Even after Dana Hurda moved from Madison to Evansville, she continued to go to the UW Health West Clinic in Madison, a 35-minute drive from her home.
The reason? Midwives. Hurda has come to depend on the specially trained nurse midwives who work out of UW and provide hospital-based midwifery services for women in childbirth. Even now that she's no longer focusing on childbearing, Hurda has relied on the UW clinic's midwifery program for her primary gynecological care.
"They really develop a relationship with you, and they spend time with you," says the 38-year-old teacher.
So Hurda was not pleased when she received a letter this summer from Physicians Plus telling her that after Jan. 1, 2013, the insurer would no longer cover UW Clinic services, including midwives. A number of other UW midwifery program patients were also unhappy, as were program staffers and independent midwives who counted on being able to refer patients who needed to be hospitalized to the UW program.
Now those patients have gotten a last-minute reprieve.
Mary Reinke, chief marketing and planning officer for Meriter Health Services as well as a spokeswoman for Physicians Plus (which is two-thirds owned by Meriter), told Isthmus last Friday that the insurer has signed a new contract that continues coverage for services and providers affiliated with UW Hospital and Clinics through next year.
"Our goal has always been to continue to have the Ob/Gyn and the certified nurse midwives in our Physicians Plus network," Reinke said. Notices patients received in June, indicating that Physicians Plus coverage for UW Hospitals-based clinicians would end Jan. 1, were sent when "there was no contract in place with UW Hospital for 2013," Reinke said in an email. "We now have a contract, and those same providers will be notified that they remain in our provider network."
A UW Hospital and Clinics spokeswoman confirms that the hospital and Physicians Plus have reached a one-year agreement for 2013 "that covers Ob services of UW Health Obstetricians and Nurse Midwives (as well as the services of the UW Hospital and Clinics Pediatrics After-Hours Clinic)."
UW spokeswoman Lisa Brunette says that all other UW Health providers at UW Hospital facilities will be out of the Physicians Plus network in 2013.
Reinke says that Physicians Plus had always intended to reach a new agreement for the Ob/Gyn and nurse-midwifery services. But that was not the impression of patients or midwives who spoke to Isthmus.
They took to heart the notice from Physicians Plus that it would no longer cover patients' visits to outpatient providers at UW Hospital and Clinics facilities and to seek out alternative providers.
The women getting maternity and gynecological care from UW's certified nurse midwives were especially hard up. That's because UW Hospitals and Clinics employs the only group of certified nurse midwives in the community that delivers babies in a hospital setting, says Debbie Healy, president of the Wisconsin Guild of Midwives.
Healy is an independent nurse midwife in private practice who attends strictly home births or births in specialized birth centers. The change doesn't directly affect her practice. But having hospital-based midwives available is important to her patients, she says.
"When my clients need to transfer in for hospital-based care, we have had an agreement with UW midwives to cover that," she says.
Had the Physicians Plus decision to cut off coverage for UW Hospitals and Clinics Ob/Gyn and midwifery services gone through, Healy and other home-birth and birth-center-based midwives would no longer have had access to that sort of backup.
Even though the situation was unexpectedly resolved for now, Healy says it still illustrates a larger problem: the fragility of access to midwifery in Madison.
That's a seeming contradiction, she notes, with the community's progressive reputation.
"We should have more midwives, serving more women," says Healy.
On Sept. 20, the midwives' guild will hold a fundraiser at the Goodman Community Center featuring a new documentary film, Freedom for Birth, that promotes the growth of midwifery worldwide.
"It highlights the need for midwifery access to care as a part of women's human rights," Healy says, "and the ability to choose not only where they give birth but also to choose their provider." The movie is to be shown in 40 countries that same evening.
The vast majority of births are low-risk events that do not require doctors or even hospitals, Healy says, but can be handled by trained midwives.
Midwives attend women through pregnancy, childbirth and after. They're more inclined to view pregnancy as a natural experience, Healy says, and believe that less intervention is better for both mother and child. Patients who prefer midwives view them as more empathetic and holistic in their approach to the mother.
Healy notes that none of the HMOs in Madison cover out-of-hospital midwifery, and only one HMO, Unity, covers hospital-based midwifery. Some private insurers do cover midwifery services in home births and birth centers, she adds.
Access to midwives is an issue for women of all ages.
"I have been getting my primary health care from the UW nurse midwives for about 15 years," says Kathryn Osborne, a Physicians Plus subscriber. Osborne, in her mid-50s, is long past having children, but notes that a midwife remains her preferred source for gynecological care. Osborne is herself trained as a certified nurse midwife and practiced in Milwaukee for 12 years; she now teaches at Frontier Nursing University, a distance-education school with a Madison campus.
Midwifery, she says, "is a model of care that supports wellness. It's the model of care that I choose for my primary care and a lot of women do."
Hurda appreciated the relationship she developed with her midwife. When her son, 6, was born and she needed a Caesarian section in the hospital, "my midwife sat with me and held my hand all the way through the surgery."
While the news that her coverage for that service will continue after all comes as a relief, Hurda is wary of the future.
She may have reason to be.
"There's a lot of barriers to midwifery access here," says Healy, the midwives' guild president. And she worries that if the Physicians Plus/UW deal turns out to be just temporary, "We're going to be right back here next year."