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The midwives faced different challenges at other hospitals. At Orange Coast Memorial Medical Center, where a physicians' group has four midwives on staff, Snell and Sherwood were told the hospital did not need any more. Orange Coast administrators did not return calls seeking comment for this story.
Irvine Regional Medical Center momentarily held some promise. Director of Medical Staff Katie Love says the hospital had moved forward with drafting bylaws to create a midwifery category and that the position of the physicians there was neutral. But the midwives could not find a doctor who could act as their supporting physician, Snell says. "The physician we were working with had agreed, but when he called to check in with his malpractice insurance, they said they would drop him if he took us on."
The result has been a frustrating transition for many of Snell's and Sherwood's patients, who have looked for any way to keep them or midwifery as part of their care. "We were told a month before we were supposed to deliver, 'You're basically screwed over,'" Denise Highshaw, who lives in Anaheim Hills and recently delivered her first baby, says of the South Coast closure. "Once we found out no hospitals were letting B.J. come on, I was pretty adamant that I wasn't going to go to an OB. I didn't want that," she says. Her urologist husband, she says, felt the same.
After weeks of sorting through different possibilities, Highshaw found a loophole that let her switch over to her husband's Kaiser insurance; Snell works at Kaiser's Anaheim hospital, but only occasionally.
"We're probably the only ones who get to have her deliver our baby at a hospital," she says. "Others have to do a home birth or have her as a doula."
Whatever they call themselves when they sign in, whether doula or midwife or visitor, both Snell and Sherwood now have their hands tied when it comes time for their patients to deliver at the hospital. One of the temporary solutions has been to have their patients deliver at Saddleback with Dr. James while they attend as visitors.
"When we go into hospital settings now, they make us sign waivers that we're not going to get in the way," Sherwood says. "It's about subtly setting the tone of who's in charge."
James says he's tried to be as hands-off as possible when he's delivering the midwives' patients. "It's worked out nicely," he says. "But the problem is that patients go to midwives because they want midwives to care for them; they don't necessarily want me there."
"It's been really hard," Snell says. "We can't do what we're trained to do."
Little stirs along the road of color-coded custom homes in this scrupulously planned Ladera Ranch community. A snippy gate attendant yaps out directions; a lone jogger climbs the paved hills. But on this warm, midweek July night, there's a break in the silence farther down the road, as voices spill out from the clubhouse on the hill. Inside, rows of women—their hands cradling their bulging bellies—and a handful of men quiet down and turn their attention to the doctor, the midwives, the doula and the moderator.
Tonight is the first of a series of town-hall meetings hosted by CABO, the network of mostly young parents, nurses, doulas and midwives who came together after the South Coast maternity ward closed and they learned there was virtually no place where midwives could deliver their babies.
On tonight's panel are Snell, Sherwood, James, doula Sherry Alden and Sue Morrison, the former head of nursing at South Coast and now head of nursing at Hoag Hospital in Newport Beach.
The meeting is boisterous. Questions abound: What exactly does a midwife do? Where can I find a midwife in Orange County? What is a birth center? How can we convince our hospital to allow midwives to deliver there? How can we get physician staff to respond to what we want?
"We're doing these meetings to let women know they have options for childbirth," says Boynton, who had Snell as her midwife twice. "We're not going to stop until we get this out there to people like me, who didn't know any better."
Boynton says her first pregnancy experience, for which she saw an OB/GYN, was cold and impersonal. She remembers being redirected to a nurse practitioner during one of her first appointments with her doctor. Several friends who went to the same doctor said he had not made it to their births. That pregnancy unfortunately resulted in a miscarriage; by the time she was pregnant the second time, she began asking around about other options. A friend referred her to Snell.
"B.J. had my husband help pull the head out," she says of her delivery at South Coast. "Then she said, 'Bend over and pull the baby out with your own hands,' so I bent over and pulled my baby out. It's such a different experience. People don't know that they can do this."
"What you want is to feel safe, to feel like you have choices for your birth," Morrison says to the group. "The big issue, the big elephant in the room, is: How quickly do we jump to a C-section?"