Elizabeth Seton Birthing Center to Close Due to Crisis in Malpractice Insurance
New York, NY, August 13, 2003—The Elizabeth Seton Birthing Center, which is affiliated with St. Vincent's Hospital Manhattan, announced this week the closure of the center effective September 1, 2003. Elizabeth Seton Childbearing Center (ESCbC), formerly the birth center at the Maternity Center Association—the first free-standing birth center in the country—is being forced to close after almost 30 years of service as a result of the current malpractice insurance crisis in the United States.
As a result of having no malpractice insurance, ESCbC can no longer deliver babies at the center as of September 1st, 2003. Letters were sent to every patient informing them of the closure. The birth center staff is in the process of making phone calls to all clients to assist with them with transitioning their care to St. Vincent's Hospital Manhattan or exploring alternative obstetrical care.
ESCbC was notified by its insurance carrier approximately three weeks ago that its policy, which expires August 31, 2003, would not be renewed. After extensive research it was discovered that options offered by other carriers were either inadequate, required excessive premiums or unavailable. This situation is not unique to ESCbC and has been experienced by other birth centers, midwives and obstetricians throughout the region.
Historically, ESCbC has provided not just prenatal care, but care to women throughout their life span. The birth center's philosophy is based on the principle that women have the right to health care that is safe, fits their lifestyle, and recognizes and respects their individual, physical, social, spiritual, psychological and economic needs.
As a free-standing birth center, ESCbC is housed in a space which includes exam rooms, multi-purpose rooms (for education and community services) and home-like birthing rooms in a building separate from St. Vincent's Hospital Manhattan, the affiliate hospital. The birth center is a not-for-profit corporation organized under New York State law and sponsored by Saint Vincent's Catholic Medical Centers. It is responsible for over 400 deliveries annually.
Clinical care at ESCbC is provided by a group of Certified Nurse Midwives, a Nurse Practitioner and Registered Nurses. Consultants such as physicians, social workers, lactation consultants and other alternative care providers enhance the care provided.
The services offered at ESCbC include: well-woman gynecology, prenatal care, natural childbirth with water-birth option, postpartum care, childbirth education, and a wide variety of community centered activities (mother's meetings, support groups, prenatal yoga classes etc.)
This closure is a situation that is not unique to the Elizabeth Seton Birthing Center, and has been experienced by other birthing centers in the city and region due to the escalating costs of malpractice insurance.
The staff of ESCbC is very proud of the many years of holistic, respectful and empowering woman's health care that has been provided in this setting. They are deeply saddened for its clients and feel a great sense of personal loss.
Contact: Michael Fagan
Corporate Director of Media & Government Relations, St. Vincent's Catholic Medical Centers
Editor's Note: The center is seeking any publicity, advice, or ideas for overcoming this situation. Please copy us with your ideas (firstname.lastname@example.org).
A retrospective study to explore the associations of placenta previa with preterm delivery, growth restriction, and neonatal survival examined birth/infant death records from 22,368,235 singleton pregnancies. Previa-related births were by cesarean. Analyses were adjusted for year of delivery, maternal age, gravidity, education, prenatal care, marital status, and race/ethnicity. Placenta previa was recorded in 2.8 per 1000 live births. Neonatal mortality rate was 10.7 with previa compared with 2.5 per 1,000 among other pregnancies, but among preterm births, placenta previa was not associated with increased neonatal mortality. Babies born to women with placenta previa weighed less than babies born to women without placenta previa; compared with babies born to women without previa, the risk of death from placenta previa was lower among preterm babies of less than 37 weeks gestation. At 37 weeks the mortality rate was higher for babies born to women with placenta previa than for babies born to women without placenta previa.
— Am J Obstet Gynecol. 2003 May; 188(5):1299–304.
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Herbs work synergistically with a good diet and vitamin supplementation. Plants that increase milk production are known to herbalists as galactagogues. They work by supplying nutrients, trace minerals, and alkaloids that encourage physiologic processes involving lactation.
A delightful-tasting, refreshing beverage may be made from fresh borage. Use the leaves, stems, and flowers to make a sun tea, add fresh lemon slices, and sweeten slightly with honey.
Seeds related to celery are famous galactagogues. Sweet, licorice-flavored seeds of fennel or anise can be eaten out of hand or added to leaf-based tea. Also good, but a little trickier to harmonize taste-wise, are seeds of dill, caraway, and cumin.
A great favorite for increasing milk is hops (Humulus luppulus). The unique flavor needs to be worked with to create an acceptable tea. Try spicing it with orange peel, ginger, cardamon, cinnamon, and brown sugar. Another strategy is to overwhelm the flavor with mints and lemon or lime.
Another popular herb is holy or blessed thistle (Carbenia benedicta). The related milk thistle (Silybum marianum) is commonly used as a blood and liver purifier. Blessed thistle, likewise, is considered to have a beneficial effect on the blood which, in turn, enriches the milk.
A cautionary note: Many references correctly laud raspberry leaf as a prime uterine tonic. However, some references also suggest using it to increase milk because of its vitamin and mineral content. Nettles, a superior kidney supporter, are often recommended for the same reason. While both are terrific herbs when used during pregnancy, they tend to be slightly astringent. This quality can shrink mammary glands and actually inhibit postpartum milk production.
Finally, a surprise: Garlic is beneficial to breastmilk, and babies love it! Studies have shown that when mothers include enough garlic in their diet for it to come through in their milk, the babies actually increase their consumption.
For those in the unfortunate circumstance of needing to shut down milk production (such as following a stillbirth), the principle of vasoconstriction may be used intentionally. Sage and shepherd's purse, taken internally, are specific for this purpose. Walnut leaves and bark may also be helpful.
Externally, poultices of powdered clay and distilled witch hazel may be applied morning and evening to contract tissue and draw out fluid. Clean dry breasts may be gently bound during the day, to compress the mammary glands and discourage filling. Remove the binder at night. To prevent infection, the mother should consider taking Echinacea, extra vitamin C, garlic, and possibly goldenseal. She should also eat well, rest, and take care of herself.
— Judy Edmunds,
in "Wisdom of the Midwives: Tricks of the Trade, Volume Two," a Midwifery Today book
WISDOM OF THE MIDWIVES: TRICKS OF THE TRADE, VOLUME TWO can be ordered from Midwifery Today's Web site. Click here.
Use calendula salve regularly on sore nipples. To make it yourself:
- Heat 8 ounces of natural oil (like olive, sesame, or almond) just until bubbles appear.
- Toss in as many fresh blossoms as the oil will cover and heat on low temperature for an hour or two.
- Remove blossoms, squeezing out all the oil, and discard.
- Add beeswax, one-tablespoon to one-ounce ratio to the warm oil and let it melt down.
- Remove from heat, pour into clean containers, label and refrigerate.
- The salve will keep nicely unrefrigerated for several weeks or for a year if kept refrigerated.
— Linda Lieberman,
The Birthkit, Vol. 1 No. 3
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Articles recently posted to the Web site:
I have had three hospital births and want the next to be born at home. However, I hemorrhaged after my last (no tears, was told I had my children too close together and my uterus was tired), and I recently had a missed abortion which resulted in a D&C from which I also hemorrhaged. Is it practical for me to continue to think about homebirth?
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Question of the Week
Q: Is it safe to use Epsom salts in the bathwater during labour and to remain in the same bathwater during the actual delivery (can it harm the baby or placenta)? I know Epsom salts are fantastic for relieving muscular pain, so would they reduce the action of the uterine muscles and prolong labour?
I am currently 34 weeks pregnant and experienced a 76-hour labour with my daughter, so I am looking for ways to relax and to hopefully prevent the same thing happening again. I am using a birth centre with midwives only attending me. I intend to use herbal teas and tinctures, essential oils, and visualisation.
— Caron Kambi
Question of the Week Responses
Q: I gave birth (completely natural) to my second child about nine months ago. Several weeks after giving birth I felt a vaginal heaviness. When I asked my midwife about it at the six-week checkup, she recommended that I kegel. I have been doing so for the past eight-plus months. I went back at six months, and she confirmed that my uterus was prolapsed. My cervix can be seen in the vaginal canal.
I know my doctors are going to recommend either surgery or a pessary (the device to "hold things up"). I prefer to treat it the natural way if possible (i.e. herbs, homeopathics, exercise). My husband and I want more children, but I am concerned about what it would do to my uterus and would it make the current situation worse.
A: Physical therapists who specialise in pelvic floor disorders can help you with exercises. From my own experience, good support from a physical therapist can make a big difference in the degree of the prolapse (also after another pregnancy).
— Hubertine Bussing
Coordinator relations health care
A: Just received a copy of "Saving the Whole Woman" by Christine Ann Kent, which is all about natural alternatives to surgery for pelvic organ prolapse and urinary incontinence. ISBN # 0-970-1440-0-8, published by Bridgeworks (www.bridgeworks.com), 1-888-514-1400, $16.95.
The author sent me a draft copy to read from a midwife's point of view, and no one has researched the options like this before! It is very detailed, offers lots of techniques, and educates the reader about what really goes on during the surgeries that are so often "the solution." This book may be just what you are looking for in your search for answers.
Breathe and believe that your body will know what to do.
— Jenny West, LM, CPM, HBCE
A: I suffered a complete inversion and prolapse during third stage with my second child thanks to the intervention of my obstetrician. It was severe (my uterus was hanging out of my vulva). I was advised never to conceive again. I did conceive again—a surprise, and only seven months later. I was very nervous about subsequent prolapse. I did not have surgery. I drank myself sick of red raspberry leaf tea through my pregnancy and was very diligent with pelvic floor exercises, many times a day. I also practised pelvic tilts to encourage the uterus back into place (as advised by an osteopath) and legs up against the wall or pillows under the bum. I had a beautiful homebirth with no further prolapse and have since had another 9-lb baby at home with no complications.
A: Arvigo vaginal massage might be very helpful. Look up their Web site at www.arvigomassage.com to find a practitioner in your area. You can also learn how to do this massage yourself after attending a workshop. It is worth the while.
— Giselle E. Whitwell, RMT, CCE and doula
A: General strengthening and healing of the pelvic floor is a natural consequence of walking frequently. Even as little as 10–15 minutes per day will dramatically affect the vaginal muscles. Will it fix a prolapsed uterus? I don't know. But it can help greatly with incontinence, cystocele, rectocele, and general vaginal muscle tone. It doesn't repair torn muscle, but it makes the muscles in the area stronger so that they don't "gape" and allow things to sag as much.
— Jennifer Rosenberg
A: Consider finding an experienced yoga teacher who specializes in women's health concerns. The restorative/supportive version of these poses would allow for greater body awareness and deeper relaxation and rejuvenation. Gradually, introduce the more classical version of these poses.
Poses (asanas) such as downward dog pose, the great seal pose, bridge pose, legs-up-the-wall pose, shoulder stand, and half-plow pose, practiced regularly, will strengthen and tone the uterus. Proper attention to the breathing during the poses is another important aspect of the practice and healing.
— Nicole Gauthier-Schatz, prenatal yoga teacher, birth doula
A: I'm not sure what you feel is unnatural about a pessary—it is just a small circle of latex-covered plastic that is inserted into the vagina to mechanically hold the uterus in place. It seems to me to be a quite simple and natural solution to your problem. It can be used quite effectively as an alternative to surgery and can also be used effectively in pregnancy to prevent prolapse. Many midwives can fit women for pessaries. Of course, kegels will continue to be beneficial as well, strengthening the pelvic floor.
A: After giving birth to my third baby (9 pounds), my uterus prolapsed to the extent that the cervix could be seen at the vaginal outlet. My midwife recommended that I lie on my back, bend my knees so that my feet were touching my buttocks and knees straight up in the air, lift my bottom up as high as I could so that my shoulders/head and my feet were the only things touching the bed or floor, and do hard kegels and hold each one as long as I could. This method worked beautifully. The uterus went back in place within 24 hours of doing the exercises often (not much strength because I had just given birth, but did the best I could). I continued to do the exercises daily for about six weeks to be sure the muscles were very strong. I gave birth to my fourth child two years and three months later with no uterine prolapse. I know of others who have tried this method with great success as well.
A: As a homeopathist I have some experience with uterine prolapse. This treatment can change the quality of tissues (weak, loose connective tissue may be one of the reasons for prolapse; if so, reposition and surgery may not help). We have several remedies for prolapse: sepia, lilium tigrinum, natrium muriaticum, stannum, cimicifuga, and others. Individualization is essential for homeopathic prescribing. Homeopathist must know the special features of *your* prolapse. Please, find a good homeopathic practitioner in your region or e-mail me on email@example.com. I'll need to know your symptoms in details.
Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Exclusively on the BirthLove site: Gloria Lemay, celebrated midwife and teacher, is offering advanced online doula education. She covers a vast amount of topics that today's doulas and student midwives need to know: herpes simplex II, medical terminology, pediatric exam of the newborn, prenatal diagnostic tests, business and professionalism, pregnancy-induced hypertension, gestational diabetes and so much more. The course is free for all BirthLove members. Check it out! www.birthlove.com/glo_doula.html
Question of the Quarter for Midwifery Today Print Magazine
Question of the Quarter: What does "instinctive birth" mean to you? How do you facilitate it?
Our favorite responses will be published in Midwifery Today magazine, December 2003. E-mail your response to: email@example.com. Responses are subject to editing for space and style. Try to keep the word count under 400.
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Thank you for the article on the intact perineum. It was so inspiring and really helpful for me to read while I am considering a homebirth. To know and expect the changes in your body while awaiting the birth of your child seems so important to me and is stressed in your article. It feels good to know that midwives are so in tune with the entire birthing experience and not just "getting the baby out." Thank you again.
— Elizabeth Hain
I had the pleasure of attending your Paris Conference in 2001. I returned to Bahrain where I received the support I needed from American Mission Hospital to implement waterbirths. Our first waterbirth was at the end of 2001, and we have had 15 successful waterbirths to date. There has been wide interest, and many of those who were unable to utilise the waterbirth facilities have successfully used other gentle birth techniques to achieve their memorable births. The squatting position has been adopted by many using the squat bar that I had custom made. Homebirths are not allowed but I seem to have struck a happy medium in the hospital setting.
From the information I have obtained I believe that American Mission Hospital is the only establishment in the Middle East that offers waterbirth as an option and that the only waterbirths in the Middle East have been conducted here. I would be interested to hear if there are other areas in the Middle East practicing waterbirths. I would also like to know if any restrictions are imposed on women who have a positive HVS for GBS or enterococci, as the paediatricians will not allow use of water in labour if this is the case.
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Oregon Coastal Conference, September 26-28. Accommodations (yurts and meals) included in price. Visit www.globalmidwives.org or call 541-488-8254 for details. See you on the beach!
Beechwood Midwifery, a homebirth practice in Rutland, VT, is offering preceptorships for students desiring a midwifery education through National College of Midwifery. See www.beechwoodmidwifery.com and www.midwiferycollege.org for more info and/or call 802/786-0740.
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