We recently had the opportunity to chat with Pam Harmon, Administrative Director of the Mary V. O’Shea Birth Center at St. Peter’s Hospital in New Brunswick, NJ. The birth center is named in memory of a longtime New Brunswick resident who bequeathed a portion of the funds for the facility. New Jersey’s only hospital-owned birth center opened in November 2019 and has been CABC-accredited as an alongside midwifery unit since opening. Pam notes that the birth center was opened to meet the needs of the community and to provide choices in birth settings.
Tell us about the model of care in your birth center.
St. Peter’s Hospital is a perinatal center with over 5,200 births annually. Although located in the same building as L&D, the birth center is on a different floor and functions as a totally separate unit. The birth center’s care model is rooted in the philosophy that birth is a natural process and that medical intervention should only be used when necessary. It is a midwifery-led model and us-es the same risk criteria as most birth centers. Patients sign on with the birth center early in pregnancy and work with the midwives to develop a birth plan and learn about the care model. Their post-partum length of stay averages 6-8 hours. Postpartum follow-up includes daily phone calls for 7 days and a 24-hour office visit for parent and newborn.
What exciting things are happening in your birth center?
We are introducing nitrous oxide this year. We had to stop plans when COVID hit, so now we are ready to offer it in the birth center.
We are in the planning an outpatient lactation service. Consultations will be available to anyone in the community.
We are implementing neonatal privileges for our midwives so they can discharge the newborns when peds is unavailable.
What advice do you have for some-one who is thinking about opening a birth center?
Learn the CABC Indicators before planning and developing a birth center, whether it is freestanding or an alongside midwifery unit. They can guide you as you plan, and this makes it easy to achieve CABC-accreditation.
We organized a birth center steering committee with key stakeholders who met monthly. It included senior administration so there was understanding and support from the beginning. We also invited payers to participate in the planning in order to get their buy-in.
The steering committee then separated into sub-committees to review each section of the CABC Indicators. This assured that all members were familiar with the Indicators and the importance of incorporating practices that were not the same as inpatient obstetrical care.
What changes have been made in L&D because of the birth center?
The birth center has had a positive impact on our inpatient L&D unit culture and on the staff. Many practices have been adopted by L&D, including use of birthing tools, positioning techniques, aromatherapy, and actively including the birthing person in the plan of care.
What are you most proud of about your birth center?
“I am most proud of the birth center staff. Everyone who works in the birth center is passionate about physiologic birth and supporting laboring patients in achieving the birth experience that they desire.” Each laboring patient is assisted by a midwife, and RN, and a tech who is also trained as a doula.
“The passion and commitment that I see every day from our midwives inspires me to push through obstacles so they can continue to provide the very best care to our patients. I am their biggest advocate and serve as the direct link to senior administration so that they continue to support our birth center.”
What is Your Birth Center’s Greatest Challenge?
“Our biggest challenge right now is handling our rapid surge in volume. Although it is a good thing to have, it places tremendous stress on the staff when assuring that we can book appointments in a timely manner.”
Why do you think it is important for your Birth Center to be CABC-accredited?
“I think that it is imperative to be CABC-accredited because it ensures the highest quality standards are being met, which results in optimal patient experience and outcomes.”
We also appreciate the sharing of best practices that occurs when CABC Specialists are here doing site visits. During our last site visit the Specialist shared a best practice involving use of water rescue nets. We now keep them stocked in each birth suite and they are used in L&D as well.
Tell us about your staffing.
We have 6 midwives now that are like-minded and are a great team. They attend about 20 births/month—10-15 of those in the birth center. They also continue caring for birth center clients who need transfer to L&D and also care for those who give birth in L&D electively or due to medical issues. There is one mid-wife in L&D and one in the birth center.
All of the nurses and techs/doulas work only in the birth center and the midwifery office. This separate staffing helps to rein-force that the birth center is not an ex-tension of L&D but is a separate service.
In general, the nursing staff is not cross-trained in L&D and the birth center, alt-hough we have 2 nurses who had a lot of L&D experience and now prefer to work in the birth center.
We do monthly drills with L&D and NICU. Those are so important in facilitating smooth transfers and good collaboration among the staff of each unit.
We offered a Spinning Babies class for the birth center staff and it was so popular that L&D staff requested it, too.
What inspires you?
“I am passionate about supporting pregnant people in their birth experience and including them as active members of the birth team. Optimal birth outcomes are my overall goal and providing options to low-risk patients is key to improving perinatal outcomes.”