UPDATE:



Birth Center to Remain Open, but with Remote Monitoring and Lost Accreditation

Community Challenges Hospital to Do Better

Thanks to the efforts of the Campaign to Save the North Shore Birth Center, on December 15, 2008, the Board of Trustees of the Northeast Health Corporation voted against the proposed closure of the North Shore Birth Center (NSBC). However, as conditions of its continued operation, patients will no longer be permitted to receive the handheld, Doppler-based fetal monitoring that was previously in use at NSBC in accordance with national birth center accreditation guidelines.

Instead, despite their low-risk pregnancies, all NSBC patients will be subjected to remote electronic fetal monitoring (EFM), a practice that leading medical journals agree is ineffective and frequently harmful. Remote EFM will also result in a loss of NSBC’s accreditation by the Commission for the Accreditation of Birth Centers (CABC). CABC accreditation is a strong indicator of exceptional quality of care, because it ensures the use of practices proven to be safe and effective in a birth center environment.

On December 18, 2008, six representatives of the Campaign to Save the North Shore Birth Center–Nicole Aliberte, Mira Clark, Rebecca Hains, Amy Kreydin, Sarah Shamel, and Christa Terry–met with Dr. Henry Ramini, President and CEO of Northeast Health System, and three other hospital administrators. This meeting had been rescheduled by hospital officials twice, with the result that it did not take place until after the Trustees’ December 15 vote.

At the meeting, Ramini unveiled to Campaign representatives details of the plan to change fetal monitoring practices. These details are highly problematic and deeply troubling to members of the Campaign.

Ramini explained that by the end of March 2009, patients will be monitored electronically for 20 minutes to establish a baseline upon arrival at the birth center. Subsequently, every 30 minutes, another 5- to 10-minute electronic monitoring session will occur. This electronic monitoring will be “continuously transmitted to the hospital,” where it will be remotely monitored by two hospital personnel. Without even observing the patient in question, and despite the well-documented problems of misdiagnosis via electronic fetal monitoring, those personnel — NOT the midwives — will decide whether the patient should be transferred into the hospital. Ramini added that, in the case of a disagreement, these two “monitors” would be able to override the midwives’ professional judgment, with a preference toward “erring on the side of overtreating the patient.”

Furthermore, when asked whether patients would be able to opt out of electronic fetal monitoring at the birth center, Dr. Ramini said no, citing fears that if refusal were permitted, all patients would opt out. However, informed refusal is a basic patient right in the state of Massachusetts and a civil right guaranteed by the U.S. Constitution, which protects patients from being subjected to medical procedures without their consent.

The Campaign to Save the North Shore Birth Center decries the hospital’s legally invalid plan to routinely violate patients’ rights.

When Campaign representatives at the meeting cited respected medical studies and reports that detail the unreliability and risks of using electronic fetal monitoring, Ramini said that he “doesn’t know if it’s good or bad for patients,” but that hospital lawyers advise its use purely for legal reasons, so that the hospital could use the monitor printout in case of a lawsuit. The Campaign representatives provided Ramini with a large binder of evidence-based studies from established medical journals and offered a summary of key points. The evidence we presented details that electronic fetal monitoring is an unacceptable medical practice for low-risk patients, because it often leads to unnecessary and dangerous interventions. We also offered that electronic fetal monitoring can be used — and has been used, frequently and successfully — against hospitals in lawsuits, making them no less vulnerable to litigation. The attitude of the Beverly Hospital representatives was essentially this: Our minds are made up. Don’t confuse us with the facts.

The Campaign to Save the North Shore Birth Center rejects the hospital’s plan to use remote fetal monitoring. The proposed EFM plans prioritize the hospital lawyers’ exaggerated straw-man fears of a lawsuit over maternal and fetal health and the legal rights of women to accept or reject this questionable intervention.

The Campaign to Save the North Shore Birth Center demands that hospital officials allow the North Shore Birth Center to continue practicing well-established evidence-based care, including the continued practice of bedside, non-remote fetal monitoring by a handheld doppler monitor, which is widely used state-of-the-art equipment.

Our stance may be summarized thus:

1. To subject women and their babies to a form of fetal monitoring known to unnecessarily increase the c-section rate, when a more effective and safer form of fetal monitoring is already in place, is unacceptable.

2. To have medical personnel who are in a separate building hundreds of yards away determine the fate of low-risk women and their healthy babies, overriding the professional judgment of our midwives, is unacceptable.

3. To prioritize legal fears over maternal and fetal health is unacceptable.

4. To violate basic Massachusetts’ patient rights and constitutional rights regarding informed consent and informed refusal is unacceptable.

5. To institute a practice that will cause NSBC, which has held the gold standard of CABC accreditation for years, to lose its accreditation is unacceptable.

HELP US SAVE NSBC!

Here’s what you can do to help save the North Shore Birth Center and its clients from the dangerous and unethical new protocols planned by the hospital:

1. Write letters to Beverly Hospital administrators and its Board of Trustees speaking out against these plans. In our meeting with administrators on December 18, they suggested that members of the community would not be troubled by these plans. They said there has been a change in the culture regarding what patients want, and that because of this context, changes to birth center’s long-standing practices would be acceptable to the community. Let’s flood them with letters again, sending the clear message that they’re wrong!

In addition to the trustees (whose contact information is available here ), please copy your letters to the administrators who attended the December 18 meeting: Dr. Henry Ramini, President and CEO; Chip Peyson, Vice President of External Affairs; Pauline Pike, Chief Operating Officer; and Heather Jones, Director of Community and Public Relations.

2. Send letters to the editor of your local and regional newspapers. Let them know about the Campaign’s continuance and the reasons why we have to keep fighting.

In writing your letters, note that the hospital’s December 15 statement to the media made it sound as though the practice of fetal monitoring would be new to the birth center. (It stated: “The Board recognizes the national trend of birth center closings due to rising costs and has decided to take a proactive approach and modify how care will be delivered at the Birth Center. Patients delivering at the Birth Center will now receive fetal monitoring during their delivery.”) News articles appearing on this topic have presented this misleading statement as fact. Correct them: Let the media know that fetal monitoring was already in use at the birth center — appropriate bedside fetal monitoring with a handheld Doppler, which, in fact, you most likely experienced at your own NSBC birth — and that you prefer this safer, handheld fetal monitor to the remote electronic fetal monitor that the hospital is forcing NSBC to use, beginning this spring.

Useful tips for writing successful letters to the editor are available here.

3. Contact your legislators, both local and state. Let them know that Beverly Hospital is planning to violate your rights as a patient in the Commonwealth of Massachusetts by denying you informed consent and informed refusal if you give birth at the birth center! Ask them to intervene in any way possible. Make sure you point out that birth center services using only handheld monitors are far less expensive than hospital services using costly and unnecessary technology. This hospital will have to find the money to pay for these new remote monitors somehow. The extra, unnecessary personnel supervising NSBC births from a separate building will increase costs, as well. Should Massachusetts’ new health plan be further strained by higher costs such as these?

Tips for locating and writing to your legislators may be found here.

4. Keep your focus where it belongs, on safety. Our interest in maintaining birth center accreditation and appropriate monitoring methods is not because we merely want a “nice experience” at the birth center. Hospital representatives at the December 18 meeting strongly implied that all the Campaign really cared about was the low-tech, gentler “experience” of birth center birth. This paternalistic, condescending attitude has misread the basis for our concerns and couldn’t be more wrong. We are intelligent, educated women who understand the difference between real evidence-based safey measure and the hospital’s defensive use of expensive and self-serving unnecessary interventions.

Together, we’ve already won a major battle in the fight to save our birth center. Let’s not stop now–let’s win a reversal of the hospital’s plans to require remote fetal monitoring and violate patients’ rights!