The Campaign to Save the North Shore Birth Center

An Open Letter

December 18, 2008

An Open Letter to Dr. Henry Ramini, the Administration, and the Board of Trustees of Beverly Hospital

On Monday afternoon, December 15, the Steering Committee for the Campaign to Save the North Shore Birth Center learned that the Northeast Health Systems Board of Trustees had voted to keep the North Shore Birth Center open, but with the added stipulation that North Shore Birth Center (“NSBC”) patients will now “receive fetal monitoring during their delivery.”  The continued operation of the North Shore Birth Center, a valuable resource to the community and a distinguishing feature of Beverly Hospital, is something we can all celebrate.  However, the proposed new requirement for fetal monitoring is a cause of confusion and, potentially, of great concern among the community supporting the NSBC.

The Steering Committee calls your attention to the fact that NSBC does already practice fetal monitoring.  There is nothing new about NSBC monitoring the fetus; they do so by means of a handheld Doppler, which is recommended as the best practice by the American Association of Birth Centers and many leading academic studies.  We are concerned, however, by this new hospital proposal, not only because it mistakenly implies that fetal monitoring at NSBC is somehow inadequate, but also because we have reason to believe that the hospital may be making reference to controversial and clinically-questionable practice of Electronic Fetal Monitoring (“EFM”).[i]  A statement attributed to Beverly Hospital’s Director of Media Relations Heather Jones in a recent Gloucester Times article further supports this understanding (copy attached): She notes that the decision will likely cause the loss of NSBC’s accreditation with the Commission for the Accreditation of Birth Centers (“CABC”), under whose nationally-recognized accreditation and quality standards, the routine use of EFM is not allowed.[ii]

The Campaign to Save the North Shore Birth Center remains resolute in our insistence that the North Shore Birth Center remain open as a CABC-accredited birth center, where patients can receive the standards of care deemed best for a birth center setting.

On Patient Outcomes

On behalf of this community and in the best interest of patients, the Campaign is unwilling to accept the Hospital’s proposal of fetal monitoring at NSBC unless the Hospital is simply referring to the current practice of fetal monitoring by hand-held Doppler.  If intermittent hand-held monitoring will satisfy the criteria of fetal monitoring set by the Board of Trustees in the December 15th decision, then we will gladly accept that decision.  Electronic fetal monitoring has not been shown to improve outcomes for mother or baby (see Milbank report, pp. 48-49).  Worse, it has been shown to lead to unnecessary interventions such as vacuum extractions and C-Sections, thereby increasing risk and compromising outcomes.

Why Accreditation Matters

Instituting EFM at NSBC will result in loss of the center’s CABC accreditation.  The highly esteemed accreditation by CBAC is recognized as a mark of quality to consumers as well as third-party payers.  CABC uses current research to set the best practices of care in a birth center setting.  Consumers seeking a birth center are choosing not merely the physical setting, but also a specific model of care.  CABC accreditation assures consumers that this model of care is met at NSBC.  Furthermore, in order for NSBC to continue to be a viable birthing option for North Shore families, births at the center must be covered by the major insurance companies.  Birth Center accreditation facilitates insurance approval.

An Invitation

The Campaign invites Beverly Hospital’s Board of Trustees to demonstrate to the community how the proposed Electronic Fetal Monitoring would be in the best interest of NSBC mothers and unborn babies, rather than the comfort level of the hospital’s administration and risk management staff, or the hospital’s bottom line.  Our experts and research assure us that it is not a necessary or beneficial practice for the mother-baby dyad and, in fact, can lead to unwanted and expensive outcomes, such as an increase in the cesarean section rate beyond appropriate levels.  We therefore invite Beverly Hospital’s experts to share its perspective on this issue in a town meeting, at a date and time to be mutually agreed upon.  Together, we can gather a panel of experts on all sides of this issue and let the community make an informed judgment.  A representative from our campaign will contact you to follow up on this invitation.  Should you accept, we will work together finalize a date.

In Conclusion

It is unfortunate that the hospital postponed communications with leaders from the community before the Board voted on December 15.  A meeting before the vote would have afforded the opportunity for us to clarify that we not only want the Birth Center to remain open, but that we want also want it to continue to provide care in accordance with the birth center model.  We decry the lack of transparency on the part of the Board and administration on an issue that has been shown to be highly important to the community.

The Birth Center will remain open: this is good news and we applaud this decision. As you ponder the advisability of formulating any changes to the protocols at the North Shore Birth Center, however, please keep as your primary concern the health and safety of mothers and babies.  Show the community your commitment to optimizing patient outcomes by continuing to accept the use of handheld Dopplers as the form of fetal monitoring at NSBC, and by maintaining NSBC’s CABC accreditation.  Alternatively, if you truly believe EFM is associated with clinically beneficial outcomes, join us at a town hall meeting where you will have the opportunity to demonstrate to the community why Beverly Hospital has decided to ignore the most current evidence-based research by requiring routine EFM.  We invite you to come share your perspective and information at the proposed town meeting.

 

Sincerely,

Mira Clark, Rebecca Hains, Amy Kreydin, Sarah Shamel, Christa Terry, and Nicole Altieri
On behalf of the Campaign to Save the North Shore Birth Center


[i].  Please see, for example, pages 48 – 49 of the recently published report, Evidence-based Maternity Care: What It Is and What It Can Achieve, by Carol Sakala and Maureen P. Corry, published jointly by the Childbirth Connection, the Working States Group, and the Milbank Memorial Fund; see also the enclosed article by Myra Gerson Gilfix, J.D., “Electronic Fetal Monitoring: Physician Liability and Informed Consent, American Journal of Law & Medicine, Vol. 10, No. 1.

[ii].  A copy of the Standards for Birth Centers, originally developed, published, and periodically revised by the American Association of Birth Centers (formerly known as the National Association of Childbearing Centers or “NACC”), are provided with the information packet presented to Dr. Ramini by the Campaign today.

 

Wednesday, November 13, 2008

An Open Letter to the Board of Trustees of the Northeast Health Corporation

One week ago today, on November 5, we first heard the news that the North Shore Birth Center (NSBC) on the campus of Beverly Hospital might close its doors to women planning to labor and give birth in the birth center. Having given birth to 6,503 children there in the past 28 years, families from the region were stunned and heartbroken.

In the past week, a truly grassroots movement has mobilized around these concerns, driven by the passion the community feels for its birth center. Literally hundreds of people are involved.

At an emergency community meeting held on Sunday, November 10, we—the undersigned—agreed to serve as a steering committee for the Campaign to Save the North Shore Birth Center and speak with hospital representatives about this case. Unfortunately, our request for a meeting with the Board of Trustees prior to November 18, when this issue may be voted upon, has been dismissed. Therefore, we write you this letter.

Why We Care

It is in the best interests of families in the region for NSBC to remain available as a choice. This is a serious public health issue. The underpinnings of our rationale are as follows:

  • Reputable studies have found that birth center births are frequently even safer than hospital births for low-risk women and their babies, with a lower likelihood of complications.  An information sheet from the American College of Nurse-Midwives lists the major birth center studies, all published in highly reputable medical journals.
  • Studies have also found that the use of medical interventions such as electronic fetal monitoring, the administration of Pitocin to strengthen contractions, the administering of epidurals as pain relief, and so on often “cascade” unnecessarily into c-sections.  The recently released report, Evidence-based Maternity Care:  What It Is and What It Can Achieve, jointly published by the highly-respected Childbirth Connection research organization, the Reforming States Group, and the Milbank Memorial Fund, contains summaries of the results of these studies.  A copy of this report was provided to you by Judy Norsigian of the Our Bodies Ourselves Book Collective.
  • Unfortunately, such studies conclude that medical interventions common to hospital deliveries are often unnecessary and detrimental to the health of babies and women. Low-intervention childbirth is the safer option for mother and child alike.
  • Studies have demonstrated that birth centers, which are more conducive to the low-intervention childbirth that some families desire, are as safe as or safer than hospital births. The Childbirth Connection/Milbank report, referenced above, thoroughly describes these studies.
  • NSBC has a 28-year track record of safe, successful, natural childbirth. Regional families are entitled to continue receiving the superior quality of care offered there.

On Interventions

The World Health Organization has stated that a c-section rate of 15% is acceptable (see Dennis Thompson, “Soaring C-section Rate Troubles Doctors,” The Washington Post, July 13, 2007. Unfortunately, the rate of cesarean sections at Beverly Hospital is 32.4% (source: the Massachusetts Department of Health).

In contrast, the North Shore Birth Center’s non-interventionist philosophy makes it a safe place for women to give birth without risk of unnecessary interventions. These are the 2007 c-section rates for their patients:

  • C-sections for babies delivered at NSBC: 0%.
  • C-sections for NSBC patients overall (including those who planned to give birth at Beverly Hospital because they were “risked out” for medical reasons): 18%
  • C-sections for all women beginning labor at NSBC, including those transferred to the hospital: 5%

The North Shore Birth Center deserves applause for providing demonstrably superior quality of care. Families from our community must continue to be afforded this safe, healthy option.

Moving Forward

For these reasons and more, we demand that the North Shore Birth Center continue its full range of operations. Before you make your final decision, we urge you to postpone the vote that may occur on November 18, especially given the following factors:

  • A lack of transparency.
    • Community members have been kept in the dark about why the hospital is making this proposal, and we still do not understand the rationale.
  • The community has not had an adequate chance to weigh in on this issue.
    • Your decision will affect the region for years to come. We deserve more time to ensure that the Board of Trustees fully deliberates upon our perspective.
  • We have the support of national experts who would also like to weigh in on this issue.
  • We would like time to make our case to Beverly Hospital’s new interim CEO, who as a new appointee thus far has not been involved in these conversations.

Furthermore, we urge you to agree to a meeting with delegates from the Campaign to Save the North Shore Birth Center.

We also urge you to accept the offer of the American Association of Birth Centers, which is willing to advise and, if necessary, mediate this issue.

The Birth Center is a vital community resource and treasure. When you do finally vote on the proposal that is being put before you, please—cast your vote with the community. But until then, please take actions to demonstrate your commitment to the community: Postpone the vote, schedule a meeting with us, and give this important decision the full deliberation that it deserves.

Sincerely,

Rebecca Hains, Cathleen Barstow, Jennie Cudmore, Amy Kreydin, and Sarah Shamel
The Steering Committee of the Campaign to Save the North Shore Birth Center
https://savethenorthshorebirthcenter.wordpress.com

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2 Responses to "An Open Letter"

I have been involved in advanced training in Prenatal, Birth and Attachment therapy for the past 2 years and have been in the Healing and Health care field for 30 years. The North Shore Birth Center must remain open as a primary support to families with new babies. This needs to continue to be an option for parents – to enhance the physical, social/emotional and spiritual health and well-being of their babies – with lasting impact throughout their growth from babies into adulthood.

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