Medical and Midwifery Burnout Part 3(b)

Administration Bad Actors and Corporate Blackmail

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Hospital corporate business is BIG business. Making money is the mission. Everyone employed in corporate healthcare knows it. An average consumer may know it on an abstract level. Hospital advertising will claim to “be there for you in your time of need” with endearing images of children, the elderly, and newborn babies in their mothers’ arms. But consumers should understand that this warm and fuzzy advertising does not originate from altruism. Even faith-based corporations competing for profits and filled hospital beds are as crude and diabolical as any other business founded for purposes of financial gain. When corporate profit is the primary goal, you can predict that the more aggressive, for-profit healthcare institutions will be the ones to nurture the ugliest cultures of care.

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Once upon a time, there was a faith-based hospital corporation that employed certified nurse-midwives. They were one of the first hospitals in their city to “welcome CNMs”. At that time, eager nurse-midwives were somewhat naive and unaware that they were to become “lunch” for the labor and delivery nurses. (I am confident that these feasts are ongoing, in present day.) After a few years, the hospital engaged in an expansion with a lovely new labor and delivery unit. Sadly, this new unit did not consider adding a birth center to its original plans. This was a disappointment to the midwives, but not a surprise. A majority of the nurses on the unit were not supportive of midwifery so conducting a low-intervention birth, following a midwifery model of care, was not a priority for anyone but the midwives and their patients.

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At a certain point in time, a small group of midwives began to dream of creating an out-of-hospital birth center in the neighborhood. Since the majority of the hospital’s obstetrical patients were white middle-to-upper-class, there was a need in the community to serve an immigrant population which was under-insured and struggling to receive public assistance. The midwives began to develop their dream for a birth center for the under-served. It was an altruistic and reasonable plan. There were large, turn-of-the-century homes in the neighborhood which were affordable and potentially suitable to contain a small birth center.

Over time, the midwives continued to dream and construct their plan on paper. Until, one day, word got out to hospital administration. Although the birth center planning was still in early stages, hospital administration was livid. They pounced on these plans and the midwives behind them. The midwives were forced to appear before a hospital board inquisition, not unlike a law enforcement shake down. Their jobs would be terminated if they did not immediately “cease and desist” their birth center planning.

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For some reason, this megalith of a hospital believed a proposed neighborhood birth center, for needy patients, was going to present a threat to its community standing and economic stability. The amount of administrative paranoia and outrage displayed was far out of proportion for what was contemplated by these well-meaning providers. When the hospital was faced with this tiny ant of proposed competition, they reacted with animosity, threats, and removal. It was a situation that was handled poorly by the hospital, yet it was not atypical behavior for that particular administrative culture.

Since the midwives had young families, they did not want to lose their jobs. The corporation prevailed. The blackmail was complete and effective. The birth center plans were abandoned, and agreements were signed. The out-sized ferocity of the hospital forced the intended result. Corporate bullies usually get what they want and more than they require. None of this had anything to do with patient care or proposed needs in the neighborhood. It was about power, control, and greed.

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Following this incident, the hospital decided that they would build their own birth center, according to its notion of what a birth center should look like. An unsubstantiated rumor suggested that the shamed employees were not involved in the planning for the new birth center addition.

Several years have passed and I find myself hoping that the midwives in this story have moved on from that experience of corporate venality and are engaged in fulfilling midwifery practice. In a much better place.

http://www.midwivesontrial.com