Women and Infants Change Order Initiation of Review

We recently learned that Women + Infants Hospital has submitted a change order request to RIDOH to approve an additional 13.5 Million dollars to its budget to renovate its facilities, bringing the total cost up to 42 Million dollars. There is a public comment period that is open until 2/26/23. Women and Infants labor and delivery unit is in dire need of improvement. Capacity issues leave people laboring in the emergency room for long periods of time, sometimes even birthing there. Most l&d rooms currently have no shower, tub and laboring people share a toilet with their neighbor. Larger, improved rooms are needed and wanted. The proposed changes, however, have a few

Those of us who have been involved in the decades of advocacy work with Women & Infants hospital, equitable birth center regulations through the department of health, and initiatives that relate to birth justice in Rhode Island read through the change order proposal we have some concerns. We want to inform our community of birth workers, families, organizations and allies of this process and encourage public participation. Improving the lives of our community doesn’t happen at the hands of a few decision makers. Birth is safer when people are listened to, and we center the experiences and voices of BIPOC families, birth workers and grassroots reproductive justice organizations.

Our concerns:

The use of the term "Birth Center"

 - in the change order request, WIH repeatedly refers to the updated labor and delivery unit as a "birth center." WIH is not a Birth center. The term "Birth Center" has a specific meaning according to RIDOH regulations:

  "Birth center", or “Center,” means any public or private establishment, place or facility, geographically distinct and separate from a hospital or the mother's residence, staffed, equipped and operated to provide services to low-risk mothers as defined in § 8.3(A)(9) of this Part during pregnancy, labor, birth and puerperium." RIDOH regulations: Birth Centers (216-RICR-40-10-8)

- In addition to Rhode Island's regulatory definition of a Birth Center, the term carries with it an association of a specific model of care, that is referenced across a broad range of published policy and research. Notably, there are multiple studies showing that culturally-centered Birth Center care has positive impacts on improving care for BIPOC Birthing people. (Source https://pubmed.ncbi.nlm.nih.gov/34817759/) Though the definitions vary slightly from study to study, the commonalities include that birth centers are geographically distinct from hospitals, and utilize a midwifery model of care that centers informed consent and prioritizes low-intervention birth management. Our community has an expectation that a "Birth Center" uses these models of care. While WIH does have some associated midwifery practices, the institution as a whole is associated with an obstetric hospital-based labor and delivery model of care. It is not a Birth Center. 

Sources:

Capacity 

According to these and other national standards, the max birth capacity for 20 rooms is 8000/year which WIH has exceeded for years. 20 rooms is not enough. Several versions of plans for the previous labor & delivery floor and rooms have made their way around verbally. Some for additional triage, some for ABC care, some for l&d overflow, but nothing exists in writing to guarantee space and staffing for the volume of births that occur at that hospital.

New Facilities does not equal better care

As doulas who attend multiple births with different practitioners at different birthing facilities in and around Rhode Island, we have a unique viewpoint into the trends and practices in the various practices and settings. At WIH, doulas have reported attending well-managed and respectful labor, delivery, and postpartum care in some cases, and in other cases witnessing coercion, negligence, racism, and obstetric violence. Updating the physical facilities will not address any of these concerns. While improving care takes time, the misleading name and safe number of rooms are vital to the commitment to safe and respectful care.

Association between Hospital Birth Volume and Maternal Morbidity among Low-Risk Pregnancies in Rural, Urban and Teaching Hospitals the United States

Better public awareness

Real public discourse. Public comment became open on 2/11/23, but to who? I received an email from a fellow doula who received a personal outreach from our department of health. If the goal is public comment, RIDOH and WIH need to use their platforms and marketing do inform the public. So far, this outreach is being done by community doulas on their own unpaid time using our web platforms we pay for personally. Some of us have been invited to tour mock up rooms and leave ideas, comments. There has not been a response or discourse about those, and the tours have been more of an amenity tour.

Our Asks:

  1. That WIH refrain from referring to itself as a Birth Center. It is not a Birth Center. There have been multiple efforts to establish a freestanding Birth Center in RI, and there are currently none in operation. The misuse of the term "Birth Center" by WIH is not only inaccurate, but also undermines these ongoing efforts, and would misrepresent the reality of the perinatal landscape and birthing options for birthing people in Rhode Island. It would also have a negative impact on Birth Center research as it clouds the definitions.

  2. That WIH address its capacity issues and add additional labor and delivery rooms. 20 rooms is not enough. Not only is WIH exceeding its physical capacity, it is exceeding its staffing capacity. Doulas, patients and staff have witnessed many instances of negligent treatment due to staffing shortages. Even a well-trained, expert, culturally-competent practitioner cannot adequately care for patients if they are understaffed and over a responsible case-load. 

  3. Hold a public and open forum to discuss the changes in a public setting. The 190 page change document has important information that pertains to the lives and safety of everyone who receives care and works at Women and Infants hospital. This information as it is presented is complex and isn’t accessible to many people. Time should be spent to present this to the community, hear questions and responses. This also should be marketed appropriately using RIDOH and WIH websites, social media and be held in a child friendly time and space.


How to submit public comment:

All written comments by affected persons should be received via e-mail: Paula.Pullano@health.ri.gov

by February 26, 2023, when practicable. Copies of the Change Order request are available for review

in Room 410 of the Rhode Island Department of Health and may be available on-line: (LINKED HERE) 

If you have any questions or for alternative methods of submitting comments, please call (401) 222-

2788.