Birthing options are about to change for mothers on Chicago’s West Side and the near western suburbs.
Midwives and family medicine physicians at West Suburban Medical Center were told on Nov. 18 that, because of liability insurance, in 11 days, they would no longer be able to deliver babies at the hospital.
While the last day of these healthcare workers’ birthing privileges was moved from Nov. 29 to Dec. 6, as midwives organize alternative options for their patients, they’re left with the glaring reality of birthing inequity on the West Side of Chicago.
“Midwifery, I think, is going to be OK,” said Annette Payot, director of midwifery for the PCC Community Wellness Center, which has operated out of West Suburban for more than 20 years. “To us, it’s access, it’s birth equity, it’s leaving a disenfranchised community in the lurch.”
Certified nurse midwives – trained holistic healthcare providers specializing in care around and during childbirth – and family medicine doctors are a part of PCC at West Sub.
For decades, PCC providers have served as the hospital’s main delivery personnel. Eleven midwives deliver about half of the 50-some babies that PCC employees see on average every month at West Suburban. More than 30 PCC family medicine doctors perform cesarean sections and are backup physicians for midwives.
In addition to three PCC OB/GYNs who will continue delivering babies at West Suburban, the roles of the midwives and family medicine physicians will be replaced by providers from OBHG, a national hospitalist group that West Suburban CEO Manoj Prasad hired in July as additional backup for PCC family medicine providers and midwives. Currently, OBHG providers are largely there for emergencies and walk-in patients, Payot said.
West Suburban is also setting up two prenatal clinics and are onboarding four providers, two of whom are OB/GYNs.
“Please know this community needs a robust mother-baby service, and we intend to provide the best possible service with highly skilled and trained obstetricians,” Prasad told Growing Community Media, the parent company of Austin Weekly News and Wednesday Journal.
But without their services, midwives and family medicine doctors say they’re concerned about how birthing options will decrease for around 500 prenatal patients that they currently work with.
According to Payot, patients are in “panic mode,” especially those who are 38- or 39-weeks pregnant and now aren’t sure where they’ll deliver, since they won’t be helped by their midwife at West Suburban. “People are super panicked,” she said.
A majority of the prenatal patients that PCC serves at West Suburban live in Chicago’s Austin and Hermosa neighborhoods, which have long experienced systemic divestment. About 43% of these patients are Hispanic/Latino, and 44% are Black, according to Dr. Kate Rowland of the Illinois Academy of Family Physicians.
Midwife services are often comforting, and potentially lifesaving, for people of color who are giving birth.
While Black women in Illinois are more than twice as likely to die from pregnancy-related conditions than white women, the maternal mortality rate is nearly six times higher for Black women than white women in Chicago.
“We’re going to come across some challenges trying to give birth in a system that looks different from how we traditionally gave birth, in a more holistic, caring way,” said Tyrina Newkirk, vice president of the Chicago West Side Branch of the NAACP, during the launch of a parent-baby resource program in April.
Midwives help reduce rates of C-sections, premature births and newborn morbidity, according to the American College of Nurse-Midwives.
And West Sub has long been known for its midwife services, Payot said, including a long-standing legacy of water birth. In 2021 and 2022, Newsweek named West Suburban among the best maternity hospitals in the U.S.
“It really is about access to a true physiologic birth, patient centered care, trauma informed care, which really is the hallmark of midwifery,” Payot said of PCC’s midwife services, which soon will no longer exist at West Suburban.
What comes next?
Prasad said PCC’s midwives and family medicine physicians were dismissed from delivering babies at West Suburban because, after two years of warning, professional liability insurers told him they wouldn’t renew the hospital’s policy if non-residency trained individuals continued to deliver babies.
“They pointed out that we were the only hospital in the area that allowed this to happen,” Prasad said. “Given the dismal claims history of this hospital in OB, we were at risk of completely losing malpractice insurance coverage for the entire hospital, since they were unwilling to take on that risk.”
But Payot said this isn’t a realistic claim.
“This does not reflect the culture of the Chicago market,” she said, adding that PCC midwives and family medicine doctors deliver at other hospitals and haven’t run into this issue. PCC also has their own medical malpractice insurance, WBEZ Chicago reported.
Payot said that PCC providers have asked Prasad for a copy of the insurance policy to work with him on addressing it, but he hasn’t shown it to them.
“It doesn’t seem like this is happening in good faith,” Payot said of the decision.
Payot said PCC’s privileges were restricted or revised so midwives can’t deliver babies, but they can still perform other duties.
“We think it just makes more sense for us to [leave], even though we do not want to do this, we do not want to leave this community,” Payot said. “For us to just come in and do everything but deliver the baby, I think is confusing and potentially dangerous.”
The change in responsibilities, Payot said, will leave one provider to deliver all babies – work that was previously allocated between PCC providers, including a family medicine doctor, midwife, and on-call obstetrician.
“Certainly, we didn’t feel overstaffed with our last model,” Payot said, which worries her about how the workload will be handled without PCC staff.
Since OBHG was hired, Payot said PCC’s labor and delivery workflow model has gone by the wayside – a concern, considering how well it worked over the last 20-plus years.
“We had some of the best C-section rates, low intervention rates in all of Chicago, even serving a pretty high-risk population,” Payot said.
These changes in West Suburban’s labor and delivery unit come at a time when the hospital is still recovering from a financial crisis. When Prasad bought West Suburban, along with Weiss Memorial Hospital in Chicago’s Uptown neighborhood, he inherited $80 million of debt. As he works to climb out of that hole, hospital staff say it has come at the price of patient safety through gaps in medical supplies and services.
West Suburban is also in an ongoing arbitration with PCC over upwards of $1 million.
Though Payot said West Suburban has seen five different owners in her lifetime, many of whom have cut costs to maximize profits, what hospital staff see now feels more severe than in previous years. And the dynamic is different with the hospital owned by a single person, rather than large conglomerates.
“The fact that West Suburban has been a for-profit entity in this community with a really high Medicaid population never has made any financial sense to any of us,” Payot said. “We always have felt the squeeze in many ways, but certainly under Prasad, it is felt more critical.”
While the hospital’s finances are a concern, Payot said none of the PCC midwives are losing their jobs.
PCC has its own freestanding birth center in Berwyn, where mothers can deliver outside a hospital. Payot said some midwives and family medicine doctors are credentialed at Ascension St. Mary’s in Ukrainian Village, where they are encouraging their patients to deliver and trying to get more midwives credentialed. PCC also has an in-house doula service and are ensuring that those who deliver at St. Mary’s get a doula to help during labor.
“But some people are just going to have to take an ambulance to West Suburban,” Payot said, “despite urging otherwise because of safety and the fact that we won’t be there.”
Read a letter sent to Growing Community Media from Anastasia Crihfield, a PCC family medicine physician:
Read a letter sent to Growing Community Media from Kate Rowland of the Illinois Academy of Family Physicians:
