Another Midwifery Practice Closes

Who will care for my daughters? From the Cincinnati Enquirer:

International Midwives Day on May 5 should be an official day of mourning in Cincinnati this year. The April 30 closure of the Midwives Care practice here after 20 years deserves at least that recognition. I'm grateful for the chance to have had one more appointment before the elimination of this vital option in women's health care.

It's so painful to contemplate not returning to the yellow Victorian house in Northside for gynecological care. Hard to imagine not being greeted by midwife Jackie Gruer in the sunny, high-ceilinged foyer before she talks me through the clinical part of the visit.

It feels like a punch in the gut. A lifeline has been cut. An oasis has gone dry. And it's not just here; midwifery practices around the country are closing. It's a clear wake-up call to the harsh realities of health care economics and childbirth in this country.

Skyrocketing malpractice insurance costs were a key factor in the demise of Midwives Care. From 2004 to 2006, their premiums more than tripled. They pursued every possible avenue to survive, from converting to nonprofit status to holding fundraisers. Liability costs hit nurse-midwives like Gruer doubly hard, because they must practice with a collaborating physician who incurs additional liability by entering into such an arrangement. But without the physician, nurse-midwives cannot legally practice.

Midwives long have been heralded for providing lower-cost maternity care, with fewer surgical deliveries and other interventions. But in the current environment, these strengths evidently are detriments, since hospitals receive significantly less revenue for a vaginal birth than a Caesarean section. It's only logical that hospitals would act to ensure their own survival, though at the expense of woman-centered care.

Our culture's fundamental distrust of childbirth only exacerbates liability and other financial issues, and it's difficult to say whether this distrust is a cause or a result. We are losing sight of birth as a normal life event. Though birth usually occurs within the medical system, it is not pathological. Perhaps if attitudes about birth itself could be changed, the other aspects would fall into place. Jackie Gruer, in her inimitable way, hopes to make that happen by evolving Midwives Care into an education and advocacy organization. If anybody can do it, she can. I wish her my heartfelt best.

Peg Conway and her husband, Joe, are the parents of three children, all born with midwives. They live in Amberley Village.