It Seemed Like Such A Good Week For Midwifery

It was looking like a good week for midwives in Washington State, and along with them, probably the entire health care system.  And then, not so much…

One of the first bills to get a hearing in Olympia’s health care committees this week was HB 2186, sponsored by Rep. Bailey.  The bill would allow nurses to coordinate with and work at the direction of midwives.

That’d be a win for midwifery, but it’s also a win for the state.  Why?  It sort of goes like this.

1.  Care coordination:  Of the 700,000 Healthy Options patients the state covers in Medicaid, one of the highest cost items come from deliveries of newborn children that don’t receive adequate prenatal care.

2.  Volume:  The top 5 care billing codes by quantity (DRG) for Medicaid Healthy Options are all related to birth: c-section with and without complications, vaginal delivery with and without complications, and healthy newborn child.

3.  Access:  When we look out to 2014, and the 600,000 to 1 million possible Washingtonians who will be newly eligible for Medicaid (well beyond the state’s own numbers, but validated when you talk to community health clinics), one of the biggest pressures will be from younger, child-bearing populations, often with higher rates of pregnancy than the population at large (Hispanic immigrants, for instance).  In other words, this group provider class is really important for access in the coming years.

4.  Scope of practice:  By allowing midwives to direct care, it frees up physicians for other more complex care episodes.  Sure, child delivery can get pretty complicated.  But, midwives have been doing this for a few millenia.  They know when to bring a doctor into the equation.

So, in the end, a good bill doing great stuff to increase care coordination, put downward pressure on costs, to expand access to care, and to free physicians to address other more complicated episodes.

At the same time, though, we saw this little nugget in today’s Publicola, announcing the UW Nursing School was planning to eliminate it’s midwife program.

“According to a letter from nursing school dean Dr. Marla Salmon distributed to supporters of the program, the midwife program was targeted because there are no tenured nurse-midwives teaching in the program; because nurse-midwifery was “determined not to meet a societal need” (maternal and newborn health were not considered societal needs in the evaluation process), and because only tenured or tenure-track professors were allowed to vote.”

Publicola forwarded me the email correspondence.  Here it is, in its entirety, along with contact information to register concerns.

Subject: [AAUP] program elimination in the Nursing School

From: “Sharona E. Gordon” <seg@u.washington.edu>

Date: 1/5/12 5:07 PM

Shocking news is making its way around campus: the Nursing School voted to eliminate its training programs for nurse-midwives, neonatal nurse-practitioners, and perinatal clinical nurse specialists. The nurse-midwifery program is financially self-sustaining. It has graduated about 100 nurse midwives in the two decades since its founding. It is fully subscribed, with qualified candidates turned away for lack of space every year. It is a strong program, with an enthusiastic, hard-working, and award-winning faculty.

Don’t we need more primary care providers in Washington? Eliminating this important source of graduate-prepared nurses will preferentially deprive women on Medicaid of women’s health and pregnancy care choices. The State Legislature funded the creation of the nurse-midwifery program in the early 1990s in order to address the critical shortage of prenatal care providers in Washington. This shortage remains a major public health issue, as the number of births continues to rise and the number of providers continues to decrease.

Why eliminate a self-sustaining program that meets an important public health need? In my opinion, this move is bad for the Nursing School, bad for UW, and bad for Washington women and families. If you agree, please let your voice be heard.

Disclosure: the contributor is married to the enthusiastic, hard-working, award-winning director of the Nurse-Midwifery Graduate Program.

—————————————————————————-

Sharona E. Gordon, PhD

Associate Professor

University of Washington School of Medicine

Department of Physiology and Biophysics

Box 357290, 1705 NE Pacific Street

Health Science Center Room I-312

Seattle WA 98195-7290

office: 206-616-4861

lab: 206-221-5321

fax: 206-685-5290

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On 1/9/12 11:22 AM, aaup-request@mailman2.u.washington.edu wrote:

Part 1.2

Subject: [AAUP] answers to questions about Nursing program eliminations

From: “Sharona E. Gordon” <seg@u.washington.edu>

Date: 1/9/12 11:12 AM

To: “Faculty Issues and Concerns” <aaup@u.washington.edu>

Thanks to all who sent notes requesting more information.

History: Because of expected budget cuts, the School of Nursing began evaluating its graduate programs this past summer. Evaluation criteria included:

Cost
Revenue
Student demand
Faculty capacity
Funding/leverage
Uniqueness
Societal needs

I’ve attached the spreadsheet used as part of the evaluation process. It shows how each of the programs are thought of for each evaluation criterion. The data were evaluated by the “Shared Leadership Council” and recommendations for which programs to pause, with intention to eliminate, were announced to the faculty on December 15th. Tenured and tenure-track faculty voted during a meeting December 19th.

Rationale for eliminating the Nurse-Midwifery program:

The program was considered vulnerable because there are no tenured/tenure-track nurse-midwifes teaching in the program since the retirement of a tenured nurse-midwife last year. The program director is an MSN (master of science in nursing) nurse-midwife currently enrolled in a nursing PhD program and the other program faculty are MSNs or DNPs (doctors of nursing practice). The faculty have long-term associations with the program, with excellent continuity (my opinion).

Nurse-midwifery was determined not to meet a societal need. Note that maternal-newborn health was not considered to be a societal need during the evaluation.

My understanding is that all programs were given numerical scores by the Shared Leadership Council. Based on the scores and their “gestalt” interpretation of them, the programs were prioritized.

Only tenured/tenure track faculty were allowed to participate in the vote. Thus, programs populated by lecturers, etc. were at a distinct disadvantage.

I believe the opinions of the campus community as well as the community-at-large have the potential to impact implementation of the program elimination process. Please do let the administration know your thoughts. Letters should be addressed to:

Dr. Marla Salmon, Dean, School of Nursing, Box 357260; msalmon@uw.edu. Please cc to Dr. Patti Brandt, Chair, Dept of Family and Child Nursing, pbrandt@uw.edu.