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31 May 2019

To the administrators of PeaceHealth,

We are maternity care providers throughout Oregon, representing Family Medicine Physicians, Certified Nurse-Midwives, Maternal Fetal Medicine Specialists and Obstetrician/Gynecologists.

As multi-disciplinary maternity care providers, we are deeply concerned to learn that the PeaceHealth is choosing to close its midwifery-led practice . We are alarmed that a leading hospital system would choose to move away from high-quality high-value care to high-cost care with poorer outcomes.

As multi-disciplinary maternity care providers, we recognize the value that each of our distinct, independent professions brings to the practice of maternity care. We recognize that the full complement of our services works best to optimize maternal health when we collaborate to facilitate the most appropriate access to these services, individualized to the specific needs of each patient. When one of these services is severely limited it is to the detriment of the health the childbearing population.

As multi-disciplinary maternity care providers, we affirm the joint ACOG/ACNM position statement entitled Practice Relations Between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives, released in 2018. We strongly agree that, “health care is most effective when it occurs in a system that facilitates communication across care settings and among clinicians. . . [and] quality of care is enhanced by collegial relationships characterized by mutual respect and trust; professional responsibility and accountability.”1

As multi-disciplinary maternity care providers, we strive to provide the highest quality care for our families. Cesarean birth rate is a significant quality measure in perinatal care, with rates above 10-15% not shown to reduce newborn and maternal mortality .2 For 2018, the state of Oregon had a 28.1% Cesarean rate, and Sacred Heart RiverBend reported a 35.0% total Cesarean rate.3 When the births cared for by the CNMs are removed from this data, Sacred Heart had a Cesarean birth rate increases to 39.6%. By eliminating the PeaceHealth Nurse-Midwifery practice, the cesarean rate will increase significantly, thus increasing unnecessary harm to mothers and infants.

As multi-disciplinary maternity care providers, we are deeply concerned that women receiving Medicaid and being cared for at the Charnelton Community Clinic are abruptly left without providers.

As multi-disciplinary maternity care providers, our recommendation is for PeaceHealth to maintain the midwifery practice, and invest in management options to optimize this exemplary existing model of care in order to maintain equitable access to the most appropriate maternity care for all pregnant people in Lane Co.

Signed,

  1. Lori Swain, CNM (Salem, OR)

  2. Jessica Newgard, CNM (McMinnville, OR)

  3. Nancy MacMorris-Adix, CNM (Salem, OR)

  4. Angie Chisholm, CNM (Corvallis, OR)

  5. Lindsey Frank, CNM (Burien, WA)

  6. Julie Shiprack, CNM (Portland, OR)

  7. Kym Guadalupe, CNM (Bend, OR)

  8. Caitlin Campbell, CNM (Seattle, WA)

  9. Lucille Glick, CNM (Portland, OR)

  10. Holly Pranaat, CNM (Rochester, NY)

  11. Jane Houston, CNM (Gainesville, FL)

  12. Patricia Barnes-Light, CNM (Portland, OR)

  13. Molly MacMorris-Adix, CNM (Silverton, OR)

  14. Moira Tannenbaum, CNM (Ann Arbor, MI)

  15. Jeanne Murphy, CNM (Ashburn, VA)

  16. Cristina Menking, CNM (Charleston, WV)

  17. Paige Atkinson, CNM (Portland, OR)

  18. Sarah Owens, CNM (Salem, OR)

  19. Leslie Schear, CNM (Tacoma, WA)

  20. Elenie Smith, CNM (Portland, OR)

  21. Anne Ziemba, CNM (McMinnville, OR)

  22. Joanna Sullivan, CNM (Milwaukie, OR)

  23. Jamie Harrington, CNM (Winfield, KS)

  24. Heather Jorgenson, CNM (Tigard, OR)

  25. Kori Pienovi, CNM (Portland, OR)

  26. Tanya Tringali, CNM (New Orleans, LA)

  27. Angela Love, CNM (Vero Beach, FL)

  28. Mary Jo Endahl, CNM (Vancouver, WA)

  29. Kanya DelPozzo, CNM (Springfield, OR)

  30. Laura Jenson, CNM (Portland, OR)

  31. Michele Peters-Carr, CNM (Portland, OR)

  32. Nancy Brannin, CNM (Santa Fe, NM)

  33. Rose Fife, CNM (Bay City, MI)

  34. Betsy Fuzi, Student Nurse-Midwife (Kaleva, MI)

  35. Susan Paterson, CNM (Blufton, IN)

  36. Mary Walker, CNM (Portland, OR)

  37. Barbara Crone, CNM (Oakland County, MI)

  38. Rachel Clark, CNM (Annapolis, MD)

  39. Kirstin Carhart, CNM (Roseburg, OR)

  40. Katie Robins, CNM (Corvallis, OR)

  41. Tina King, CNM (Sacred Heart, MN)

  42. Kelli Stephenson, CNM (Hermiston, OR)

  43. Rebecca Ailsrock, CNM (Cincinnati, OH)

  44. Sarah Schultz, CNM (East Lansing, MI)

  45. Metta Weaver, CNM (Boise, ID)

  46. Wendy Pinter, CPM (Southfield, MI)

  47. Nikki Helms, CPM (San Diego, CA)

  48. Elizabeth Smith, CNM (Santa Rosa, CA)

  49. Monica Viera, CNM (Los Angeles, CA)

  50. Heather ONeal, CNM (Morgantown, WV)

  51. Christopher Kargel, MD - Family Medicine (Corvallis, OR)

  52. Erica Coppola, CNM (Portland, OR)

  53. Heike Hornsby, CPM (Woodinville, WA)

  54. Mary Kay Ayers, Midwife (Berwym, IL)

  55. Jeni Poell, CNM (Chicago, IL)

  56. Susan Sims, CNM (Honolulu, HI)

  57. Elizabeth Krainchich, CNM (Silverton, OR)

  58. Susan Ward, CNM (Oklahoma City, OK)

  59. Jennifer Fardink, CPM (Fort Campbell, KY)

  60. Michele Zimmerman-Pike, CNM (Portland, OR)

  61. Emily Yeast, CNM (Corvallis, OR)

  62. Angie Chisholm, CNM (Corvallis, OR)

  63. Sarah Dumas, CNM (Chapel Hill, NC)

  64. Tianna Schaeffer, RN (Eugene, OR)

  65. Glenda Hard, CNM (Horseheads, NY)

1. ACOG. Joint statement of practice relations between obstetrician-gynecologists and certified nurse-midwives/certified midwives. Washington, DC: American College of Obstetricians and Gynecologists. 2011. May 31, 2019

2. WHO Statement on Cesarean Section Rates. https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf;jsessionid=1855F377BA085C7D5737453040B24316?sequence=1. Accessed May 29, 2019.

3. Oregon Health Authority : Oregon Birth Data : Birth Data : State of Oregon. https://www.oregon.gov/oha/ph/birthdeathcertificates/vitalstatistics/birth/Pages/index.aspx. Accessed December 14, 2018.

If you are not a maternity care provider and would like to add your signature of support, please sign the "Save the Nurse Midwifery Birth Center" petition on Change.org
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