LINCOLN SQUARE — Amy Karony was in labor for two days when she gave birth to her daughter at Swedish Hospital.
The experience was so traumatic and exhausting that she asked her doctor for a caesarean section because she “felt so out of [her] mind and just couldn’t do it anymore,” she said. Then her midwife stepped in.
“The midwife actually talked me out of it because she knew I hadn’t wanted that,” Karony said. “She evaluated the situation and she took my wants and needs into account, as well. I was so grateful to have someone who could advocate for me when I felt so out of it.”
Swedish Hospital’s popular midwifery program has helped numerous North Side parents find trusted advocates, critical education and loving support systems as they grew their families, parents and midwives said.
Now, the Swedish midwifery program is merging with the obstetrics department starting in September. Hospital officials said the move is necessary because of “staffing challenges” and “increased costs” brought on by the pandemic, but having midwives and physicians working together will produce a “comprehensive continuum of care for all our patients throughout their pregnancy.”
Parents, midwives and advocates don’t agree.
Midwives are licensed health care providers who offer reproductive health care services, including pregnancy care. They do physical exams, prescribe medication, deliver babies and give other pre-natal, labor and postpartum care, according to the American College of Nurse-Midwives.
The practice emphasizes building relationships with patients and guiding the birthing process without medical interventions, which has been shown to have better outcomes for parents and newborns.
Some midwives already felt the hospital did not prioritize the program by not replacing former staff members and rebuffing suggestions on making the division more profitable, they said. Two more midwives left the hospital this summer, saying the merger would further limit midwifery care.
“As long as there’s one midwife within an institution, midwifery care is present and the powerful ways midwives can shape hospital culture only benefits an institution,” said Elizabeth Oppert, who worked at Swedish for 14 years before leaving this summer. “But without a team of midwives, there won’t be midwifery-focused birth. It won’t be what we had.”
Merging the programs also limits people’s health care choices at a time when reproductive care already is shrinking throughout the country and maternal mortality rates are rising, former midwives, patients and researchers said.
“For those of us looking to have more kids, it feels like we’ll have to find somewhere else to go,” Karony said. “The connections I made with the midwives went so much deeper than the standard relationship you have with a doctor, and it’s hard to think about not having them with me when I have another baby.”
Midwives Built A Community Of Parents, Patients Say
The team of obstetricians and midwives at Swedish, 5140 N. California Ave., will start Sept. 1, hospital spokesperson Bill Ligas said.
The shift will help meet patients’ needs, increase access to care and help “our staff be at their best when they’re with patients,” Ligas said.
“What is changing is that under this collaborative model, a patient will have a team throughout their pregnancy consisting of both obstetricians and midwives instead of selecting exclusively one or the other, and either a physician or midwife will be present at the time of the delivery,” Ligas said.
The hospital also is expanding its women’s health offerings by hiring three new OB/GYN physicians and upgrading the hospital’s birthing center, Ligas said. Hospital staff will help patients connect with other midwives in the community if they prefer to work solely with them, Ligas said.
Several North Side parents said they are “devastated” about the change.
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Midwives emphasize educating patients, engaging with families holistically and allowing patients to make their own informed decisions throughout the pregnancy process, said Lisa Kane Low, a midwife and professor at the University of Michigan who researches optimal childbirth practices.
Midwives are trained to use less invasive techniques to help guide the birthing process and promote vaginal deliveries which have fewer complications than medical interventions, said Karie Stewart, the president of the Illinois Chapter of the American College of Nurse-Midwives.
“It’s about trying to launch a healthy family at the end of the process, as opposed to frequently testing to confirm a pregnancy is healthy,” Low said. “It takes a lot of time and relationship building and there’s a trust that forms, which is what goes into the positive reports about improved outcomes and better patient experiences.”
Swedish employed around 10 midwives at its peak around 2015, but only a few remain, Oppert said.
The midwives helped create a community among neighborhood families through their “Centering Pregnancy” group, where expecting parents with similar due dates could learn from each other’s experiences and receive expert guidance, parents said.
Many families maintained friendships after having their babies and continue to support each other through parenthood, parents said.
The hospital will still offer support groups for parents, but they won’t be run exclusively by midwives, Ligas said.
Allison Wherly, who delivered both her children with midwives, said she is disappointed future parents won’t have quite the same resource she did.
“The group was an absolute lifesaver for me,” Wherly said. “I can’t go more than a couple blocks without running into someone. They created a huge network of parents, and it’s really sad to see that go.”
Swedish’s midwives played an important role in parents’ pregnancies by educating them about the process, remaining present throughout the birthing process and continuously advocating for their needs, former patients said.
“I’m devastated about losing this midwife program in the community because I think having multiple options nearby is the best way to go,” said Laura Smith, a former patient who lives in Bowmanville. “It gave me peace of mind to know I lived a mile away from the place I’d give birth to my son.”
It’s common for hospitals to cut costs by downsizing midwifery programs because maternity care doesn’t bring in as much revenue as other hospital departments, Stewart said.
“Unfortunately, when that happens, midwives tend to fall in line with what obstetricians do and the midwifery model of care can ultimately be lost,” Stewart said. “Midwives are certified as nurses, so they’re more likely to help fill in gaps and catch the overflow.”
Studies have shown seeing a midwife improves pregnancy outcomes for parents and newborns. Midwife-assisted births result in fewer cesarean sections, fewer premature births and a greater sense of respect and autonomy for the patient, according to an analysis from The Commonwealth Fund, a New York-based foundation that promotes equitable health care.
Reducing midwives to cut costs is a “simplistic” approach that incorrectly assumes midwifery and obstetric services are “interchangeable,” Low said.
“I would argue hospitals that cut midwifery services because they’re too expensive are using the wrong metrics and actually going against what the data tells us,” Low said. “It’s not taking into account the quality of care and it’s also taking away a patient’s autonomy to determine who they want to go to for care.”
‘She Helped Me Advocate For Myself’
Jen Poulin and her husband Glen Veed worked with Swedish Hospital midwives to deliver both their children. They started working with the midwives about 28 weeks into Poulin’s first pregnancy because they weren’t completely satisfied with her gynecologist.
The midwives spent more time asking Poulin about her “preferences and hopes for the birth experience,” she said. Veed noticed the midwives took the time to get to know the dads, address their concerns and “provide support for the whole family.”
“With the medical model, I felt like a patient at a doctor’s office,” Poulin said. “But the midwives gave much more deference to the patient in my experience. Throughout the pregnancy and delivery, they generally spent more time with me and went into more detail about everything that was going on.”
Poulin had to have a cesarean section to deliver her first child in January 2019, a “traumatic experience” because the doctors didn’t ask for consent while preparing her for the surgery, she said.
“It was a bad situation, but when the midwife came in, she made things so much better,” Poulin said. “I knew she was a person I could rely on and I could trust. She was able to see that I needed help and she encouraged me to use my voice. She helped me advocate for myself in a situation where I couldn’t do that for myself.”
After receiving countless recommendations from neighborhood moms, Karony decided to work with the midwives at Swedish Hospital because she wanted to have control over her pregnancy and birth, she said.
Karony’s midwives “did everything in their power to support me in having the birth I envisioned,” stepping in to prevent unnecessary medical treatment and help her avoid the c-section she did not want, she said.
“Without midwives, those kinds of things will happen more often because it’s just the way things have always been done in hospitals,” Karony said. “When there’s a midwife present, they can evaluate all of the evidence and change the practice to suit the patient.”
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