In the North Country, there are not many options for birthing people for maternity care. The news that the Tender Touches birthing center at Massena Hospital is closing is a big blow to the North Country. Birth workers and those concerned with positive birth outcomes and birth choice in the North Country are deeply troubled by this decision.

Barbara Hillis (CNM) is one of the few hospital-based midwives in the region. Many pregnant people around the county have sought out her care, even driving more than twice the distance to their closest hospital in order to become her patient. The reason being that the midwifery model of care is very different from that of an obstetrician, and for people who are not high-risk, midwifery care is more appropriate and in many cases, preferred.

A midwife is a trained professional who supports pregnant people before, during, and after giving birth. An obstetrician is a surgeon. This is at the core of the difference in care each professional would provide. For most birthing people, childbirth is not a medical or surgical emergency. In a study of 23,100 births, comparing midwife attended and obstetrician attended births, midwifery care was associated with significantly fewer interventions. “In low-risk pregnancies, midwifery care in labor was associated with decreased intervention, decreased cesarean and operative vaginal births” (Souter).

The World Health Organization states that “Since 1985, the international healthcare community has considered the ideal rate for cesarean section to be between 10-15%” (WHO). Cesarean section is a life-saving procedure when used in an emergency, however, its overuse on non-emergency births presents many risks for the birthing person and the baby. Barbara Hillis’s caesarean section rate was in line with this recommendation at about 10%. In 2017, the most recent year for which data was available, Massena Hospital has an overall c-section rate of 37.1%, which leaves room for improvement. However, the other major competing hospital in the area, Canton-Potsdam, has a striking 48.3% cesarean section rate and is the third highest in the state of New York. Claxton-Hepburn’s rate is not far behind - 44.4%. Both Canton-Potsdam and Claxton-Hepburn have an episiotomy rate above 20% whereas Massena is touting 0% episiotomies. Due to these staggering numbers, pregnant people in the North Country who are unable to hire Barb, either due to her schedule or insurance coverage, or other reasons, have been known to travel as far as Watertown, Saranac Lake, or Burlington to obtain the type of care they know is best for them and their babies.

Beyond cesarean section, there are a number of interventions that pose risks to birthing people and their babies that are frequently used in the medical, obstetrical model of care that are not used unless determined to be absolutely necessary in the midwifery model of care. These include 1) augmenting labor with the use of pitocin or other synthetic prostaglandins which pose risks of uterine rupture and fetal distress, 2) epidural, which confines a birthing person to bed, making labor progression slower, and makes it difficult to push effectively, 3) episiotomy, which increases risk of infection, hemorrhage, prolonged recovery time, and incontinence (Jansen).

The announcement that Massena Hospital is closing the Tender Touches Birthing Center has caused much upset in our community. Birthing people already had so few options. There is a high demand for a midwifery model of care since it is the most appropriate model of care for birthing people without high risks. Now that Massena Hospital is closing Tender Touches and it is unclear how or if Barbara Hillis will still attend births, pregnant people in the North Country are having to make very difficult decisions between traveling a long distance to deliver their babies with a hospital-based midwife or choose to give birth with the very real risk of unnecessary interventions that could have long-term physical, emotional, and psychological consequences.

We encourage people who care about birth choice and birth outcomes to contact David Acker, the CEO of St. Lawrence Health System at dacker@cphospital.org and express their concern. We also encourage you to contact your local hospital and express your concerns over the high intervention rates and lack of midwifery options for birthing people in our community.

Camilla Ammirati, Canton; Kathleen Ba, Canton; Kayla Beaudin, Potsdam; Elaine Bellinger, Canton; Sarah Bentley-Garfinkel, Canton; Jessica Burgoyne, Potsdam; Megan Carpenter, Canton; Megan Cloutier, Massena; Colleen Coakley, Canton; Carol Coakley, Canton; Nellie Coakley, Canton; Matthew Cota, Richville; Rainbow Crabtree, Canton; Lauren Diamond-Brown, Potsdam; Jessie Diamond-Brown, Potsdam; Lauren Diop, Canton; Kiley Frank, Canton; Alex French, Potsdam; Kayla French, Potsdam; Ulrike Galasinski, Canton; Kathleen Gansen, Potsdam; Tyler Gansen, Potsdam; Emily Hastings, Canton; Megan Holloway, Hermon; Kyle Holloway, Hermon; Cassandra Jock, Potsdam; Morgan Kelly, Massena; Alison Kern, Governeur; Louis King, Massena; Mary Kinney, Madrid; Jessie LaRose, Potsdam; Kira LaRose, Potsdam; Linda LeBrasseur, Massena; Sarah Lister, Potsdam; Sara Lynch, Potsdam; Megan McDonald, Brasher Falls; Kristin McKie, Canton; William McKinney, Madrid; Chantelle Mere, Parishville; Briana Morris, Massena; Amanda Newton, Winthrop; Marissa Newvine, Potsdam; Jarilyn Nichols, Massena; Alicia Otis, Massena; Jonathan Pabis, Canton; Sara Pabis, Canton; Desiree Parish, Richville; Katelynn Perry, Norwood; Peter Pettengill, Canton; Rebecca Rivers, Canton; Bianca Root, Massena; Kimberly Sirles, Massena; Kayla Sladewski, Potsdam; Cathy Smith, Massena; Anna Sommer, Canton; Chris Strebendt, Potsdam; Rachel Sturges, Canton; Valerie Summer Morristown; Alicia Taillon, Madrid; Jennifer Thomas, Canton; Leigh Ward Charette, Madrid; Sara Wells, Massena; Kurt Wells, Massena; Rosa Williams, Canton and Katharine Wolfe, Canton