Midwife program may be cut
Publication Date: Wednesday Jan 1, 1997

STANFORD: Midwife program may be cut

Enrollment was growing, but financial troubles threaten the service

by Heather Rock Woods

The Stanford Midwifery Service is anxiously awaiting a very important due date. After attending 250 births, the program's certified nurse-midwives are waiting for Thursday, Jan. 2, the day Stanford Health Services President Peter Van Etten is scheduled to decide whether to cut back, abandon or fully maintain their service.

Stanford Health Services had decided in November to reduce the service because of financial troubles. But after an outpouring of support from women and their families who have used the service, the administration is reconsidering the budget cuts.

"The problem is not one of service--it's an outstanding service--it's one of finance," said Dr. Maurice Druzin, chief of Stanford's obstetrics division and medical director and founder of the midwifery program.

"Unfortunately, there are problems with managed care and reimbursement," Druzin said, adding that the service is expensive because of the staff required to ensure someone is on call all the time.

Before the cuts, three full-time and one part-time midwife provided prenatal care and attended women continuously during labor and delivery. The service began in July 1994.

"The practice is growing, but it's not covering costs," said Linda Walsh, director of the midwifery service. "It's purely a business decision. This is a fallout of what's happening from managed care."

Walsh said that midwives' salaries and educational costs are lower than those for obstetricians, but their reimbursement rates are the same.

The part-time midwife has been laid off because of the original proposal--to cut the service from the equivalent of 3.4 full-time positions to 2.4 positions. But sticking with that decision could doom the program, because it means the service can't guarantee its patients will be attended by a midwife during labor and delivery. Since hearing of the cuts, fewer women have enrolled in and continued in the program, further jeopardizing its finances.

Palo Alto resident Julie Williams, who is due in June, decided not to enroll in the program after her first visit. When faced with the possibility of being delivered by "a random intern or resident or faculty member on duty, with a medical approach, my answer was no," she said.

Instead, Williams found a midwife in a private practice that her insurance covers. But she wrote a letter to Van Etten and the head of the OB/GYN department asking to reinstate the program.

If Stanford Health Services decides to keep it, the midwives and administration would work out a new administrative and financial structure. "The question is what form will it take," Druzin said. "It would be the same type of service to the public, but the internal workings need to change."

The nurse-midwives have delivered an average of 13 births a month, although the number was growing. Before the cuts, Walsh had projected reaching 20 to 22 births a month by the end of spring 1997.

"I think its important to have midwifery at a large institution like this. It exhibits that most pregnancies are normal and healthy," Walsh said.

Midwives tend to spend more time with patients during prenatal visits, put a stronger emphasis on patient education, and rely less on technology and medical intervention to keep women comfortable and safe during pregnancy, labor and delivery. A nationwide study found a dramatically lower rate of Caesarean sections for low-risk women treated by midwives compared to those treated by physicians.

What do you think?

To register your opinion on this or any other story in today's Weekly, call our ReaderWire line at 326-8291 (then press 1), send e-mail to readerwire@paweekly.com or fax us at 326-3928. 

Back up to the Table of Contents Page