Families who choose to give birth at home or at a freestanding birth center ease the strain on hospital systems. It is unnecessary to burden hospitals with the responsibility of providing basic medications that could safely be administered outside the hospital setting.
Hospitals strained by the COVID-19 pandemic have seen worsening outcomes for elderly patients admitted for non-COVID related illnesses. Patients have delayed care, presenting at later stages of their illnesses, and then staffing and supply chain issues have made it increasingly difficult for hospitals to meet the needs of these patients. There is no need to increase the burden on hospitals by having healthy families travel to the hospital for basic medications their Licensed Midwife could provide if allowed by law.
The COVID-19 pandemic has strained health systems around the world in unprecedented ways, with all health systems grappling with limitations in staffing (physicians, nurses, respiratory therapists, and pharmacists), supplies (medications, tests, ventilators, high-flow oxygen machines, and vaccines), and space (hospital beds, subacute nursing facility beds, and dialysis units). (Myers & Liu, 2022)
The pandemic is more persistent than we imagined it would be. It has taken a huge toll on hospital staff and caused enormous labor shortages. Many hospital workers, strained to their limits during the pandemic, have quit their jobs. A survey of 6500 critical care nurses shows 92% reported the pandemic had “depleted nurses at their hospitals, and as a result, their careers will be shorter than they intended” (Health Affairs, 2022).
Hospitals have found it increasingly difficult to replace those workers who have quit. There has been a huge surge in the use of travel nurses to alleviate staffing shortages. Nurses averaged $73,000 per year, or $1400 per week prior to the pandemic. Now, travel nurses are being paid between $5000 and $10,000 per week (Health Affairs, 2022). This is causing an enormous cost to hospitals for nursing care.
Changing the law so that Licensed Midwives may administer needed medications in the community setting just makes sense. Hospitals are struggling. Why add to their workload? Licensed Midwives can and should be able to provide these essential services without hospital involvement, provided the law is changed to allow Licensed Midwives to practice within their full scope of practice.
Families choosing community birth with licensed midwives face unnecessary barriers to care. One midwife shared this story about a patient who needed a RhoGAM injection.
This client was a Black single mom of 6, living in SW Virginia, with no car, and no childcare. She had an ultrasound at the local hospital on Thursday afternoon, confirming a miscarriage. Being Rh negative, she needed a shot of RhoGAM® within 72 hours. On Friday morning, I was unable to find a way to get her RhoGAM®. She had previously been dismissed from care at one local OGBYN office, and even though I called and begged them to see her again, they refused. I called the only other local OBGYN clinic in town. They have no attending OB in the office on Fridays until 1:00 pm, so I left a detailed message with the nurse. At 1:30 pm, when the nurse called me back, she told me that the attending OB had refused to see my patient because she had not been seen at their clinic yet in that pregnancy. I explained that she was only 6 weeks pregnant, and that it was impossible for her to have already established care in any practice. I also argued that she was seen at their office for postpartum RhoGAM® 4 months prior, so she was an established patient. We had the ultrasound confirming miscarriage and all her lab work. I argued that because the patient had no vehicle and no childcare, that she was unable to access RhoGAM® in any other way. The nurse replied that the attending OBGYN had recommended she go to the ED for RhoGAM®. The patient decided to forgo the RhoGAM®. She could not surmount the barriers of no childcare, no vehicle, no access to an appointment, and the time constraint of needing RhoGAM® within 72 hours of miscarriage. The bus system in our city shuts down at 8:00 pm. Her only option to access RhoGAM® was to leave her children unattended for many hours, take a 2-hour bus one way to the ED, and risk not being able to get home from the ED until the next morning.
This should never have happened. RhoGAM is a safe medication that Licensed Midwives are trained to administer. Our law needs to be changed so that no other mother goes through something like this again.
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