Nationwide, Certified Nurse Midwives (CNM) attend approximately 10% of all births. In Pennsylvaina the percentage is slightly better, at about 11-12%.* How does the Lehigh Valley stack up against this?
I can not find data specifically on how many births are attended by CNM’s in the Lehigh Valley, but I can make some estimates. At last count, the five hospitals that have LDR’s in the Lehigh Valley have just six CNM’s to attend hospital births. There were 9181 hospital births in the Lehigh Valley in 2009. For those six CNM’s to attend a total of 10% of hospital births, they would need to attend approximately 153 births per year per midwife, about 13 per month.
Let’s take a bit of time to look at how this would work out.
The average prenatal visit in the midwifery model of care is approximately 30 minutes, and with each client having approximately 14 prenatal visits during her pregnancy and one post partum visit, that would work out to approximately 1147.5 hours per year in prenatal and post partum care. If the average midwifery client needs 8 hours of labor assistance and post-partum checks in the hospital (my guess based on doula clients…I really don’t know what the average amount of time would be. I can tell you that I guessed what I thought was a LOW amount of time. The very first birth I attended with a CNM attending, she and I both spent over 24 hours supporting the client), that would be an additional 1224 hours per year for the midwife. So far we have 2371.5 hours per year of work. This does not include the time spent doing GYN care, paper work, or attending continuing education.
If we assume that the typical midwife takes 2 weeks of vacation time per year, 2 weeks worth of holidays (the typical white collar worker gets 10 paid holidays in a year), and 1 week of sick days; that leaves 47 weeks per year that the midwife is working. If we divide 47 into 2371.5 hours, we find that this works out to work weeks that are 50 hours long…and remember again that this does not include any time for doing GYN care, paperwork or attending continuing education–all of which are things midwives do.
So that leaves me with only 3 conclusions that I can draw:
- CNM’s attend significantly fewer than 10% of hospital births in the Lehigh Valley, or
- CNM’s in the Lehigh Valley are not working from within a “midwifery model of care.” That is, they are not providing longer prenatal visits where they can advise women on healthy pregnancy, thus reducing the need for interventions. They are not “labor sitting” with their clients, which has been shown to be one of the primary benefits of midwifery care during labor, leading to reduced intervention rates and increased maternal satisfaction with the birth.
- CNM’s in the Lehigh Valley are working insanely long hours–80 hours per week perhaps.
Note that these same conclusions can be drawn about a CPM or other type of midwife who has a high client load. In the case of many of them, they work insanely long hours which means that they may neglect their own health or their families.
I suspect that there is a mix of the first two explainations happening with CNM’s in the Lehigh Valley. I definitely believe that fewer than 10% of hospital births in the Lehigh Valley are attended by midwives. But of those midwives who do attend hospital births, I think that there are some that seek to provide the midwifery model of care, and others that don’t.
So who are the midwives who are doing births at hospitals in the Lehigh Valley?
Dr Alessandro Boschi at St. Luke’s Allentown has two midwives on staff, though a nurse who answered the phone at St. Luke’s has said that they aren’t “like traditional midwives who will labor with you.” Dr. Boschi’s practice is in Lehighton.
Andrea MacLaren from Pocono Midwives and Associates in Stroudsburg attends births at St. Luke’s Bethlehem.
OB/GYN Associates of Lehigh Valley Health Network (LVHN) have 3 midwives who attend births at Lehigh Valley Hospital Cedar Crest. However, in the case of this practice, women can not opt in or out of midwifery care. The midwives rotate primary call along with the OB’s for low risk women. If a low risk woman attending this hospital arrives in labor when one of the midwives is on call, she will be assigned to the midwife whether she wants a midwife or not. Like Dr. Boschi’s practice, the midwives are not laboring with the women because they usually have several women who are laboring at the same time. I’ve also been told that these midwives only take call during daytime hours Monday - Friday, which would greatly reduce your likelihood of actually having one be on call for your labor.
Sacred Heart Hospital in Allentown and Easton Hospital do not currently have midwives who attend births.
Out of this scarcity, many Lehigh Valley women have been turning to the Hackettstown Midwives in New Jersey, home birth midwives or two birth centers in the Reading/Pottstown area.
Laurice Dunning of Lehigh Valley Midwives and Associates attends homebirths, but she is currently doing that without OB back up.
There are a few CPM’s and non-credetialled midwives who also provide homebirth services to women in the Lehigh Valley, however none are located in the Lehigh Valley, but rather are a significant drive away. I live on the west end of the Lehigh Valley, and the closest homebirth midwife to me is a 50 minute drive. For women on the east end of the valley, they can find a midwife who is about 30 minutes away, another who is about 45 minutes away, then the ones that I would drive at least 50 minutes to could be close to 1.5 hours from them.
Interestingly, Lehigh Valley Health Network (LVHN) had an article about midwives in a recent edition of their “Healthy You” newsletter. I view the piece as little more than a puff PR piece, and not a serious effort to encourage women to utilize midwives. Why do I view it that way? Well rather than going to one of the midwives in their network (the 3 at OBGYN Associates) who actually provide prenatal care and attend births to get quotes, they got quotes from a midwife who works in the LDR triage unit at the hospital. So women who want a midwife for their birth might try contacting her, and be frustrated in their efforts. If they had really wanted to promote midwifery care they could have, at the very least, mentioned the midwives at OBGYN Associates since they are employees of LVHN, but they didn’t even do that, leaving it up to the woman to seek out a midwife.
*These numbers are estimated using the CDC Wonder 2005 data. The CDC Wonder data reports on birth attendant for the birth. Certified Nurse Midwives should not be the reported birth attendant for cesarean births (though they are for about 250 cesarean births in PA, and about 4500 cesarean births nationwide), so I estimated a 25% cesarean rate for CNM attended births to determine what percentage of births are attended by CNM’s.