Birth pangs

by Wally Graves


St. Joseph Hospital in Eureka will soon move all its beds to a new seismically sound wing where on the ground floor a birth center and nursery will offer state-of-the-art accommodations so impressive that a midwife group has opted to move its affiliation to St. Joseph from General Hospital, causing General to go on a nationwide search for replacements.

A midwife (who prefers anonymity) told me her group was pursued by Mad River Hospital in Arcata, by General and St. Joseph. St. Joseph, the group decided, "looked like the winner."

She explained that St. Joseph had recently bought out the Eureka-based obstetrician/gynecologists who have backed this group of midwives over the years, and since the midwives are "just workers, with neither money nor power," it made sense to stay with the OB/GYNs familiar to them.

She said it was a tough call, because -- despite the promised new large rooms and whirlpools -- as everyone knows, St. Joseph is guided by church doctrine on matters of reproductive rights.

"But," she said, "they're open about that -- they're not exclusive. If our patients prefer General, then we'll deliver them there."

Meanwhile, from General Hospital you may have seen a full-page ad in local publications picturing a happy mother named Kim Petrusha holding her baby and announcing in large, 36-point type, "Now I know where all my children will be born."

"They make me feel so comfortable," Petrusha says of the nurses at General, "rubbing my feet, helping me control my breathing. And they looked right into my eyes when they encouraged me. They were right there with me, all the way."

And at Mad River Hospital in Arcata, a woman in early labor will also have the option of easing the back pain of early labor in the new Jacuzzi room. When her time comes, she will be ushered to a delivery suite with its private shower, comfortable seating for family and friends, and a rebuilt heating system that keeps the birthing suites cooler than the warm nursery down the hall.

Until construction is finished and until the new mothers can enjoy the soothing sound of fountains in a garden outside, they'll get a "survival kit" of cassette player and earphones, ear plugs, almond massage oil and a baby shirt, all in a bag personally hand-embroidered by Birth Center Co-Manager Shauna Thorson.

The Jacuzzis, the ads and the competition for midwives signal a lively upgrade in local hospitals' attention to women planning a family. With the birth rate falling, it's a buyer's market. Women, I was told, are starting to shop around.

But the re-entry of St. Joseph into the birthing business raises concerns about the future of reproductive rights.

"Reproductive rights" include not only the highly politicized abortion, but also surgical sterilizations not commonly offered at Catholic hospitals -- hysterectomies, tubal ligations and vasectomies -- as well as counseling on all aspects of sexual behavior, including contraception. Executive Nursing Director Leslie Blasewitz points out that Mad River lists a woman's "choice" as paramount in its philosophy of counseling and care, and -- as at General -- service at Mad River is not overridden by religious doctrine.

At St. Joseph Roger Martin, spokesman for community affairs, was friendly and cooperative in our discussion of the hospital's new wing. When I mentioned I'd heard that some surgeries such as tubal ligations might not be available for women he suggested I talk with Sister Peggy Detert, who in turn, when she heard my inquiry, referred me to Sister Ann McGuinn, who sent me elsewhere.

At last I arrived at the office of Jeannette Lackett, area vice president of Patient Care Services, who assured me that prospective mothers could presume that when St. Joseph's birth center opens next month it will offer the same procedures currently provided women by Fortuna's Redwood Memorial, St. Joseph's sister institution.

These acceptable procedures, as I understand them, include tubal ligations, but with the proviso that the surgery be not solely for sterilization. A pre-existing indication -- for instance, severe high blood pressure, or a history of post-partum depression -- could qualify the woman for this surgery. The attending physician must document in writing that the woman needed surgery for other than solely sterilization, and the reason must be included in the patient's medical record.

When I saw a copy of this policy statement it sounded to me designed to get the dedicated, though perhaps beleaguered, Sisters of St. Joseph of Orange out from between a rock and a hard place: to satisfy the bishop -- and by extension, the pope -- on the one hand, and still provide Redwood Memorial patients this relatively simple surgery which would prevent further pregnancies.

I ran this idea past a local doctor familiar with the policies of both Planned Parenthood (famous for its liberal approach to choice) and local Catholic health providers. The doctor, off the record, acknowledged that a surgeon not conforming to Catholic doctrine could easily "wink at" the restriction, do the surgery and sign whatever was required, all with a clear conscience. "What's the big deal?" he said.

Susan Fogel, legal director for the California Women's Law Center in Los Angeles, who tracks such things statewide and who's keeping her eye on Humboldt County, told me it was a very big deal. A woman's medical record could be compromised by establishing a marginal "pre-existing" health condition just to placate a religious sentiment.

Fogel asked, "What happens when the patient later on wants to get health insurance? And her record shows a condition put there to satisfy somebody's religious conviction that has little or nothing to do with medicine?" She said women deserve better than such "marginalized" care. And, she added, what if the Catholic hospital were the only one in town?

In 1993 North Coast health providers commissioned a firm, Rosenberg and Associates, to study our health care system. The report cautiously concluded, "... there appears to be some potential for the hospitals to begin engaging in increased competition, with the objective of eliminating one of the two facilities in Eureka. This appears troublesome in that not only does it call for significant expenditure of resources in duplicative technology, but it also raises concerns such as the role of religious institutions in addressing family planning and abortion. ..."

With its new birth center St. Joseph is, in fact, duplicating services heretofore provided by General. The Rosenberg study also noted that "Because a fragmented market has made it difficult for individual providers to deliver high quality health care service in a cooperative, efficient manner, rural communities are finding that their health care delivery systems benefit when facilities and practitioners join together to form integrated provider networks."

St. Joseph has recently bought out a number of major medical practices throughout the county -- Arcata Family Medical Group, Willow Creek Family Medical Group, Drs. James Anderson and Ed Kemper, Fortuna -- and is in exclusive negotiations with the five physicians at Eureka Family Practice.

Simply put, by expanding into duplicative services, and by buying out physicians' practices, is St. Joseph eyeing monopoly (with an eye perhaps to wielding Catholic doctrine on women's rights)?

Or is St. Joseph merely fulfilling its avowed intention of "holistic community planning" as set forth in a lengthy study it commissioned in 1995, two years after the Rosenberg report?

Conversations I had with local physicians, psychologists, nurses, benefits coordinators, technicians, hospital administrators and county health workers reveal a continuing fascination with St. Joseph's expansion.

A national group called Catholics for a Free Choice is circulating locally a publication which alleges that to our north, in Eugene, Ore., 70 percent of the hospital beds will soon be controlled by Catholic health care in a county where only 4.4 percent of the people are Catholic. (Humboldt is 30 percent Catholic.)

Such takeovers are all part of a national plot by the Catholic health care system, the story says -- "the nation's largest"-- which "does not provide women who need them with reproductive health services that are deemed 'morally and spiritually harmful' by the National Conference of Catholic Bishops."

To which St. Joseph's Jeannette Lackett -- who has heard all this before -- adds, "Eureka has always had two hospitals and always will have."

With St. Joseph's new birth center Lackett thinks women now will have "more choices" rather than fewer.

When I persisted plaguing Lackett in her office about those tubal ligations, and what they might do to a woman's medical record, she put me in touch by speaker phone with Corinne Bayley, senior vice president for mission and value, down at St. Joseph's headquarters in Orange County.

In a lively, lengthy discussion, we determined that when there's but one hospital in town and it's Catholic (like the Queen of the Valley Hospital in Napa) and when a woman wants a tubal ligation, her physician either documents a pre-existing medical, obstetrical or psychological indication, or she goes to Planned Parenthood for her surgery.

It's a matter of conscience, we agreed -- the Catholic doctrine, on the one hand, and the attending physician, on the other. If the physician "lies," Bayley said, there's little the hospital can do.

Humboldt County's Deputy Health Director Rebecca Stauffer sees a potential problem here. Will women seeking surgical sterilization following delivery at Redwood Memorial -- and soon at St. Joseph -- be "fully informed that their medical record might risk being clouded with misleading information about their health?"

Dr. Stauffer, a pediatrician, strongly believes that patients should be made aware of their options. She noted that no Planned Parenthood facility exists in Fortuna, and said that Redwood Memorial's "restrictions about surgical sterilization should be stated openly and publicly so their patients know the rules."

It seemed, in talking with Bayley and Stauffer, that our local Planned Parenthood in Eureka and St. Joseph are in fact symbiotic sisters, thriving not in spite of the other, but because of it.

The people I talked with at Arcata Family Medical Group, now under contract to St. Joseph, said today's so-called managed care system was wreaking "complete devastation" on the medical group -- even threatening bankruptcy. St. Joseph's offer, accepted last year, looked benign. It stipulated but two restrictions on their practice: no abortions in the clinic and no physician-assisted suicides ("which we didn't do anyhow").

When Arcata's Mad River Hospital heard that the city's premier medical group was being bought out by St. Joseph, they feared losing patients. But it hasn't turned out that way. Though the Arcata practice is owned by St. Joseph, the doctors continue sending patients to Mad River "because it doesn't make any sense to send people to Eureka who want to stay in Arcata."

These local paradoxes reflect the nation's: Medicare is going broke; the seven American Catholic cardinals are pleading that the president disapprove federal funds for late-term abortions; and the president's most outspoken supporter in the U. S. Senate is Ted Kennedy, a pro-choice Catholic, whose brother was the only Catholic president in history.

A 1995 poll funded by Catholics for a Free Choice indicated that two-thirds of American woman -- Catholic and non-Catholic alike -- feel that religious belief should play no role in access to health services.

And who knows? Someday the pope may change his mind, or maybe the pope's power is overestimated.

In 1960 when John Kennedy won the White House it was darkly rumored that The Catholics Are Coming. But President Kennedy was far too busy doing what he did best to realize that he was supposed to take over the country in the name of Pope John XXIII.

John XXIII was a broad-minded, peace-loving pope who tried to draw people together. He called a Vatican Council to bring the church up to date, and the majority voted to lighten up the church's old-fashioned rules on birth control.

In 1963, the year John Kennedy was killed, a new Pope, Paul VI, took over. Paul VI preferred the old ways, and in 1968 issued an encyclical called Humanae Vitae/Of Human Life reaffirming the church's traditional teaching on birth control, now interpreted as: no abortions, no hysterectomies or tubal ligations for the sole purpose of sterilization for women, no vasectomies for men and no contraceptives for anybody.

Of those women whom Catholics for a Free Choice polled, three-fourths acknowledged they were "religious," but nearly two-thirds used birth control.

Wally Graves, who lives in King Salmon, writes from time to time for the Journal.

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