By On the occasion of our 20th anniversary
By Gustavo Arellano
By R. Scott Moxley
By Alfonso Delgado
By Courtney Hamilton
By Joel Beers
By Peter Maguire
By Charles Lam
Like all midwives, Snell and Sherwood treated labor as a vigorous, lively, normal experience; the midwife, who knows her patient's body and the baby well, is there to examine, coax, support and ultimately help her patient deliver with as little medical and physical intervention as possible. If there were no complications, the physician was never called into the room. If there were, Snell and Sherwood worked collaboratively with James to deliver the baby.
"We can get as medical as we need to be. If a baby is in trouble or mom is, we say, 'We can't do this,'" Sherwood says. "Then they're delivered into the hands of the OB/GYN."
"It was a wonderful experience," says Parker of her second birth, which was at South Coast. She saw Snell throughout her entire pregnancy; Snell was out of town when Parker went into labor, so Sherwood delivered the baby. "I was actually happy and excited this time around," she says. "I just have full confidence in Lisa and B.J. to take care of the baby and to take care of me."
All this came to an abrupt end when the small maternity ward closed in June because of a drop in deliveries there and high overhead costs, according to hospital administrators. Doctors, nurses and midwives who were delivering babies at the hospital were given six weeks to relocate themselves and their patients. For nurses, it meant scattering throughout the county for new jobs at various maternity wards. For doctors such as Ken James, it would mean transferring patients to the other hospital where he had privileges.
But Parker and the 50 or so other patients who were going to Snell and Sherwood weren't sure what would happen. Some assumed they would just transfer to another hospital like James' patients.
"The difference, of course, is I have privileges somewhere else, so I say to my patients, 'We can't go to South Coast; we'll go to Saddleback,'" James says. "The problem is, for the midwives, they don't have any other hospitals to go through, so their business kind of dissolved or is dissolving. It's really sad and disappointing."
Snell and Sherwood are familiar with the ins and outs of hospital privileging. Sherwood worked at local hospitals for most of her 24-year career as a labor-and-delivery nurse before earning her master's degree at USC, becoming a nurse midwife and working at Kaiser. Snell has been a nurse since 1977, has a Ph.D. in public health, directed the midwifery program at USC, worked at Daniel Freeman Medical Center in Los Angeles, and served as director of the birthing center at UC Irvine Medical Center in Orange (the county's second; the other is in Irvine) in the mid-1990s. They both knew that gaining hospital privileges following South Coast's maternity-ward closure might be tricky, but they were hopeful.
The first option was to go to Saddleback Memorial Medical Center in Laguna Hills, where James already had privileges and where he offered to again serve as their supporting physician (a role that, in his case, led to the doubling of his malpractice insurance, despite the fact that both Snell and Sherwood are required to carry $2 million to $3 million in malpractice coverage of their own). Snell and Sherwood approached administrators, who, they say, expressed interest. But the decision ultimately would be up to the doctors.
In April, Saddleback's OB/GYN committee met to discuss the possibilities of granting the midwives hospital credentials. Dr. Elizabeth Lyster, an OB/GYN who worked with Snell and Sherwood at South Coast for three years and who first worked with Snell at USC, was at the meeting. Lyster says her fellow physicians didn't have safety concerns about midwives. "[Midwives] practice excellent obstetrics," she says. Dealing with serious complications is up to the doctors, and the midwives know this, Lyster says. This collaborative model, she says, worked well at USC.
And yet the doctors at Saddleback balked. "No one wanted the [midwives]. They saw them as a threat," says James, who was also at the meeting. James says doctors expressed fear that opening the door to Snell and Sherwood would invite in too many other midwives who could potentially undermine the business of the physicians. "That whole competition thing is not real," James says. "Patients who want natural childbirth will seek it out."
The Weekly's requests to speak with Dr. David Lagrew, medical director of the Women's Hospital at Saddleback, about the meeting and the hospital's decision were declined. The hospital released only this statement: "The decision to offer a midwifery program is an issue facing many hospitals in our region. At this time, Saddleback Memorial Medical Center does not have a midwifery category in our allied health staff."
Snell and Sherwood also approached physicians with privileges at the next-nearest stop, Mission Hospital in Mission Viejo, but the physicians they spoke to said they could not act as supporting physicians for the midwives, Sherwood says.
A spokesperson for Mission Hospital says the hospital had not been approached by any midwives and said Dr. Marvin Posner, director of maternal and fetal medicine at the hospital, was not available for an interview.