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Hahnemann Hospital Closure - and History of the Midwives Who Worked There

Hahnemann’s Nurse-Midwifery practice was founded by two Penn graduates. Numerous Penn students had the opportunity to learn at Hahnemann, and some joined the practice after graduation.

Penn Nurses for Sexual and Reproductive Health recognizes the closure of Hahnemann as a major loss in access to reproductive health and choice in Philadelphia, and a devastating example of the priority of profit over the health of the community.

Hahnemann Hospital abruptly announced closure to its employees in a letter on June 26th. The CEO and owner, Joel Freedman, is an investment banker from California. His plan is to sell the hospital, which some consider prime real estate, for the construction of luxury condos.

The 496-bed hospital said it would close on September 6th. Despite a “cease and desist” letter from the Department of Health and an order from the Philadelphia Common Pleas Court to delay closing until a clear plan is in place, the closing of the hospital has moved full speed ahead. As of 7 am on July 12, all non-emergency surgeries and procedures - including childbirth - were stopped. Since July 17, the emergency department has stopped admitting patients; any patients who need in-patient care are being transferred elsewhere. The department will close entirely on August 16th.

The closure of Hahnemann represents a blow to accessible health care in Philadelphia at large. As a “safety-net” hospital, Hahnemann has served mainly low-income communities.  Two-thirds of all patients utilizing government health insurance and one-half reported having utilized free clinics in Philadelphia. In particular, Hahnemann’s closure will decrease access to reproductive care for vulnerable populations in Philadelphia. The closure of the labor and delivery floor on July 12 added to a growing shortage of birthing units in Philadelphia which will disproportionately affect low-income individuals, posing both a logistical and psychological burden on already marginalized communities.

Over 800 pregnant patients planning to deliver at Hahnemann were notified that they need to make alternative plans for their delivery. Jefferson University Hospital moved quickly to give Hahnemann midwives and OBGYN providers emergency admitting privileges. These families will now either follow their midwives to the Jefferson labor and delivery unit or find a new provider at another hospital. According to a staff member from the Drexel OBGYN practice, employees recently received a letter stating that all clinicians from the department – including the midwives – will be terminated, alongside a total of about 40% of Drexel’s practice.

Associate Professor Emeritus of Nurse-Midwifery Bill McCool commented in a recent WHYY article saying, “Any time a woman is pregnant and is going to deliver somewhere, a lot of the well-being of that pregnancy depends on the woman feeling confident in the provider that she’s working with and the institution where she’s going to deliver in. To have that rug pulled from under you, especially when you’re at nine months of pregnancy, it’s a big deal.”  

The Hahnemann midwifery practice was founded in 1986 by two Penn Nurse-Midwifery graduates, Katy Dawley, CNM, Ph.D. Penn (’85) and Michele Moloney-Kitts, CNM Penn (’85). Before nursing school, Dawley worked at CHOICE, a Philadelphia organization serving a population of people with limited access to medical care by providing referrals, counseling, education, and advocacy. Dawley recalled, “We worked very hard looking at prenatal care provision in the city. We visited every clinic, every hospital, to see what kind of care women received. It was clear there was no continuity, and if you looked at statistics in Philadelphia, we had high maternal and infant morbidity and mortality.”

She decided to change the system from the inside by becoming a midwife, and then by opening the Hahnemann midwifery practice. When patients didn’t trust their doctors or knew they would be treated with disrespect at a particular place, they might call 911 and go to the nearest hospital instead of seeking to deliver their baby with the practice they saw prenatally. Or perhaps they didn’t make many of their prenatal appointments with a particular office because of the stigma they faced, so showing up somewhere for the purpose of continuity was insignificant. In a phone interview, Dawley stated, “our goal was to change the nature of how poor people receive care.” 

The midwives saw their patients in close to a dozen clinics across the city and patients would come to Hahnemann to deliver. After the first year of practice, the City of Philadelphia looked at continuity of care outcomes; the midwifery practice had a 98% show rate at Hahnemann for delivery. The midwives were able to create trusted relationships with their patients by doing things in which midwives are often experts: meeting people where they are, listening and showing empathy, supporting bodily autonomy and shared power, and grieving and celebrating alongside the families for whom they care. Plus, the midwives provided taxi transportation that would get their patients to Hahnemann when it was time to have their baby.

Dawley recalled that 10 or more Penn nurse-midwifery graduates worked at the Hahnemann practice over the years. For a time, they also took nurse-midwifery students. One of those midwives, Mari-Carmen Farmer, CNM (’17), and new Chairperson for the Philadelphia affiliate of the American College of Nurse-Midwives, worked at the practice for the past two years. In an email to the members of Philly Metro Midwives, the Philadelphia chapter of the American College of Nurse-Midwives, Farmer said:

This loss will inevitably represent a further narrowing of choices for birthing people and families in our city, especially for the populations we serve, who tend to already be at the margins of society in so many other ways. Despite the circumstances we are faced with, we are committed to continue providing the high standard of care we are used to delivering and working to build new partnerships that will allow us to continue practicing in the collaborative manner that our families have come to rely on…we are sure of one thing - this closing represents an important moment in time to draw attention to the inequities that exist within the healthcare system, to the implications of the failure of our nation to figure out a way to sustainably care for all people, and to the essential contributions of midwives in providing quality affordable and culturally appropriate care.

Farmer also shared moving words on her Facebook page highlighting the closure’s impact on her patients and colleagues and the connections between justice and healthcare.

Penn Nurses for Sexual and Reproductive Health recognizes the closure of Hahnemann as a major loss in access to reproductive health and choice in Philadelphia, and a devastating example of the priority of profit over the health of the community.

 

Posted August 6, 2019