Birth Center to Remain Open, but with Remote Monitoring and Lost Accreditation
Community Challenges Hospital to Do Better
Thanks to the efforts of the Campaign to Save the North Shore Birth Center, on December 15, 2008, the Board of Trustees of the Northeast Health Corporation voted against the proposed closure of the North Shore Birth Center (NSBC). However, as conditions of its continued operation, patients will no longer be permitted to receive the handheld, Doppler-based fetal monitoring that was previously in use at NSBC in accordance with national birth center accreditation guidelines.
Instead, despite their low-risk pregnancies, all NSBC patients will be subjected to remote electronic fetal monitoring (EFM), a practice that leading medical journals agree is ineffective and frequently harmful. Remote EFM will also result in a loss of NSBC’s accreditation by the Commission for the Accreditation of Birth Centers (CABC). CABC accreditation is a strong indicator of exceptional quality of care, because it ensures the use of practices proven to be safe and effective in a birth center environment.
On December 18, 2008, six representatives of the Campaign to Save the North Shore Birth Center–Nicole Aliberte, Mira Clark, Rebecca Hains, Amy Kreydin, Sarah Shamel, and Christa Terry–met with Dr. Henry Ramini, President and CEO of Northeast Health System, and three other hospital administrators. This meeting had been rescheduled by hospital officials twice, with the result that it did not take place until after the Trustees’ December 15 vote.
At the meeting, Ramini unveiled to Campaign representatives details of the plan to change fetal monitoring practices. These details are highly problematic and deeply troubling to members of the Campaign.
Ramini explained that by the end of March 2009, patients will be monitored electronically for 20 minutes to establish a baseline upon arrival at the birth center. Subsequently, every 30 minutes, another 5- to 10-minute electronic monitoring session will occur. This electronic monitoring will be “continuously transmitted to the hospital,” where it will be remotely monitored by two hospital personnel. Without even observing the patient in question, and despite the well-documented problems of misdiagnosis via electronic fetal monitoring, those personnel — NOT the midwives — will decide whether the patient should be transferred into the hospital. Ramini added that, in the case of a disagreement, these two “monitors” would be able to override the midwives’ professional judgment, with a preference toward “erring on the side of overtreating the patient.”
Furthermore, when asked whether patients would be able to opt out of electronic fetal monitoring at the birth center, Dr. Ramini said no, citing fears that if refusal were permitted, all patients would opt out. However, informed refusal is a basic patient right in the state of Massachusetts and a civil right guaranteed by the U.S. Constitution, which protects patients from being subjected to medical procedures without their consent.
The Campaign to Save the North Shore Birth Center decries the hospital’s legally invalid plan to routinely violate patients’ rights.
When Campaign representatives at the meeting cited respected medical studies and reports that detail the unreliability and risks of using electronic fetal monitoring, Ramini said that he “doesn’t know if it’s good or bad for patients,” but that hospital lawyers advise its use purely for legal reasons, so that the hospital could use the monitor printout in case of a lawsuit. The Campaign representatives provided Ramini with a large binder of evidence-based studies from established medical journals and offered a summary of key points. The evidence we presented details that electronic fetal monitoring is an unacceptable medical practice for low-risk patients, because it often leads to unnecessary and dangerous interventions. We also offered that electronic fetal monitoring can be used — and has been used, frequently and successfully — against hospitals in lawsuits, making them no less vulnerable to litigation. The attitude of the Beverly Hospital representatives was essentially this: Our minds are made up. Don’t confuse us with the facts.
The Campaign to Save the North Shore Birth Center rejects the hospital’s plan to use remote fetal monitoring. The proposed EFM plans prioritize the hospital lawyers’ exaggerated straw-man fears of a lawsuit over maternal and fetal health and the legal rights of women to accept or reject this questionable intervention.
The Campaign to Save the North Shore Birth Center demands that hospital officials allow the North Shore Birth Center to continue practicing well-established evidence-based care, including the continued practice of bedside, non-remote fetal monitoring by a handheld doppler monitor, which is widely used state-of-the-art equipment.
Our stance may be summarized thus:
1. To subject women and their babies to a form of fetal monitoring known to unnecessarily increase the c-section rate, when a more effective and safer form of fetal monitoring is already in place, is unacceptable.
2. To have medical personnel who are in a separate building hundreds of yards away determine the fate of low-risk women and their healthy babies, overriding the professional judgment of our midwives, is unacceptable.
3. To prioritize legal fears over maternal and fetal health is unacceptable.
4. To violate basic Massachusetts’ patient rights and constitutional rights regarding informed consent and informed refusal is unacceptable.
5. To institute a practice that will cause NSBC, which has held the gold standard of CABC accreditation for years, to lose its accreditation is unacceptable.
HELP US SAVE NSBC!
Here’s what you can do to help save the North Shore Birth Center and its clients from the dangerous and unethical new protocols planned by the hospital:
1. Write letters to Beverly Hospital administrators and its Board of Trustees speaking out against these plans. In our meeting with administrators on December 18, they suggested that members of the community would not be troubled by these plans. They said there has been a change in the culture regarding what patients want, and that because of this context, changes to birth center’s long-standing practices would be acceptable to the community. Let’s flood them with letters again, sending the clear message that they’re wrong!
In addition to the trustees (whose contact information is available here ), please copy your letters to the administrators who attended the December 18 meeting: Dr. Henry Ramini, President and CEO; Chip Peyson, Vice President of External Affairs; Pauline Pike, Chief Operating Officer; and Heather Jones, Director of Community and Public Relations.
2. Send letters to the editor of your local and regional newspapers. Let them know about the Campaign’s continuance and the reasons why we have to keep fighting.
In writing your letters, note that the hospital’s December 15 statement to the media made it sound as though the practice of fetal monitoring would be new to the birth center. (It stated: “The Board recognizes the national trend of birth center closings due to rising costs and has decided to take a proactive approach and modify how care will be delivered at the Birth Center. Patients delivering at the Birth Center will now receive fetal monitoring during their delivery.”) News articles appearing on this topic have presented this misleading statement as fact. Correct them: Let the media know that fetal monitoring was already in use at the birth center — appropriate bedside fetal monitoring with a handheld Doppler, which, in fact, you most likely experienced at your own NSBC birth — and that you prefer this safer, handheld fetal monitor to the remote electronic fetal monitor that the hospital is forcing NSBC to use, beginning this spring.
Useful tips for writing successful letters to the editor are available here.
3. Contact your legislators, both local and state. Let them know that Beverly Hospital is planning to violate your rights as a patient in the Commonwealth of Massachusetts by denying you informed consent and informed refusal if you give birth at the birth center! Ask them to intervene in any way possible. Make sure you point out that birth center services using only handheld monitors are far less expensive than hospital services using costly and unnecessary technology. This hospital will have to find the money to pay for these new remote monitors somehow. The extra, unnecessary personnel supervising NSBC births from a separate building will increase costs, as well. Should Massachusetts’ new health plan be further strained by higher costs such as these?
Tips for locating and writing to your legislators may be found here.
4. Keep your focus where it belongs, on safety. Our interest in maintaining birth center accreditation and appropriate monitoring methods is not because we merely want a “nice experience” at the birth center. Hospital representatives at the December 18 meeting strongly implied that all the Campaign really cared about was the low-tech, gentler “experience” of birth center birth. This paternalistic, condescending attitude has misread the basis for our concerns and couldn’t be more wrong. We are intelligent, educated women who understand the difference between real evidence-based safey measure and the hospital’s defensive use of expensive and self-serving unnecessary interventions.
Together, we’ve already won a major battle in the fight to save our birth center. Let’s not stop now–let’s win a reversal of the hospital’s plans to require remote fetal monitoring and violate patients’ rights!
[The Boston Globe’s coverage of our November campaign to save NSBC was critically helpful. The below message is re-posted from Paul Levy’s blog as a show of support. We do not want to see the Globe go under!]
We have all read recently about the threat of possible closure faced by the Boston Globe. A number of Boston-based bloggers who care about the continued existence of the Globe have banded together in conducting a blog rally. We are simultaneously posting this paragraph to solicit your ideas of steps the Globe could take to improve its financial picture:
We view the Globe as an important community resource, and we think that lots of people in the region agree and might have creative ideas that might help in this situation. So, here’s your chance. Please don’t write with nasty comments and sarcasm: Use this forum for thoughtful and interesting steps you would recommend to the management that would improve readership, enhance the Globe’s community presence, and make money. Who knows, someone here might come up with an idea that will work, or at least help. Thank you.
(P.S. If you have a blog, please feel free to reprint this item and post it. Likewise, if you have a Twitter or Facebook account, please add this url as an update or to your status bar to help us reach more people.)
Northeast Hospital Corporation Board of Trustees Approves
Plan to Continue Birth Center Operations, But Questions Remain
BEVERLY, MA (December 16, 2008)—In response to the Board of Trustees of Northeast Hospital Corporation announcement that they have approved a plan to keep the North Shore Birth Center (NSBC) open, members of the Campaign to Save the NSBC are cautiously pleased by this major victory on behalf of mothers, fathers, babies, and the North Shore population. Beverly Hospital has listened to the will of the community, and the Campaign applauds their decision insofar as it relates to keeping the NSBC operational.
However, the Campaign members decry the lack of transparency and lack of direct communication that has been the hallmark of the Board’s and the Hospital administration’s actions since the threat to the NSBC was brought to the attention of the public.
“Although hospital administrators had promised to more openly communicate with us, we learned of this decision indirectly, from the press,” explains Campaign leader Rebecca Hains. “Furthermore, although hospital administrators agreed to meet with representatives of our campaign, they have repeatedly rescheduled that meeting, and they arrived at this decision without having the conversation we were promised. Therefore, many of the community’s concerns and questions remain unanswered.”
For example, the Campaign is concerned by the portion of the Hospital’s announcement that appears to add a new constraint to NSBC deliveries: In their statement to the press, the Hospital notes hat patients will receive fetal monitoring, although the precise type of monitoring remains unclear. Patients birthing at Beverly hospital are subject to electronic fetal monitoring, an unproven and essentially unnecessary technology. NSBC patients have always received intermittent fetal monitoring by handheld Doppler, as is recommended as the best practice by the American Association of Birth Centers and many leading academic studies.
The Campaign urges the Hospital to allow the NSBC to continue using intermittent fetal monitoring, rather than subject women seeking natural childbirth to the restrictive and problematic electronic fetal monitoring system.
In fact, prior to this decision, the Campaign and several experts in the field of maternity care have provided information to the Board that demonstrates that there is NO evidentiary basis for requiring electronic fetal monitoring and that the practice has NO proven benefit but, rather, great potential for harm because it leads to higher cesarean-section rates. Furthermore, the Campaign feels very strongly that every woman who gives birth at the NSBC must have complete freedom to make an informed decision about whether or not she will agree to or opt out of electronic fetal monitoring.
“Instead of choosing to move all births to the hospital, the board has voted to move aspects of the hospital to the NSBC. I am concerned that, although they heard the community’s message: ‘Keep the birth center open,’ they missed the underlying reasoning: we want an alternative that is different!” says Campaign Steering Committee member Sarah Shamel.
Furthermore, the Campaign is concerned that the NSBC will be at risk of losing its accreditation by the highly-respected Commission for the Accreditation of Birth Centers (“CABC”) if electronic fetal monitoring is required. The Campaign is also greatly troubled about the possibility of additional limitations being imposed on the NSBC in the future.
Although the Board may have come to a decision, the Campaign remains intent on meeting with interim CEO Henry Ramini, Chief Operating Officer Pauline Pike, and Vice President Chip Payson on December 18, as previously scheduled, to make sure that the voice of the community is heard by its local hospital and to demand increased transparency in hospital decision-making.
Media inquiries should be directed to Christa Terry at christadterry at gmail dot com.
Thanks to ThePetitionSite.com we have an online petition setup specifically for the Campaign to Save the North Shore Birth Center.
Click here to sign the petition and view how many signatures we have to date! Be sure to click on the “bookmarks” to share with friends on Facebook, MySpace, Stumble and more.
Posted November 20, 2008on:
What: A meeting to discuss our plans moving forward in support of the North Shore Birth Center
Where: The First Parish Unitarian Universalist Church, 225 Cabot St. Beverly MA
Note: There is a public parking lot behind the church off of Hale Street/Briscoe Street. People will need to enter the back door, on Essex Street/Briscoe Street. The front door will be locked. If the back door is locked, ring the bell. The meeting will take place upstairs in the sanctuary.
When: Sunday, November 23rd from 2 to 3:45 pm
Please come and share your ideas! We need YOUR help to save the Birth Center!
The North Shore Birth Center is in jeopardy!
There is a very serious move to close the North Shore Birth Center, a midwifery practice situated on the campus of Beverly Hospital in Beverly, Massachusetts.
On Tuesday, November 18, 2008, the Board of Trustees of the Northeast Health Corporation considered the proposal to close the Birth Center. During that early-morning meeting, nearly 200 people–adults, children, and babies–bundled up against the cold and held a rally. This rally advocated for the same things as previous efforts, which included a letter-writing campaign, daily picketing, and an open letter to the Board:
- A delay of the vote on the Birth Center’s fate, since such an important decision with long-term consequences for our community should not be rushed, and
- A meeting between community members and the Board of Trustees, to seek more transparency about the Hospital’s concerns and to open some dialogue that would allow the community–which had thus far felt silenced by hospital administration, which refused to communicate with representatives of our campaign–a real voice in this decision.
Featuring energetic speakers, colorful signs, and lots of cheering, the rally outside of Beverly Hospital made headlines: All the major Boston television stations, newspapers, and radio stations covered the story.
Several hours after the Board of Trustees met, the hospital released the following four-sentence statement.
The Board of Trustees takes its responsibilities to this organization and to the community very seriously.
Consistent with other birth centers around the nation, the North Shore Birth Center is experiencing a significant rise in the cost of malpractice insurance premiums.
The Board of Trustees is diligently weighing the impact that the closure of the Birth Center would have on the community; the level of community interest in its continued operation has not gone unnoticed. The Board intends to leave the Birth Center services unchanged while it continues to examine and discuss this important issue.
In other words, our rally and other efforts were a success! The Board of Trustees recognized the need to move slowly and give the proposal full deliberation.
However, we are not out of the woods yet. As the Boston Globe points out, this statement “ma[kes] it clear that the center’s future is still very much in question.” We still need your help!
Help us save NSBC!
The members of this group are against this proposal and want the Board of Trustees to vote against it. Women deserve to choose the birth experience that is right for them and their families. We ask the Board of Trustees to refrain from making a decision that would deny this choice to families of the North Shore.
NSBC is one of only two birth centers left in the entire state of Massachusetts! Let’s work together to protect it!
ABOUT THE NSBC: Established in 1980, the North Shore Birth Center has facilitated the births of over 6,000 babies to women with “low-risk” pregnancies seeking a natural childbirth. We want the North Shore Birth Center to continue offering quality, compassionate care in an alternative birth setting.
Join the Campaign to help us make our case to the Board of Trustees and hospital administration.
We are now in the process of planning Phase Two of our campaign. We will update this page with information on how you can help as soon as possible. In the meantime, see these links to learn more about our efforts:
How to stay informed:
- Article: “Beverly Hospital Shelves Plan to Close Natural Birthing Center” in the Boston Globe
- Article: “Birth Center Still Open, For Now” in the Salem News
- Article: “Salem Moms Fight to Save Birth Center (Updated)” in the Salem Gazette
- Article: “Vote Delayed on Possible Closing of Birth Center” in the Boston Herald
- Article: “Birth Center to Remain Open–For Now” in Boston’s White Coat News
- Video: “Dozens Rally to Save Natural Birth Center” on WBZ-TV / Channel 4
- Article: “Trustees Delay Vote on North Shore Birth Center” in the Salem News
- Video: “Supporters try to save North Shore Birth Center” on NECN
- Video: “Protesters rally to keep natural birthing centers open in MA” on NECN
- Article: “Protest aimed at saving birth center” in the Salem News
- Article and Video: “Group Protests Closing Of Birth Center” on WCVB TV / Channel 5
- Video: “Protesters rally at Beverly Hospital” in the Salem News
- Article: “Insurance costs endanger birth center,” in the Cape Ann Beacon
- Article: “Fight begins to save birth center,” in the Beverly Citizen
- Article: “Birth center to close?” in the Salem News
- Article: “Protesters want North Shore Birth Center kept open” in the Danvers Herald
- Article: “Viewpoint: Fear should not drive birth center decisions” in the Danvers Herald
- Article: “Birth center’s possible demise ignites protest” in the Boston Globe
- Article: “Hundreds to rally in support of Beverly birth center tomorrow” in the Salem News
- A post on the blog “I Know How Babby is Formed” and cross-posted on “Trunkbutt at Tanagra”
- Two posts on the blog “Massachusetts Friends of Midwives”
- A post on the blog “The Belly of the Goddess”
- A post on the blog “A Baby in Salem”
- “Birth: Everyone’s got an opinion” in the acclaimed international feminist blog, The F-Word: Contemporary UK Feminism
- “Protecting Birthing Choices: Can Grassroots Efforts and Social Networking Do the Trick?” on MOMformation, the BabyCenter blog
- “North Shore Birth Center to Close” on Massachusetts Mom
- “Get BOLD: Save a Birth Center!” on BOLD Thoughts, from Karen Brody, founder of BOLD, playwright of Birth
- The “Monday Teeny Poll” on Teeny Manolo
- “North Shore Birth Center” on World Wide Wood
Please note: The members of the Campaign to Save the North Shore Birth Center are not affiliated with the North Shore Birth Center or Beverly Hospital. We are consumers who care passionately about NSBC!
Last Update: Wednesday, November 21, 9:09 a.m.
What an amazing day. If any one had any doubt that we as citizens can influence our community, today was proof positive that we can and have made a difference. The rally was a great success – although the proposal to cease births at the Birth Center is still on the table, the vote was postponed, as our group demonstrated just how important the North SHore Birth Center is to our community, and that this proposal needs to be more closely scrutinized.
I overslept – one of the hazards of having a recent Birth Center baby at home. I woke up at 5:30 – just when I had planned to leave my house in Boxford. Amazingly, I managed to nurse Bridger, and bundle both of us up in half an hour. We arrived at the rally at 6:35, and it was such a thrill to see the sidewalk in front of the hospital packed with families! As I drove up to park on a side street, I was even more encouraged to see all of the local news crews out to cover our event. Bridger and I settled in with a sign. The mood was festive, drivers passing by as a whole were so supportive – lots of beeps and thumbs up. There were easily over 100 people present by the time the Board began arriving. Several people were interviewed, myself included, and later at home I watched as we were covered on all the local news stations. We also had speakers – including the first woman to birth at NSBC – what an inspiration to see not only the new birth center babies – but grown adults carrying ‘Birth Center Baby’ signs. The group did then walk onto the hospital property, only to be told by the administration to leave. Our wonderful midwives had food and coffee at the birth center, but unfortunately there was a security person standing out front to keep rally participants out. I was told that only patients could be on the property – but I still get my well woman care there, so… Several of us did get by to warm-up and nurse our kids – thank you midwives for having goodies for us! I got home just in time for the noon news.
What a fun day – although I would have loved for the propsal to have been denied outright, this was a major victory. We were heard, we made a positive impression on the Board, and we have brought awareness and attention to such important health issues. Because protecting birth options is not just a woman’s issue – this is a family issue and community concern. My sincere thanks to the Steering comittee, and to all those who wrote letters, picketed last week, and showed up this morning in the cold. Let’s keep up this good work!!