Midwives Are In The House!

Austin Woman Magazine

The Obstetrical team at OB/GYN North has brought collaborative obstetrical care to Austin women.

Midwives are in the house! For the first time since 2002, when midwives were banned from assisting at births in Austin area hospitals, Certified Nurse Midwives (CNM's) are delivering babies at St. David's North Austin Medical Center. This monumental shift in obstetrical practice policy is the result of the tireless efforts of one woman – Christina Sebestyen, MD.

"I am a strong proponent of the physician/midwife collaborative model of obstetrical care," says Sebestyen. "I trained alongside midwives. I saw firsthand the high quality of care they provide. I just couldn't imagine practicing without midwives."

Her resolve to practice alongside midwives put Sebestyen at a crossroads in her career. After relocating to San Antonio with her husband, a military serviceman and emergency room physician, Sebestyen was discouraged when she was unable to find a practice situation that shared her philosophy. Strongly considering all of her options, including returning to New Hampshire to practice, Sebestyen met Margaret Thompson, MD, then a solo practitioner at OB/GYN North in Austin. Finally, Sebestyen had found another practitioner with a similar approach to women's health care and Sebestyen joined Thompson in the practice in 2006. In 2007, Thompson completed her law degree and due to personal circumstances, she decided to retire from obstetrics. She transitioned out of practice in February 2008 and Sebestyen assumed responsibility for the practice in March 2008. Simultaneously, Sebestyen had been negotiating with the administration at St. David's North Austin Medical Center to grant hospital privileges to midwives to assist at births. St. David's granted midwives hospital privileges in March 2008.

"When I started the process to bring midwives back into the hospital, there was a fair amount of pushback, mostly from fellow physicians," says Sebestyen. "The laws in Texas state that physicians must always be physically present when midwives are assisting at births. For many physicians, this stipulation made utilizing a midwife undesirable. The thinking was, ‘If I have to be present for a midwife to assist at a birth, I may as well do the delivery myself.' Interestingly, it was the hospital administration that swayed the vote. On the day that we were to vote whether or not to grant midwives privileges, the hospital administration brought forward and cited data from the World Health Organization (WHO) which advocates the collaborative physician/midwife model of obstetrical care. WHO states: ‘The collaborative MD/CNM model of obstetrical care provides the best obstetrical outcomes.'" With this information, the hospital and physicians voted to grant midwives privileges to deliver at North Austin Medical Center. The timing couldn't have been better. North Austin Medical Center was also in the process of instituting the Obstetrical Hospitalist (hospital-based physician practice) program, which went into effect in August 2008. With the hospitalist program, there would always be an obstetrician in house, so midwives would always have physician assistance if they needed it. Sebestyen refined her staff in the summer of 2008 and in August, midwives began assisting at births. "It's as if the stars all aligned to make this happen," say Sebestyen. "We'd hit a road block and then there'd be a solution."

Such was the case for her meeting her future practice partner, Andrea Campaigne, MD. Campaigne was completing her training in obstetrics at The University of Texas Health Science Center in San Antonio in 2008 when she met Sebestyen. The physicians shared the similar belief that women should make the decisions about their health care. They also shared passion for collaborative obstetrics. When Campaigne completed her training in late summer of 2008, she joined OB/GYN North in September.

Currently the five-woman practice (two obstetricians and three midwives) sees 520 women and delivers 43 babies per month. Compared to many group practices in the area, this is a small practice. But the five practitioners are in solid agreement when it comes to patient care and practice style. In keeping with the collaborative care model, patients see each practitioner for ante partum care. This ensures that the patients know and are comfortable with all members of the team and that there is seamless transition at labor and delivery.

"There are no worries when I leave at the end of the day and sign my patients over to my colleagues," says Campaigne. "I know that they are getting the same quality and style of care that I would give them myself."

"It's this assurance that allows me to really go home," says Sebestyen. "Prior to this practice, there were times when I wasn't on call but because of concerns that I had about a particular patient that was in labor, I stayed in house. Now, I don't have any such worries. I can go home and know that my patients are receiving the same type of care as if I were there."

"When I meet prospective patients, I explain to them that we have a collaborative practice with midwives and a rotating call schedule," says Campaigne. "When we are on call, we are on call for 24 hours and then we are off for 24 hours. If I am on call and get called in at 3 a.m., I don't feel pressured because I have a full day in the clinic coming up. I will be off at 8 a.m. and will have 24 hours to recuperate. I complete my deliveries, do post partum rounds and even teach breastfeeding techniques to the patients. I feel that this is a gift that the practice gives to me, to rest and recuperate, and in return I can give patients my full attention."

The passion and joy that both Sebestyen and Campaigne share for the collaborative physician/midwife model of obstetrics is palpable as they discuss their practice, their hopes and goals for their patients and their hopes for obstetrics in general. Likewise, the midwives with whom they practice are equally satisfied. Liane Miller, CNM is one of the midwives who feels honored and privileged to work with her colleagues at OB/GYN North.

"Sometimes I still can't believe that I get to come to work each day and do what I love," explains Miller. "The philosophy is very consistent, to facilitate choices in women's health, labor and birth. I always stress to patients, we don't do anything without your permission."

Miller trained in England and comes to OB/GYN North from a large practice of midwives at Fort Hood. While she provided excellent patient care there for six years, she missed the collaborative practice environment. There was no patient empowerment. There was a set standard of care and everyone followed it. At OB/GYN North, Miller believes, "I'm doing what I've been trained to do."

Sebestyen and Campaigne are constantly looking at ways to improve and expand care to Austin women. Plans are underway to add Centering Pregnancy (a group form of prenatal care) to the practice as well as to expand services for low income women. The midwives are equally eager to broaden their care and to provide even more women with the opportunity to have a memorable and self-directed birth. As Miller put it, "My goal is for every one of our patients to have as close to their ideal birth as possible. Now realistically, things happen. But most all of our patients leave the hospital after giving birth with a sense of ‘Yes, I did it!' What more could we ask for?"

Christina Sebestyen, MD, worked as a one woman advocate to obtain privileges for midwives to assist at births at North Austin Medical Center.

By Darline Turner-Lee