I try not to be cynical. Or feel overly despondent at the forces that loom in our midst so much larger than any single individual which impact our birth experiences and our initiation into new parenthood. I know from experience that I can help new parents have awareness, skills, and some control over the decision-making processes that greatly impact their lives and the life of their child. Yet, in order to make choices, those choices actually need to be there. So, it was a real blow this week when I learned from one of my couples that UCLA/Santa Monica Hospital called them with the news that they were closing the UCLA Nurse Midwives program. This information was confirmed by a friend who has worked for many years with the program. My couple felt devastated. I feel devastated. And angry.
Let me start of by sharing that on my stats page, the CNM’s at the Hospital stats are primarily those of my couples who have delivered with the UCLA Nurse Midwives. With the midwifery program they have experienced a very high natural birth rate and very low epidural rate (and those who benefited from epidural anesthesia had this intervention for a much shorter duration). The couples taking my Bradley classes have been very satisfied with their birth experiences with the UCLA Midwives. These maternity care providers also had an extremely low cesarean rate for my couples and for those whose births benefited from a cesarean, they knew without any doubt (and no coercion) that it was a necessary intervention for them.
I do not think this program perfect – the pressures of the hospital setting made for a more clinical atmosphere and I did not see any knowledge of birth psychology and the consciousness of babies (in my personal experiences attending births there) – however, that is nothing unique to them and is a major problem in ALL hospital settings. In general, I felt they demonstrated a fair level of respect for women and birth, more than the vast majority of local OB’s. As a teacher, I privately wished more couples had switched care over to them. I always felt a sense of optimism and positivity knowing when a mother had chosen the UCLA Nurse Midwives that they were getting the best possible care in a hospital setting and were more likely to achieve their goal of an un-medicated birth as well as reduce the chances of an unnecessary cesarean.
A midwife attended birth in the hospital setting is one of the safest modes of birthing, far safer than working with a private obstetrician (OB). Knowing that we are social creatures and influenced by our culture and the beliefs of those around us, a midwife attended birth in the hospital can fulfill the context of the safety most first time mothers are seeking (culturally accepted with the equipment and personnel nearby should an emergent scenario occur). In a group practice midwifery setting, although continuity of care is not there during the pregnancy period, a birthing mother is likely to have the same midwife there for her labor/birth as they often have 12 – 24 hour shifts. This is comforting to a woman in labor. In addition, a midwife is always present on the floor in addition to having access to an obstetrician to assess any complications outside a midwife's scope of practice that could arise. This is by much more safe than having a private obstetrician, who is not going to be on the floor for most (if any) of your labor as he/she will be in their office or at home, checking on status updates from afar. If their office is close by, an OB may stop in to check on progress and then skedaddle (most often with suggestions of intervention) – no one makes more money hanging around the labor process. Furthermore, most women don't even get their actual OB on the big day as OB's in group practices rotate shifts for being on call (which can impact a mother's felt sense of safety.)
So, this decision in no way benefits birthing families. The experiences of women, babies and the impact on new families in no way, shape or form ever entered the decision makers' thought processes who chose to terminate the midwifery program. It has nothing to do with health. It has nothing to do with safety. It has nothing to with caring. It has nothing to do with social responsibility. It has everything to do with money. And, very probably, ideological belief systems as well as institutionalized politics.
I know from my friend that around 50% of the births with the midwives (both when they were are Ronald Reagan and UCLA/Santa Monica) were epidural free births. Natural births are not profitable. This is a major loss of revenue for the hospital. So, here again we have their financial bottom line very likely at the very heart of this decision (I don’t even know if it’s bottom line, or just greed, but it comes down to money) and placing the interests of the institution ahead of any societal obligation to ensure the health and well-being of mothers and babies. Ignore their advertising and marketing. It's all bunk. It doesn’t matter what they hype or try to sell you. What’s the reality? Hospitals are not happy if you have a natural birth. They make money through procedures. They need to pay that anesthesiologist on the floor. They want their administration and board of directors happy, not you. Not your baby.
This is the fault of a consumerist society and of our reliance on the insurance industry. The fact is that our health care “system” operates as a business (and no need to feel sorry for them as physicians purposefully chose this model of “health care” in order to benefit themselves decades and decades ago.) Times have changed with physicians now under the thumbs of hospital administration and insurance companies (although higher up on the totem pole than pregnant people according to their hierarchy) So, ultimately hospital administration and insurance companies have the biggest influences on your birth. And these people and institutions, far removed from your every day life and concerns, don’t give a damn about you or your baby. They don’t spend any time trying to understanding or even consider the impact of early life experiences on our total health over a lifetime or how the events at birth impact families over the long term.
In addition, I understood from my friend that the UCLA Nurse Midwives lost a third of their clients to home birth at the start of the pandemic. This trend may have continued over the course of this very trying past year – I don’t know. Pregnant people who have opted for midwifery care in the hospital, while operating under evidence based care, still are bucking cultural norms. Midwives are still not well-known in the U.S. as the optimal maternal-infant health providers for women who are healthy and low-risk as OB’s keep a tightly-locked fist on retaining their dominant market share to benefit themselves and their own businesses. This could easily be changed by new public health policies and educational programs, but OB’s and hospitals resist changes and lobby to protect their own perceived self-interests. We just don’t have the structures in place to create positive change. It’s all free market.
I would also like to touch upon the ethics of this decision, both on the part of pregnant families and the midwives. Creating a vacuum of care for birthing people during a pandemic by limiting their options during an already traumatic and stressful time is the height of irresponsibility to the community and is a distinct betrayal of trust. This decision also has a profound impact on the midwives – leaving them without jobs in the middle of a pandemic that has disproportionately had a negative impact on women’s employment to begin with. I can only sum this up with, “Shame on you, UCLA.”
So, this leaves pregnant women and couples with one less option in their efforts to navigate a very dysfunctional “system” that is ill-equipped to benefit them. Frankly, I believe at this point it’s a true necessity for more couples who qualify to birth their baby at home or at free-standing birth centers. The only thing hospitals and doctors respond to is the bottom line - money. If it doesn’t hit them in the pocket book, they are not going to change. They won’t add midwifery programs to their hospitals or change practices to make birth better for birthing families until they lose enough customers to the extent they realize they must adapt. Hospitals won’t change unless they are pressured in very real tangible terms.
What you can do:
If you have given birth at with the UCLA Nurse Midwives and value the experience you had there, please write to the hospital administration letting them know of your shock and outrage. That you chose UCLA specifically for the midwifery program and that you will be considering another option for any subsequent births since the program is being terminated.
If you are healthy and low-risk, consider giving birth at home or at a freestanding birth center rather than at a hospital. A home birth has many benefits. There are also a few midwives who have hospital privileges. I understand this may cost more out of pocket. All I can say as a parent is that it’s a drop in the bucket over the long haul of parenting expenses. Traumatic birth and unnecessary interventions also have hidden costs.
If you are not able to have an out-of-hospital birth, it is not appropriate for your health needs or it truly feels not right for you, it is extremely important that you have very complete education and preparation for your birth experience and new family life. Do not go into a hospital birth un- or under-prepared. This is institutionalized birth and without knowledge you will just be put into the big birth machine, which does not give individualized care. You can have a very good hospital birth, but your sense of agency and awareness will be what makes this more likely to happen. Otherwise, you are playing the lottery game as far as being lucky. Most of us don't win the lottery - just sayin'.
I am very disappointed that this choice has been extinguished and angry on behalf of the families I work with. It is a real loss to our community. I sincerely hope that this decision will be reversed. I am hoping the minute I publish this, someone will write to me telling me I am mistaken. That I got it wrong - how dare I write that this program is over? What a relief that would be. I would be delighted hear the news that I was fed misinformation and gladly announce the retention of the midwifery program at UCLA. Maybe the midwives will find another avenue with which to offer excellent care to birthing families. I’ll keep you posted with any new information I encounter. In the meantime, navigate the options you do have the very best you can. Thank you for reading my rant!
8/20/2024 UPDATE: On 3/1/21 after I wrote this original article, I received news from my clients that this program was reinstated and they were very happy. However, in the last years it has become apparent that the current "midwifery" program at UCLA is no longer a true midwifery program - it has been gutted completely and I would consider this an obstetrical and institutional based program. This has been a major loss to our community. And I no longer recommend the UCLA midwifery program to my clients.
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