Filling the Gap
The Southern Maryland community served by St. Mary’s Hospital is quickly growing. The hospital serves as the birth site for the nearby Patuxent Naval Air Station. The number of births at the 100-bed facility recently jumped from 600-800 births a year to more than 1,000. The four OB/GYNs serving this county of 90,000 are all in private practice. With growing businesses, these community providers found that juggling busy outpatient schedules with inpatient demands for labor support or hospital-based procedures was resulting in disruption in their clinics, lost revenue, and frustration for them and their patients alike.
Collectively, the community OB/GYNs got together and decided to hire a CNM laborist to help cover the bases. Lawrence Tilley, MD, chief of obstetrics and gynecology at the hospital, had watched the success of the hospitalist model at St. Mary’s and has a certified nurse-midwife on staff at his private office. He finds that offering nurse-midwifery services in his practice acts as a draw for patients. At the hospital, he would like to add more midwives to the staff, for 24/7 coverage.
Hundreds of miles away, in a busy urban healthcare delivery system with different needs and rhythms than those in rural Maryland, the CNM laborist model also fits the bill. At Mt. Sinai Hospital in Chicago Laborist Darryn Dunbar, CNM, attends the births of nurse-midwifery patients served by the Access Community Health Network, a large healthcare organization that manages 44 Federally Qualified Health Centers in the Chicago area. The hospital sees 4,000 births a year, of which close to 10% are attended by midwives. Dunbar is one of two CNM laborists at Mt. Sinai who care for Access midwifery patients, most of whom are on Medicaid. He works solely in the hospital, providing inpatient coverage after hours and on weekends to the clients of a seven-midwife team that, with the addition of his laborist services, is able to offer almost continuous midwifery coverage.
“The goals were to extend midwifery coverage, to increase patient satisfaction and safety by having continuity of on-site care for this group of patients, … to improve staffing ratios in labor and delivery, and [to] provide relief for the residents and house officers,” says Dunbar.
His many years of experience as a full-scope CNM in busy, urban settings with high volume and increased social and medical risk factors make him well suited to providing care in this setting. In addition, in Illinois (as of this year) Dunbar can bill directly for his services under Medicaid and receives 100% of the physician reimbursement rate. He can also serve as the billing provider when he supervises the deliveries of residents in the hospital training program.
Dunbar is a valuable member of the OB team. He receives patients who come in through the ED and helps with OB triage, first assists with cesarean deliveries on occasion, and “runs the board” when the residents are off the floor for educational obligations, are in surgery, or are busy with other patients. The nursing staff, house attendings, and residents have all come to rely on his watchful eyes and helping hands.
Nurse-midwives, according to their professional philosophy, believe the best model of healthcare for a woman and her family is one that promotes a continuous and compassionate partnership, including individualized methods of care guided by the best evidence available, therapeutic use of human presence, and skillful communication. They believe in watchful waiting and non-intervention in normal processes, the appropriate use of interventions and technology for current or potential health problems, and consultation, collaboration, and referral with other members of the healthcare team, as needed, to provide optimal healthcare.