(Image: Kaiser Permanente)
(Image: CHS)
By Mina Sakay/UW News Lab
As expectant parents begin their pregnancy journey, many seek out midwifery care to reduce the use of medical interventions in labor. But starting in early 2025, that care will be harder to find as decades of midwife-assisted births on Capitol Hill is coming to an end.
Kaiser Permanente’s Capitol Hill-based midwives will no longer deliver babies at Swedish First Hill Hospital in Seattle, according to more than one Kaiser Permanente medical professional, effectively ending the oldest hospital-based midwifery program in Seattle.
Certified nurse-midwives are medical professionals who offer personalized support and care to patients. Midwives deliver babies and provide holistic family-centered care during pregnancy, labor, and after birth.
The Kaiser Permanente Capitol Hill Midwifery Clinic — originally Group Health before the health care giant swallowed up the smaller provider in 2015 — has been open to the community since 1990, providing services and care to families, according to the Change.org petition created by community members hoping to save the program.
The year of the merger, the former Group Health Capitol Hill campus transitioned from a focus on maternity services, forging a partnership with Swedish. Previously, around 1,700 babies a year took their first breaths of fresh Capitol Hill air at 15th and John.
The new babies land on First Hill these days. Often, there has been a Capitol Hill midwife to help.
“The importance of having certified nurse-midwives in every ob-gyn practice is crucial to improving health outcomes of both babies and mothers,” said Alice Ambrose, a medical assistant at the Kaiser Permanente Capitol Hill Midwifery Clinic. “The Kaiser midwives are trained in full spectrum perinatal healthcare and Kaiser is one of the only places left in Seattle that they can do this work.”
When Rian Watt and his wife began their pregnancy journey this year, they opted to use a Kaiser Permanente midwife and joined the CenteringPregnancy program. The CenteringPregnancy program offers newly pregnant Kaiser Permanente members prenatal care through a combination of one-on-one sessions with a clinician and group sessions dedicated to discussing pregnancy related issues.
“The Kaiser Permanente midwives team really made us feel safe and cared for throughout the entire pregnancy, all the way through delivery and postpartum,” Watt said. “When we were offered the opportunity to use the midwives program, we jumped at the chance.”
KUOW was first to report on the local changes by Kaiser Permanente earlier this year.
Kaiser made the move because there is higher demand for midwife-staffed deliveries in other districts, according to Linnae Riesen, the Kaiser Permanente Senior PR & Media Relations Manager. Data over the past five years demonstrated to officials that there is a higher demand for midwife-staffed deliveries in Bellevue and Tacoma, Riesen said.
“As we continue to evaluate our services, we are making this change in our staffing to ensure we have consistent staff and resources where our members need them most,” said Dr. Linda Tolbert, Chief Executive Officer and Executive Medical Director of Washington Permanente Medical Group, in a written statement provided by Riesen.
Pregnant members who plan to utilize a midwife and established care before August 19, 2024, will be able to receive the same care from their current midwife, regardless of their due date, according to Riesen.
While newly pregnant members in Seattle establishing care after the cutoff date will have the option to deliver at Swedish First Hill with a Kaiser Permanente ob-gyn or family medicine OB provider, or with a Neighborcare Health midwife. Otherwise, they will be directed to travel to Bellevue or Tacoma for midwifery services.
“Outsourcing midwifery care and decreasing access to midwifery care in the biggest city in the Northwest is hugely disappointing for people who really believe in low intervention and high prevention care,” said Ambrose.
Current Kaiser Permanente patients who want to stay and receive midwifery care in the Kaiser system have expressed concern, as they will be forced to travel to Bellevue or Tacoma, or to seek care from midwives at Neighborcare Health, said one Kaiser Permanente midwife, who prefers to speak anonymously due to risk to her job.
“I feel both anger at Kaiser Permanente for closing down an extremely successful program, and a great amount of sadness for future couples who might want to give birth with a midwife,” said Watt.
Midwives, obstetricians and gynecologists, and staff were not consulted about changes to the program, nor was input collected from patients, according to more than one Kaiser Permanente medical professional we heard from.
“Staff in the clinic, midwives, and obstetricians are the ones that have to communicate to patients about this transition, when we have also not been given any transparency from Kaiser Permanente Washington executive decision makers, nor information on when patients will receive notice,” said Ambrose.
It felt like I had someone in the room who was an advocate for me, that I was familiar with, and that helped to educate me on the different scenarios that could occur during birth
Jennifer Sharp, a first-time mom, gave birth in July in Seattle with the Kaiser Permanente Capitol Hill midwives.
“It felt like I had someone in the room who was an advocate for me, that I was familiar with, and that helped to educate me on the different scenarios that could occur during birth,” Sharp said.
Sharp had initially heard about the program change during a CenteringPregnancy group meeting through other patients, and emailed Kaiser Permanente for clarification. Sharp said she likely would have found out about the change only if she had sought out the same form of care for a future pregnancy.
“I had such a positive experience and was so impressed with the program,” Sharp said. “I am upset that others will not have access to that same care.”
“I chose a midwife myself many years ago for my pregnancy because midwifery care has less medical interventions in labor and delivery,” said Ambrose. “They spend more time supporting their patients through the labor process than most medical doctors would.”
Additionally, patients still seeking midwifery care in Seattle will have the option to choose a midwife through Kaiser Permanente’s expanded network with Neighborcare Health, according to Riesen.
Neighborcare Health, a low-income and uninsured focused group of clinics, offers care at its locations throughout Seattle.
The Kaiser Permanente senior midwife and educator, who has worked as a midwife for over 20 years and wishes to remain anonymous due to risk to her job, said that there are concerns from the midwifery community about access to care in the Neighborcare system, and possible negative impacts on their targeted population, which includes refugees, non-English speakers, and unhoused people.
“If Kaiser Permanente sends individuals who have been using Kaiser’s program to Neighborcare, I worry it will crowd out individuals who desperately need these services,” said Watt.
The Kaiser Permanente sites have also played a critical role in training up to eight midwifery students a year, which won’t be possible in the new structure, according to one Kaiser Permanente midwife who prefers to remain anonymous due to risk to her job.
A Kaiser Permanente midwife and educator said she is concerned that this change will negatively impact the educational opportunities for students.
“Patients are really trying to advocate for themselves and for future parents,” said Ambrose.
The Change.org petition established in August has more than 1,100 signatures to support preservation of midwifery services in the Kaiser Capitol Hill location.
“There was a wide array of individuals in my prenatal care class from all different demographic backgrounds, a few who voiced they are a one-car household, or who utilize public transportation and would have difficulty in traveling for care outside of Seattle,” Sharp said. “Kaiser Permanente is removing care where it hurts.”
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Big bummer. We really valued having a midwife (as well as a doula) when our two kids were born. Sorry to see this will no longer be an option for Kaiser members.
This is such a disappointment. It’s indicative of how little we value health. Bet you anything this has something to do with profits even though Kaiser is a nonprofit. They’re likely losing money on this, sadly. Healthcare shouldn’t exist to make money! Are these midwives out a job now?
The article says that there is greater demand elsewhere, including Bellevue and Tacoma. So, it sounds like the midwives are simply being reassigned to locations that need them more than Capitol Hill. This may tell us something about where parents want to raise their children more than anything else. I seriously doubt that it has to do with profit. Midwife assisted births likely cost less than using a OBGYN
I agree with you about them losing money. which is really disgusting. They are also closing down 3 medical offices. 1 in Gig Harbor, Poulsbo,and Ballard. I feel bad for their employees. Hopefully they will all be placed in other facilities, and they’re gonna be really crowded. And then what about the patients, now having to travel elsewhere. I just don’t think Kaiser really cares about the patients or their employees, at least not when it comes to making the money. I really don’t understand how they can even claim to be a non profit anyway.
This makes me sad, as this was where my daughter was born (during Group Health days). We had a wonderful experience with our midwife and doula. It also puts a point on something I said to a friend just this afternoon: ‘Seattle is toxic to families’.
This is why nearly all of the apartments being built near the downtown core are 1br and 2br. There are a usually 1-2 3brs per building, but the supply isn’t nearly big enough for a family with more than one kid (even those that can afford them)
Are Europe and Japan toxic too? Many people just don’t want to have kids in this world.
Because previous generations made it too expensive by hoarding housing and limiting its supply. It’s sad that so many only care about property values and parking
Seattle has nearly the lowest number of children per capita in the country. I believe there may be 2 cities that are lower, and the number of children is actually dropping. It has been like this for many years, so it stands to reason that the services and amenities that are associated with babies, children and families would be sparse when compared to other communities. I don’t know that I would say that it’s toxic to families. For the same reason, you don’t find a lot of large department stores in small rural areas or Ethiopian Restaurants in Wyoming
The decline in midwifery services has affected pregnant women in other cities as well. I was one of the last to have a midwife-assisted hospital birth from a major clinic on the East Coast – shortly after my baby was born, my midwife lost her hospital privileges. Midwife care in the hospital is an amazing model that provides the hands-on care of a midwife, which can also facilitate non-medicalized birth, while providing a location that can support an emergency. This news is a big blow to expectant mothers and their families in Seattle.
In 1983 and 1987, we made the choice to drive from North Seattle to Redmond for prenatal care and delivery of our 2 kids because Group Health had a midwifery program there. Best experience of our lives. So sad to see this opportunity going away for so many. Childbirth is a natural event and midwifery is a safe and supportive service for most moms and babies.