Memorial Hospital and the Future of Maternity Care

The future of Memorial Hospital in Pawtucket is still uncertain. Motif has been covering the debate around the obstetrics unit closure, and with Mother’s Day on the horizon had the opportunity to talk with Lisa Gendron and Kaeli Sutton of the Coalition to Save Memorial Hospital Birthing Center to discuss the future of Memorial and maternity care in RI.

Emily Olson (Motif): What is the Coalition and what are its goals?

Lisa Gendron: The Coalition to Save Memorial Birthing Center is a grass-roots organization made of medical and non-medical perinatal professionals, advocates and families created to inform the community of Care New England’s plans to close the OB Unit (known as the Birthing Center) at Memorial Hospital.

Our initial goal was to protect access to the family-centered, evidence-based maternity care provided at Memorial Hospital. Since its inception three months ago, the Coalition has successfully pushed for transparency in the hospital regulatory process and demanded a plan for continuity of care for Birthing Center patients. Additionally, we have worked to ensure that our community and local government understand that maternity care access is a serious issue for the residents of Pawtucket, Central Falls and the East Bay. The Department of Health’s initiative to eliminate barriers to care access proves this is an issue of great importance in addressing health disparities in the state.

The statewide attention to these issues, along with the passionate response from families and birth professionals, has inspired our recent creation of a sister Coalition to Improve RI Maternity Care.

EO: What does Memorial’s obstetrics unit offer that other obstetrics units don’t?

LG: Family physicians, OBs, midwives, nurses, doulas and associated medical practitioners have nurtured a culture of care in which every family is supported and trusted to make informed healthcare choices specific to their health histories and belief systems. Nurses, midwives and physicians are well-versed in non-pharmaceutical labor support. All families have access to doulas, and where applicable, skilled VBAC (vaginal birth after cesarean) support and Gentle Cesarean Birth (ie, immediate skin to skin and breastfeeding, families kept together throughout procedure, and doulas welcomed in the OR). Additionally, because family physicians and nurse midwives commonly provide care for entire families, patients are provided a continuum of care not possible in other specialties, which allows for individualized care that supports better outcomes.

This exceptional care model is consistently offered to all families – not only those who know to seek it out – and is supported by the entire hospital culture.

EO: How come other hospitals can’t or won’t do what Memorial does?

Kaeli Sutton: What is functionally feasible at a small or mid-sized community hospital is different from that at a large tertiary care hospital. Having said this, the Coalition strongly believes that all RI maternity hospitals can, and should, implement as many of the practices currently employed at Memorial as possible. The national Coalition for Improving Maternity Services has excellent resources for hospitals looking to do this, and the specialists at Memorial could be consulted toward realization of this goal.

Whether other hospitals have the genuine commitment to make these changes, the Coalition can’t answer. We can only watch what happens and observe whether hospital administrations move beyond rhetoric into action.

Though with varying levels of consistency, each of our state’s OB units already offer one or more of the “best practices” the Coalition is advocating for. We would love to see all OB units engage in systemwide efforts to build on what is good in their system, and strive to create professionally collaborative and family-centered cultures of care.

EO: I’ve read in this debate how important access to quality care is for the impoverished residents of Central Falls and Pawtucket, however, I’ve also seen statistics that say the majority of women in those areas choose to give birth at Women and Infants (WIH). Can you explain that?

KS: Although where women deliver their babies might seem like a simple matter of choice, this is almost never the reality. True “choice” is a complicated concept even for the most economically and educationally privileged women in our society. In the US, few women are well-informed about what models of maternity care are safest and most supportive of them and their babies. Generally, they choose their place of birth and practitioner by friend or family referral, insurance coverage and location. Women with fewer educational and economic advantages often have little or no choice in the matter – they can only access the community health center that serves the neighborhood they live in. So the better question might be: What model of healthcare best serves the women and babies of Central Falls and Pawtucket, and do they have access to it?

To simplify this complex public health issue, we can make two points. The first is that many of the most underserved families in Pawtucket and Central Falls have delivered at WIH rather than Memorial since 2004 because of a partnership formed between the Blackstone Valley Community Health Center and WIH. We believe that at least a part of the move was to provide quality patient care; however, over a decade later we are left wondering whether the move benefitted these communities. Pawtucket and Central Falls have the highest numbers of health disparities. Would returning deliveries to Memorial serve families better (and address some of Memorial’s low-patient volume issues)? There is significant data suggesting that populations most impacted by health disparities have better outcomes when they can access care within their community.

EO: Individualized care leads to more positive outcomes for moms and babies and better birth experiences, but the business of healthcare requires doctors to see more patients more quickly. How do you reconcile the needs of patients with the needs of the healthcare industry?

KS: American maternity care is in crisis. We spend more money on healthcare than other developed countries, but our outcomes are not as good. We rate 46^th in the world for maternal mortality, we have an unreasonable number of babies born prematurely and with low-birth weight. . . and the list continues.

We know that we need more family practices and midwifery model of care practices in our system — midwife- and family doctor-attended births have consistently been proven safest for the majority of mothers and babies.

Families are served best when they are recognized as individuals with their own beliefs and needs — health is a complex equation. However, this model of care takes time and patience, which is lacking in the high-paced/ high-volume/ low-quality culture of care that exists in many hospitals.

Asking doctors to see more patients more quickly is a short-sighted solution and ultimately, not financially sound. So how can we provide high-quality, personalized, financially viable healthcare? There are experts in every healthcare policy related field trying to figure this out. There are economically sound countries that successfully provide high-quality universal healthcare, so we know it’s possible, and we encourage our policymakers to take a serious look at these examples to inspire change in our current system.

The Coalition supports the model of care exemplified by the Birthing Center — care supported by scientific evidence as healthiest for mothers, babies and families and  highly cost-saving. Our greatest long-term need for a healthy nation, physically and economically, is good outcomes for mothers, babies and families. Reimagining healthcare is a complex and timely issue, and improving maternity care is an essential part of this discussion.

Care New England’s illegal attempts to close the obstetrics unit before submitting a complete application and obtaining approval from the DOH were halted in early March. After twice requesting additional information, the DOH accepted Care New England’s complete application on April 22. DOH will make a decision within 90 days of this date.