Less than four years after launching an in-house midwifery unit, McKenzie-Willamette Medical Center in Springfield is disbanding it to the dismay of midwifery advocates.
The unit, McKenzie Midwives, is located in the hospital and employs six certified nurse midwives and five support staff, according to employees.
Many hospitals in Oregon have midwifery units, but with McKenzie-Willamette’s pending action, no hospital in Lane County will have one, said Emily Zeno Yeast, president of the Oregon affiliate of the American College of Nurse-Midwives. The hospital told employees the unit would close July 7.
Zeno Yeast, a nurse midwife at Good Samaritan Regional Medical Center in Corvallis, wrote earlier this month to McKenzie-Willamette leaders and the hospital’s Tennessee-based owners urging them to reconsider.
But spokesperson Jana Waterman said Wednesday that the hospital will stick to the July closure date.
McKenzie Midwives delivers about 10 babies a month – or about 17% of the hospital’s total births – Waterman said.
Asked about employees’ view that the hospital was closing the unit to save money, Waterman seemed to acknowledge that was one of the reasons in a comment to The Lund Report. “Globally, the healthcare landscape has changed since we launched McKenzie Midwives in 2019. The program became unsustainable as other options arrived locally,” she said.
In recent years two nonprofit standalone midwifery centers – Our Community Birth Center and Oregon Birth and Wellness Center – have opened in the Eugene-Springfield area, a response to PeaceHealth’s decision to shut down its standalone midwifery center in 2019.
Said Waterman: “Fortunately, our community has several midwifery service options that likely have the capacity for 10 additional births per month. Patients wanting to birth at (McKenzie-Willamette) may transition to an obstetrics physician with privileges at McKenzie-Willamette.”
Historically profitable hospital
With about 1,000 employees and 113 beds, McKenzie-Willamette is one of only two hospitals in the state that are for-profit. Owned by a private entity, Quincy Health LLC, McKenzie-Willamette has historically been one of Oregon’s most profitable hospitals. Like all Oregon hospitals, the pandemic hit it financially, but it did comparatively well during that crisis.
For the first nine months of 2022, it reported an operating profit of $1.9 million on operating revenues of $180 million, or 1%, according to state data. For all of 2021, it reported an operating profit of $18 million on revenues of $248 million. At the height of the pandemic in 2020, the hospital reported an operating loss of $5 million on revenues of $216 million.
Prior to the pandemic, it yielded big profits for its owners. In 2019, it reported an operating profit of $32 million on revenues of $230 million – a profit margin of 14% – which was typical for the hospital in 2015-2019 period.
Nationally, midwives for decades have pushed to establish themselves firmly in the health care provider system.
Certified nurse midwives oversee women’s reproductive health and childbirth, including pregnancy, birth and postpartum care. Their education and certification status is considered equivalent to that of a nurse practitioner. During vaginal childbirth, certified nurse midwives typically provide their patient all needed care, unless there is an unforeseen emergency requiring a physician.
Many Oregon hospitals have integrated certified nurse midwives into their in-hospital labor and delivery centers, Zeno Yeast said, adding that hospital systems with in-hospital midwives include Legacy Health, Providence Health & Services, Oregon Health & Science University, Asante Health, St. Charles Health and Good Samaritan.
“Twenty percent of babies in Oregon are delivered by midwives, most in hospitals,” she said.
In her letter to hospital leaders, Zeno Yeast wrote: “In the midst of a well-publicized maternal health care crisis, you are moving against the tide of best practice. … At a time when there are national and statewide efforts to increase access to midwifery care, you have chosen to close the only hospital-based certified nurse midwife practice in (Eugene-Springfield).”
Patients need to be handed off
Zeno Yeast said she was especially frustrated because McKenzie Midwives was successful. In-hospital midwifery service is crucial because many expecting mothers who prefer using a midwife also want to give birth in a hospital where a physician is immediately at hand in case of an emergency, she wrote in her letter to the hospital.
“While some families do opt for birth at home or in a (non-hospital) birth center, many need to be in a hospital due to risk factors, insurance coverage, or simply by preference,” she wrote.
In a message to staff earlier this month announcing the pending closure, McKenzie-Willamette CEO David Butler wrote that the hospital was “working with patients to transition their care.”
One McKenzie-Willamette employee said workers were startled by the decision.
“Financial concerns were cited as the reason for closure,” said the employee, who requested anonymity for fear of management reprisal. “There are only vague plans on how to transition the nearly 100 patients (at McKenzie Midwives) who are set to deliver this year.”
AlexAnn Westlake, a certified nurse midwife and executive director of Our Community Birth Center, said standalone birth centers and in-hospital midwifery units work in tandem to provide optimum care.
“Community-based midwifery birth center care is not a replacement for hospital-based midwifery care,” she said. Westlake said her center occasionally has transferred pregnant or laboring clients to McKenzie Midwives when risk factors developed that required hospital care.
“These families have been grateful for the opportunity to continue their care with a midwife in the hospital,” she said.
But some clients prefer to start their pregnancy care at a midwifery center in a hospital, she said.
The vast majority of births take place in hospitals. In Lane County, 3,339 births were recorded in 2022, with nearly 70% at PeaceHealth RiverBend, a total of 94 at the two nonprofit birth centers, and 822 at McKenzie-Willamette, according to Oregon Health Authority data.
McKenzie-Willamette’s ownership has been on a roller coaster in recent years. The hospital is part of Quorum Health, a small group totaling 21 rural and small-city hospitals in 13 states, that at one time was a publicly traded company. McKenzie-Willamette has long been Quorum’s star financial performer. Most of its other hospitals have been persistent money losers, financial reports show. Beset by heavy debt and operating losses, Quorum in 2020 filed a reorganization plan under federal bankruptcy law. It emerged several months later as a private entity under the ownership of Quincy Health LLC, a newly formed private company. Quincy Health’s financial performance has been poor and the company’s credit rating is CCC on S&P Global Ratings’ A-D rating scale, S&P reported last fall.