Midwifery for the 21st Century
This article was originally written for the Jewish Healthcare Foundation's WHAMglobal blog.
Walking into a similar setting in the mid-1950s would have likely presented us with a somewhat different landscape. It was then that the traditional home births started declining in favour of hospital births – a trend that would reach 98% births through hospitals, today.
I doubt, as we followed the Jewish Healthcare Foundation’s staff into the Geisinger Medical Center, that our group of JHF Fellows realized we were about to witness a change in this pendulum.
As we would soon find out, the hospital we were standing in was only half of Geisinger’s innovative birth delivery model. The other half was conveniently located ten minutes away. A previously independent community hospital, the Geisinger Bloomsburg Hospital now served as an extension to Geisinger’s tertiary care hospital. The Geisinger Medical Center initially expanded as it ran out of space, a common problem. The vision behind the acquisition, however, went beyond servicing more beds. Geisinger chose to redesign a care model where each patient received the right care, at the right moment. What began as a shift of overflow from the Geisinger Medical Center to the Geinsinger Bloomsburg Hospital soon turned into an innovative model that returns to the roots of giving birth.
The United States has both a history of underserving certain populations while over-treating others. The rate of maternal death in the United States is the only amongst industrialized countries to continue rising, while the C-section rates continue to rocket. For Geisinger, the Geisinger Bloomsburg Hospital opened the possibility for an alternative care where patients would get the appropriate level of care they required. Having more space available, the team began to triage: high-risk cases were directed towards the tertiary care with the OB and surgeons on-hand, while low-risk mothers-to-be were taken under the midwives' wing at the Geisinger Bloomsburg Hospital. And the two centres remain connected, only a few blocks away.
Geographic proximity may be Bloomsburg's biggest asset, but two other factors contribute to this community's success. On the one hand, the midwives have a very good grasp of their resources. At the Geisinger Bloomsburg Hospital, midwives are quicker to sound the alarm compared to a regular context, when potential problems emerge: "Backup is only 20 minutes away, so we plan ahead. We put the breaks on earlier", says senior midwife Shari (Sharon) Wachob, MSN, CNM.
Teams are the other salient element: "It's important to find the right people", Wachob shares with us. "The midwives can't be cowboys. The doctors can't be hovering around us, they need to trust the midwives. And the doctors also need to be willing to come at a call's notice - even if they are at the end of their shift". As she carries on explaining, part of the reason this collaboration works so well is because of the attitudes and mindsets of the people on the team.
The integration of midwives into the delivery system seems like a return of a pendulum swung too far. In its own way, Geisinger has brought innovation into maternal care - even if that model rests on decades of childbirth with doulas and midwives, across continents. What is most remarkable is that it did so in a financially viable way, while battling misconceptions and established conventions. From our trip to the hospital, the passion and commitment of the team shone through.
Addendum: Although the Bloomsburg GMC model of midwifery works as it does because of the proximity of the two sites, Geisinger also offers midwifery services at a number of other sites: Lewistown, Holy Spirit, and GWV. In October, GCMC will be opening a labor and delivery unit which will operate on a model similar to GMC and Bloom with GWV. They are also expanding midwifery services at outpatient clinics with the aim to improve access to care.