This week, I was stunned to learn via Twitter that St. Joe’s hospital is going to be closing it’s maternity ward in September. This space has long been a place where I’ve provided my views and commentary on maternity care developments in Minnesota, including costs, outcomes, strikes, options…..
Changes in my life have meant that I can’t and don’t focus on the maternity care system as much as I did a year ago. But this change (and others, including HCMC’s idiotic decision to cut childbirth education and doula care as a means to fund a big shiny building, literally tossing aside a vulnerable population to plump up their bottom line) feels both seismic and inevitable all at once.
First, a few words about St. Joeseph Hospital and a disclaimer: My son was born there 9 years ago. It wasn’t my first choice, but it’s was my best option given our health insurance at the time. I had one crappy midwife and nurse, left, came back after my water broke, had a decent midwife and good nurse, but was only able to eat crappy hospital food postpartum thanks to the Republican National Convention and tightened security rules. As a doula, I’ve had a mixed set of experiences there, including the one and only time the charge nurse hauled me into a room to yell at me. It’s cool though– it was after her staff seriously screwed up and yelling at me made her feel better.
To place St. Joe’s into context: It’s long been lauded as the place with the lowest cesarean rate in the Twin Cities. This is true. But there are a lot of reasons why this is the case. First of all, it’s been the hospital used by the OB group in MN with the lowest primary cesarean rate. Healtheast in of itself does not have OBs on staff, so cesarean rates at their hospitals is pretty much a factor of the independent OB groups and admitting privileges. It’s also long been the choice of homebirth midwives when they need to transfer patients from home to the hospital. Yes, the culture there is different. But it’s also a hospital that lacks a NICU of any kind (and really barely has the capacity for Special Care Newborns), doesn’t have much in the way to care for high-risk pregnant people, and has had a ban on VBACs for over a decade (though rumors swirled constantly that the ban was going to be lifted–I guess we can put THAT to rest).
I have had a lot of thoughts on possible motives for the closing that I’ve been asked to share, so here you go:
- St. Joe’s became the hospital in the 5 county metro area with the fewest births within the Fairview/Healtheast system. From an organizational standpoint, closing the smallest unit makes some sense in the larger scheme of things. St. Paul residents lose a hospital option for birth in DT St. Paul, but the U of M has a NICU, midwifery care, perinatologists, neonatologists…so that allows for there still to be care that’s not just in the suburbs. Adding that capacity to bring St. Joe’s into line was never going to happen, either to build the facilities or hire the staff.
- St. Joe’s has the only birth unit that has never undergone any improvements…for a very, very long time. It was kind of dated when my son was born there, and nothing there has really changed since then. Woodwinds birth unit has been expanded once (or twice?) since they opened, St. John’s had at least two rounds of remodeling in the last 10 years, Southdale just finished a gigantic remodel last year, probably their third I can remember, the U has undergone remodeling, and Ridges has had a few improvements made over the years. I’m guessing though, that the merged hospital system took a look at the portfolio of birth options and realized that if they were going to stay relevant in the arms race that is maternity care remodeling (I’m looking at you, Allina, for exacerbating it), they had to decide if it was worth the millions of dollars it was going to take to bring the birth rooms into the same specter of luxury Twin Cities families have come to expect.
- I really do believe the hospital spokeswoman when she said it wasn’t going to be a job-loss situation. The addition of Midwives at Ridges and Southdale and the cultural shift that brings very likely could mean that some Labor and Delivery nurses will decide that the shift to offering midwifery care and waterbirths and nitrous oxide is more than they want to put up with and (hopefully) decide that they are no longer best suited to work within that climate of more patient-centered care. The Fariview/Healtheast merger was probably the impetus for the addition of midwives at FV Southdale and FV Ridges. Healtheast has Nurse Midwifery care at all 3 of their hospitals, and Fairview has always had CNMs at the U of M hospital. Even though Park Nicollet/Healthpartners and North Memorial scaled back midwifery care, between the half a dozen or so freestanding birth centers that have opened and the creation of at least two new Fairview Midwifery clinics, there easily could be a very welcome, but very real, shortage of CNMs if there isn’t one already. The closure of the St. Joe’s birth unit is a way to more wisely reallocate resources. I have no doubt that the good care providers from St. Joe’s will continue to be good providers no matter how they are reassigned.
I’m sure, then, that you may be curious to hear my opinion on what other options people should consider.
For pregnant people who are drawn to giving birth in a place with as few unnecessary interventions as possible, any one of the freestanding birth centers is the most logical pick. In fact, some of the operational quirks of St. Joe’s meant that, in some medical emergencies, staff has to be called in–they aren’t always in-house. The freestanding birth centers do transfer to hospitals with that kind of staff in house 24/7. The difference is safety of care is pretty much non-existent in my opinion.
For families looking for more personalized care, I strongly encourage them to look at Family Med doctors as a viable option, especially those at Entira, in private practice, those who practice at North Memorial.
If you have to work with an OB, please check out the most recent annual report from MN Community Measurement. Go to page 135 in the report and look at the data there as a starting point to evaluate your options. But really, because so few OB births happened at St. Joe’s, this patient segment shouldn’t be affected too much.
Really, at the end of the day, I’ll give you the same advice I always have: Tour a couple of places. Ask questions. Don’t opt into care just because it’s the provider you’ve always seen. You are responsible for seeking out care that fits your needs. And if you find yourself hating a place or provider, there are ALWAYS other options. Oh, and hire a doula.
I want to thank BringMN for linking to my Guide for Birth options this week, though I had a moment of panic because it’s woefully out of date. One other thing: The BabyLove Alliance, a 501c3 that I co-founded, is looking for help raising money to get us through the next step in offering affordable doula and mental health care to families. We are officially recognized as an Essential Community Provider by the MN Department of Health, but contracting with all of health insurers will take some $$. Please consider helping support that work with a tax-deductible donation.