Midwife‐led continuity models versus other models of care for childbearing women.” The Cochrane Library (2016).