The Obstetrics and Gynecology (Ob/Gyn) Department at the University of Chicago Hospitals mandated this summer that the private nurse-midwife practice within the department could no longer accept new patients to its clinic. The three midwives will be allowed to continue until their current patients have delivered, but they are closing in the immediate future, according to Charity Cooper, one of the certified nurse-midwives.
Restructuring within the Ob/Gyn department is primarily responsible for the closure. In early 2003, Dr. Arthur Haney was appointed chairman of the department to replace Dr. Arthur Herbst, who had led the department since 1976. The announcement came on July 28, when Haney, chair of the Ob/Gyn department, announced that the 15-year-old midwifery program was no longer economically sustainable and would be forced to shut its doors.
Cooper, along with the two other certified nurse-midwives in the practice, Patricia Schneider and Susan Mersch, provide prenatal and postpartum care to privately insured patients, and attend to the births of each of these women. In addition the midwives run a teen parenting clinic for young mothers from the area.
"Traditional Ob/Gyn is tailored toward pathology and what can go wrong in pregnancy," Cooper said. "Midwives see birth and pregnancy as a natural event and approach it from a sense of normalcy. It is geared toward normal women in normal pregnancy so there is less of a high-tech, invasive aspect than in traditional hospital-based deliveries."
In an official statement about the current situation of the midwifery clinic, the hospital cites several issues that have been discussed and looked at when making this decision.
"The lower reimbursement, dramatically rising overhead costs due to malpractice insurance rates, and limited demand for midwives at our hospital have made a separate midwifery practice within our department financially untenable in this health care environment," the release read.
In response to the decision by the Ob/Gyn department, a group of faculty and community members have organized to form Friends of the U of C Midwives, a coalition within the Parent Support Network.
The group members, many of whom used the midwifery program for their own pregnancies, held a rally September 12 to protest the hospital administration's decision and show support for the midwives, said Dina Weinstein, communications director for the group. She added that the administration has been unresponsive to any of their appeals and protests thus far.
"As soon as I heard about the decision from the hospital, we began writing letters and alerting the media to the issue," Weinstein said. "Women choose midwifery because they want to be in a hospital setting but have the option to be without so much medical intervention. We are trying to communicate that the University of Chicago Hospitals need to listen to the community."
Alison Winter, associate professor of history and a patient of the midwives, worked with Amanda Woodward, associate professor of psychology, to organize an effort within the faculty to identify supporters of the midwifery cause. Their effort coordinates with the larger Friends of U of C Midwives' goals to target the faculty members as one of the four main constituent groupsfaculty, students, alumni, and community membersthat would voice their opposition to the hospital's decision.
To support this plan, Winter and Woodward began a letter writing campaign. This letter, which was submitted to President Don Randel, Haney, and other hospital administrators, contained over 140 faculty signatures, including over 20 medical professionals, according to Winter.
She said that they have not yet received any response from their letter.
But the financial concerns are valid, according to Dr. Atef Moawad, Professor Emeritus in the Ob/Gyn Department and the founder of the midwifery services at the University Hospital. He said that although he believes midwifery and its concept of non-interventive care to be an integral part of health care during pregnancy for low-risk births, it has always proved to be difficult to support on a financial scale. Although he retired shortly before the decision to shut down the practice was made, Moawad said he understands the economic reasons behind the final decision made by the department.
"Something is wrong with the health-care system in the U.S. and not necessarily with the University of Chicago or its hospitals," Moawad said. "It seems to me that this criticism and campaign should be directed toward third party payers, as well as the government, who are not meeting their obligations nor realizing the importance of development of first class midwifery services in Illinois and the U.S."
Although they have decided to end the private midwifery practice, the hospital administration did outline two options within its official statement in an attempt to "utilize the skills of the midwives in the obstetric service in an economically sustainable way."
In the first proposed option, the midwives would be part of a mixed-practice within the obstetric department, where they could provide prenatal and postpartum care but only deliver babies during the daytime hours. Obstetric physicians would handle all night and weekend deliveries, even of those women who chose midwifery prenatal care.
The second option would have the midwives form an independent practice which would be separate from the department and without the need for subsidies, but would allow them to deliver in the hospital and accept malpractice risk for their deliveries; in this case, their prenatal and postpartum care would be done at an outside clinic.
Although these options were discussed, neither was found feasible or acceptable under the proposed conditions, Cooper said. The midwives also put forth three of their own options to remain at the hospital in a more economically feasible environment, including partnering with the Board of Health and working with South Side clinics. However, the university would not accept any of their proposals, Cooper said.
"This decision will leave the women of the area with fewer opportunities for diversity in birth and fewer voices within the hospital for the normality of birth," Cooper said. "We were taught how to make a place for normal birth within the increasingly high-tech field of obstetrics. But it seems that the hospital has decided to lead the department in that high-tech direction anyway."