Coming out of general anesthesia, Erin Salkin opened her eyes and looked around the hospital room, searching for the woman who could answer her question. She’d just given birth to her first child, Dylan, and she wanted to know if the emergency cesarean section doctors had performed meant she couldn’t have another child naturally, as she’d hoped.
“There is no doubt in my mind that you can have a natural birth,” the midwife reassured her. “No doubt at all.”
But when Salkin went into labor again three years later and searing pain ripped through her body, she couldn’t help but wonder whether she’d be able to have a natural birth this time.
After 22 hours of labor, Salkin was exhausted, but her midwife encouraged her to keep pushing. It took another two hours, but Salkin eventually did give birth naturally to her second son, Caius.
“Childbirth is a dangerous but also a natural thing,” says Salkin, who had both her children with the help of certified nurse-midwives from the Mountain Area Health Education Center.
Now, however, she fears other local women won’t have that opportunity due to changes announced in late October by the MAHEC Ob/Gyn Specialists.
Effective Jan. 1, the certified nurse-midwife service will emphasize on in-office access and prenatal care, eliminating the current 24/7 call schedule. This means there’s no guarantee a midwife will be present at the time of birth.
“For four or five years now, we have been struggling to stay above water, and then we got this 15.5 percent budget cut this year,” CEO/President Teck Penland explains. During those years, he notes, MAHEC administrators worked diligently to keep the midwifery program intact while continuing their mission of education and quality patient care.
They considered options ranging from cutting back on the number of physicians to terminating their OB-GYN residency. But in the end, says Penland, “It really forced us into another level, and we feel like we made the only decisions that we had in front of us.”
Distressed about the changes, Salkin created the “Mamas for MAHEC Midwives” Facebook page. To date, more than 250 mothers have rallied behind the midwives, saying there must be another solution to the budget-cut blues.
Allison Margerison, a registered nurse who gave birth to her daughter, Nora, in February with a MAHEC midwife’s help, is one of them. “There is nothing more normal and natural than women helping other women bring babies into the world,” she asserts. “It’s been this way since the beginning of time; that is the backbone of the midwifery model. OB-GYNs are trained pathologists and surgeons, so they often have a completely different way of looking at birth,” she continues, adding that midwives “provide a needed and desired alternative to the medical model of birth in our community.”
Currently, there are two groups of certified nurse-midwives practicing in the Asheville area: MAHEC and New Dawn Midwifery, each with four midwives on staff. Both groups use Mission Hospital, though New Dawn also offers home births for low-risk women. After Jan. 1, however, only New Dawn will offer a 24/7 call schedule.
“Unless another birthing center opens up between now and then, New Dawn is pretty much the only choice,” says Salkin. “And that breaks my heart, because I love these [MAHEC] midwives, and I have a special connection with them.”
But Dolly Pressley Byrd, who delivered Salkin’s younger son, says MAHEC’s new care model could expose a more diverse group of Western North Carolina women to midwifery and how it differs from other forms of care. Midwives, for example, perform medical exams and deliver babies in lieu of an OB-GYN, whereas doulas provide emotional and physical support to women in labor and their families.
Historically, notes Byrd (no relation to the author), “Our typical population for midwifery care has been well-educated women who have pursued this avenue as a choice. But there are lots of women out there who don’t even know it exists. Those women, she continues, “are maybe more disenfranchised with the whole medical community, impoverished, that kind of thing.”
Last year, MAHEC’s nurse-midwives were honored by the American College of Nurse-Midwives for having the highest rate of successful vaginal births after a C-section among low-volume practices. Byrd says she hopes the new approach will enable these care providers to maintain their high standards while serving a broader segment of the community.
And despite some patients’ dissatisfaction with the changes, says Dr. Kellett Letson, director of the nonprofit’s OB-GYN division, the most important aspect of the care the program provides — the doctors, nurse-midwives and residents — remains the same. “While we can respect the disappointment in the reorganization of care, these are the same people that have supported natural childbirth and patient-centered care all along,” he points out. “The suggestion that the care would be drastically different, or that we would want to change anyone’s plan or begin to intervene in ways that people are not interested in, is simply false.”
Salkin, meanwhile, says she hopes women will continue to support the midwives and advocate for the care model that made them choose MAHEC to begin with. When giving birth to Caius, she explains, “I put everything on [the midwife] and all of my trust. You look forward to seeing these women and sharing this moment with them, because they’re so passionate and skilled at what they do.”
— UNCA senior Caitin Byrd is an editor at The Blue Banner, the campus paper.