Ever since Missoula’s first birthing center closed last January, I’ve been watching with interest the efforts of Jeanne Hebl, a certified nurse midwife who worked there, to open a new one. Now, those efforts are finally looking successful, but a rift between Hebl and Community Medical Center has thrown another curve ball at Missoula parents interested in midwife-supported natural birthing.
Missoula’s first Birth Center opened in May 2006, but the November 2008 death of its founder, Dr. Lynn Montgomery, yanked the rug from under it. No other doctor was willing to permanently take over Dr. Montgomery’s role, and—without a supervising OB-GYN with admitting privileges at Community Medical Center—the first Birth Center was no longer able to provide birthing services to mothers who preferred to deliver in a hospital.
Deprived of this vital revenue stream, the Birth Center’s business model was no longer viable. Dr. Montgomery’s widow leased the practice to Community Medical Center, which promptly discontinued offering birthing services there.
Since then, Hebl has worked to restore a Birth Center-style facility to Missoula. After about a half year in an intermediate space that was too cramped for a birthing room—restricting Hebl to offering only prenatal care and home-birth services—Hebl opened a new Birth Center at 2404 39th Street in early October. Last week, I learned that her staff had completed work on one of two planned birthing rooms, so I stopped by to take a look.
“We’re carrying on the philosophy of the old Birth Center,” Hebl told me as she proudly showed off her new facility’s first birthing room, which is designed to look more like a bedroom (or, really, a high-end hotel room) than a medical setting. A large bed, a gas fireplace, a rocking chair, and plenty of natural light all contribute to the homey atmosphere, and a spacious bathroom with a big birthing tub is readily accessible at one end of the room.
No one has delivered yet in the new birthing room, but Hebl tells me that the first likely candidate is fast approaching her due date, so the room could receive its inaugural use any day now.
This brings us to Hebl’s recent rift with Community. While most mothers who begin their deliveries at a birth center finish there, some end up transferring to a hospital (usually for non-emergency reasons, such as changing their minds about receiving an epidural). Naturally, if one of Hebl’s patients transfers to the hospital, she will want Hebl to come with her, but—in early October—Community Medical Center banned Hebl from its premises under threat of arrest.
Even before the ban, and ever since the closing of the old Birth Center, Hebl had operated in a grey area when accompanying patients to Community Medical Center. Like at most hospitals, Community Medical Center’s labors and deliveries are supervised by OB-GYN doctors. These doctors accept legal responsibility for various aspects of the delivery; in turn, they are allowed to authorize people such as certified nurse midwives to provide medical services for the laboring mother, up to and including catching the baby.
Before last winter, Hebl received this authorization from Dr. Lynn Montgomery, the founder and head of the first Birth Center. After Dr. Montgomery’s death, another Missoula OB-GYN provided authorization on a temporary basis, but that arrangement ended with the closing of the first Birth Center.
Ever since, any time that Hebl has accompanied a patient to the hospital, it has been as an invited guest of that patient, with a status similar to that of a family member or doula. As a result, Hebl was limited in the services she could provide.
“Mainly I was there to support patients and advise them about the choices they have,” Hebl said. “The extent to which I could do that depended a lot on which nurses were present. Some of the nurses there are very open to whatever the patient wants, while others can be less flexible. I guess some of them must have felt like I was crossing a line, although no one ever told me where that line was. I wish they would have discussed it with me before cutting me off.”
In response to the ban, several of Hebl’s past and present patients have been lobbying hospital officials to reverse their decision. Hebl says that there have been some positive developments, though she can’t yet comment on any specifics. An email requesting comment for this article from Community’s Chief Medical Officer, Dr.Jonathan Weisul, has so far gone unanswered.
“Unfortunately, I need them a lot more than they need me,” says Hebl. “I guess we’ll just have to wait and see, but I’m hopeful we can reach an agreement that puts the patients first.”
The new Birth Center is at 2404 39th Street. The phone number is 406-541-7115.