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
Dozens of studies examining nurse midwifery care have proven that for healthy, low-risk women, cesarean rates tend to be lower (around 8 percent to 10 percent) when they deliver with midwives. Cesarean rates nationally and statewide jumped 46 percent between 1996 and 2005. In 2006, nearly 1 in 3 women in California had C-section births. Rates in Orange County are similar to the rest of the state, with some hospitals—including Kaiser, Saddleback and St. Jude Medical Center in Fullerton—having a rate closer to 1 in 5.
These national and local rates for C-sections, which are considered major surgery and do have a higher risk of complications than vaginal delivery, are not broken down by the degree of risk in a given pregnancy—or whether the C-sections were chosen by the mother-to-be or her doctor or done in an emergency. Still, they are far higher than the World Health Organization's recommended rate of 10 percent to 15 percent. Once that rate is exceeded, the WHO concluded in 2005, "the maternal injury and death consequent to major abdominal surgery begins to eclipse the lives and health saved." Despite spending nearly twice as much on births, the U.S. still has poor infant-mortality rates when compared to the rest of the developed world, ranking below Cuba, South Korea and the European Union.
"I think people view a C-section as easier," Morrison says after the meeting. "I think it's convenience, consumer-driven . . . but your complication rate is going to go up."
For his part, Dr. James says he's learned to be more patient working with Snell and Sherwood. "Just the other night, we were delivering a baby at Saddleback, and the mother had been in labor all day," he says. "I was thinking, C-section, C-section, C-section, but B.J. said, 'Hold on, now,' and a couple of hours later, she did it, she delivered. I don't doubt what my decision would have been, but I think the patient got what she wanted."
At the meeting, Lauren Mitchell, a former South Coast labor-and-delivery nurse who now works at Irvine Regional, wants to know what can be done to educate labor-and-delivery nurses, who are there during most of the labor process and who, she says, are often less familiar with what full natural childbirth with a midwife looks like.
"There's no emphasis whatsoever on natural births. It's just inductions and planned C-sections. That's kind of our daily routine," Mitchell says. "If it weren't for me having worked at South Coast with B.J. and Lisa, I don't think I would have known how beautiful and wonderful [natural birth] could be."
When the question comes up of what will now happen to the group who once labored and delivered together, the panelists exchange glances. Snell says she is exploring the option of opening up a birth center; she ran the first free-standing one at UC Irvine Medical Center in the mid-1990s while she was the head of maternal child nursing there. But she still would also like to be able to work in a hospital collaboratively with physicians and nurses even if she opens the birth center, she says. "We don't want to replace physicians because we are a team."
"The midwives did an outstanding job and the outcomes were great," Dr. Manuel Porto, professor and chairman of the Department of Obstetrics and Gynecology at UC Irvine Medical Center, says in an interview about the birth center. But the center, which was just two miles from the hospital and where physician residents practiced natural birthing with Snell, eventually closed because it was not financially viable, Porto says. This had to do with a loss in patient load for insurance reasons not related to the center, he says.
For Sherwood, the question is difficult. She hesitates, then tells the group that she will be closing down her half of the practice and taking a position with a physicians' group in Phoenix, where she'll be able to deliver in a hospital. Some in the audience wipe away tears.
"We want to jump up and down. What can we do?" someone implores from the back.
The panel offers some suggestions: Call the hospital CEOs. Talk to the hospital medical staff since they make decisions about who gets privileges. Call the chairpersons of OB departments. Ask that they write midwives into their bylaws. Educate nurses. Educate women in your own communities.
There is talk of petitions, letters, phone calls and future meetings to be held in every city in the county, including one in Costa Mesa in late August. "We're not going away," she declares. "We are definitely not giving up on the hospitals."
B.J. Snell jumps up from her desk and peeks out over her small round glasses at Robin Parker. "How're you feelin'?" she says with the slightest southern inflection, a vestige of her Alabama roots. She crinkles her nose, and there's a flicker: her hallmark, mid-sentence smile.
It's there again when she's talking to Parker about her baby's fetal position or explaining newborn blood draws and screenings. She measures Parker's 34-week belly, applies a little jelly, and then places a Doppler listening device not far from her navel. A thumping echo, like something submerged in deep water, fills the room. Even though she's heard similar baby heart pounds thousands of times over the past 30 years, Snell smiles proudly, this time holding it longer as she looks into Parker's eyes. "He sounds great," she says.