Health Care

Kansas midwife law means some moms-to-be must make other plans at this hospital

Midwives, mothers-to-be protest outside Shawnee Mission Medical Center

A group of midwives, moms-to-be and others protested Sunday outside Shawnee Mission Medical Center.
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A group of midwives, moms-to-be and others protested Sunday outside Shawnee Mission Medical Center.

A group of midwives and moms-to-be protested Sunday outside Shawnee Mission Medical Center after the hospital found itself without a doctor willing to enter into the formal partnership the midwives need to practice under Kansas law.

An obstretrician/gynecologist in the hospital's network worked with midwives until recently. Kara Winkler, a nurse midwife from Lenexa, said that when that doctor decided to discontinue those partnerships, no one else at the hospital was willing to take them on.

That's forcing some pregnant women who had hoped to give birth at Shawnee Mission Medical Center to make other plans.

“Our moms are really upset about the situation,” Winkler said.

Certified nurse midwives are advanced practice nurses with extra training in gynecological medicine, prenatal care and postnatal care. They're generally appealing to women with low-risk pregnancies who prefer minimal medical intervention.

By delivering with a midwife at a hospital, moms-to-be can plan for that type of experience but have medical support on hand if something goes wrong.

But Winkler said Shawnee Mission Medical Center is one of a growing number of facilities where she and her colleagues are no longer able to ply their trade because of the collaborative practice requirement.

Shawnee Mission Medical Center spokeswoman Morgan Shandler said the hospital supports midwives, but the situation is not entirely within the hospital’s control.

The obstetricians affiliated with Shawnee Mission Medical Center are not employees but community physicians who have admitting privileges at the hospital. The physicians who are employees of the hospital aren’t as good a fit to partner with midwives because they don’t follow women through their entire pregnancies.

“Shawnee Mission Health recognizes the benefits of midwifery care for low-risk patients, and has been privileged to have midwives on our medical staff for many years," Shandler said. "Recently, the community physicians who supported many of these midwives have chosen not to continue those partnerships, and physician affiliation is required for midwives to provide care at the Shawnee Mission Birth Center."

Shandler said the medical center would look for additional opportunities to incorporate midwives in the future.

Winkler said she and the other midwives didn't blame the doctor they used to work with, who told them she just couldn't keep up with her own practice while also doing midwife supervision.

“She was busy,” Winkler said.

She said other doctors seemed reluctant to sign the collaborative practice agreement with the midwives because of misconceptions that it would increase their malpractice liability.

The situation could repeat itself at any Kansas hospital.

The state's certified nurse midwives pressed for legislation that would allow them to practice independently of doctors in 2015 and 2016. A lobbying group for Kansas doctors opposed the bill and a compromise was struck to allow midwives to practice independently only if they get two medical licenses: one from the state's nursing board and one from the board that regulates doctors.

Winkler said that unusual arrangement has held up the process of writing rules and regulations to enact the bill and so, for now, nurse midwives can only deliver babies in Kansas under physician supervision.

“If we did not need that we could be at any hospital delivering babies,” Winkler said.