Bonus Episode | Midwives Under Assault by Hospital Administrators

I have one doctor come up and go, did she really just get let go for that? Because here's what I did in my office. And nobody even blinked and I've had at least three or four different physicians from the OB department come up and tell me it's impossible that they're letting her go just for that. I'm here today with you guys to try and raise awareness about the fact that something is going on, against midwives, against birthing centers and against choice for women.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

I'm Cathy Parisi. I am the midwifery and clinical director at the Connecticut childbirth a women's center in Danbury, Connecticut. I have been a midwife for 27 plus years. I started off working at AOL for a couple of years as a midwife and a large practice and then got the invitation to come and join the opening of the Connecticut childbirth Women's Center in 1997. I have been the director there since 1999. And have seen a lot of stuff happen over the years. When I first joined in 97. I received clinical privileges at Danbury hospital. And as a as a historical thing, I actually was born in Danbury Hospital. I'm from Danbury, I worked there for nine years as a labor and delivery nurse in both the unit and as a manager of the evening and night shifts. So I have a very long history at Danbury Hospital. I'm here today with you guys to try and raise awareness about the fact that something is going on against midwives against birthing centers and against choice for women who want to do anything other than enter a hospital and be told what their their non choices are. I have not had that experience really at Danbury hospital, to be honest, I have enjoyed very much along with my colleagues doing deliveries at Danbury, I find the physicians, the nursing staff, the supportive staff are are quite wonderful. But the administration in the last couple of years as the new Vance health system has taken over, has, has started with I feel as a campaign against my midwifery practice. I can't prove it. But there's something going on. We lost a midwife last year for a similar circumstance. Stephanie was one of my midwives and she she was investigated and in the end told you can have your privileges reinstated, but you have to go through six months of this, this remediation, she finished the remediation and basically said, bye. I can't stand here with this kind of culture. We thought that was kind of a blip. Go ahead if you have anything to interrupt.

Uh, yeah, I mean, so she went through the remediation so she could leave in good standing, but she knew it was all a bunch of nonsense. And are you it sounds like I've heard a lot of stories about this lately. It's been extremely disturbing. And it's been very clear the more details that are given in each instance of people reporting these investigations that they're there, as you said, a campaign. And they're under some kind of false pretenses, like these bogus pretenses of often professionals who've been doing what they've been doing without a single complaint for many years. And suddenly there's this force coming down on them. And clearly, you've seen that happening. Are you willing to give the details of what the so called investigation was against her?

The Stephanie investigation, I'm not at liberty to talk about there's some ongoing stuff. I can certainly talk more about what's going on now with this. This current midwife if you're ready for that story, I'm certainly yes, anything you can share is helpful. Yes,

in April, one of my midwives saw an 18 week pregnant lady for a routine visit. She had no complaints other than a mild headache, which is fairly common in your second trimester. And the midwife took the patient into the room and had a difficult time finding heart tones with her Doppler she heard some scratchy heart tones but wanted to make sure that she really had heart tones so she brought the ultrasound which we have on our unit is in our in our office as much as most physicians and midwives to for point of care testing. And she ultrasound the patient was sure she counted heart tones at 150 to 160 beats a minute. Sofitel movement reassured herself and Thought she reassured the patient and the patient left the patient call the next day and said, I'm still not feeling this baby moving around. I need some more reassurance. And so I invited her back and I happened to be on call. And the patient came back and I put an ultrasound because I could not find heart tones. And unfortunately for this family the baby had expired. The concern that I have relates to the fact this patient made a complaint to the hospital that she felt the midwife was acting outside of her scope of care, which is not true. And the hospital decided then to investigate this particular incident that happened in my office, not an incident that happened inside the hospital had nothing to do with the hospital and started their investigation. We also did a peer review, and found that there was no fault. This is a pre viable gestation. I don't mean it's any less heartbreaking for this woman and her family. But there was nothing this midwife could have done. Even if she was wrong, and she miscounted heart tones or didn't see heart tones and movement. She could never have fixed the problem. You have a question, Trisha. Just how could she have been accused of practicing outside of her scope of care finding heart tones, that's her job.

I do not have any idea. And as a matter of fact, the American College of nurse midwives does include point of care ultrasound in their standards for midwifery care.

And you've been doing that for for many years, seven years this for 20 years. It's part of what everybody does. Part of the investigation, I'll jump forward a little bit focused on the fact that they told this midwife that she was operating outside the standard of her license, which is not true, that she is not credentialed or certified an ultrasound. And the retort is, neither are most of the obstetricians who are currently operating out of Danbury hospital or any hospital, you learn from doing. I'm not talking about doing an anatomy scan, you know, figuring out is there a discrepancy in a twin to twin gestation, that sort of thing? This is point of care, is the baby head up, head down? How far along is the pregnancy? Are their heart tones, that sort of thing?

And had she not actually done the ultrasound? And maybe the baby did have heart downs the day before? And maybe something happened overnight? That's very possible that, you know, the next day, of course that and had she not done that she would have been accused of negligent care for not checking in with an ultrasound.

Absolutely correct. Absolutely correct.

Do the midwives work for the hospital? And if so what power or recourse do they have? If something like this is happening? So as a result, you are saying they're allowed to do what they're being accused of? Not? They're saying you weren't allowed to do this, they are allowed to do this. I just did not start in the hospital today with you. Of course, you can do this. And you just said that they all the authorities would agree on this. If they were to look at all the information, what recourse is there? And do you guys work for the hospital? Technically, they pay the paycheck? Is that the issue? The first issue?

Absolutely not. We're actually a private facility. We are a midwifery practice, just like an OB practice not employed by the hospital. We credential at the hospital. So we have privileges there. And there are a set of bylaws that allow hospitals almost a monopoly over what they are allowing themselves to do with their medical executive committee. They can take privileges away, basically at whim, obviously, because this is it's I'm just to this day, it's been April two months. And I'm still flabbergasted that this woman is at risk of losing her privileges permanently. So the recourse at this point is we have hired an attorney, we do have counsel, and this attorney is going to try and defend this midwife, and I'm not really sure with the board of directors or the medical executive committee, but try to defend her and get them to reverse their decision. The problem we have right now is that I had one midwife resign, she retired. I have another midwife whose last days this week because quite frankly, in Fairfield County, she can't find a house to buy in her price range. I have this other midwife who is accused of performing outside her scope. She can't provide care at the hospital. But the last two months we've been covering her. I'm left with three midwives. I can't operate at the hospital and at the birth center with three midwives. Our practice is way too busy. And it's heartbreaking to me that I'm hoping this is only for the short term, but we have notified patients that we will not be doing deliveries in the hospital voluntarily the rest of us after July 1. And I'm just I patients are angry patients whose And I am too I'm, I don't even know what to say, to not be able to, you know, provide the care. I had a woman on Saturday who came into labor I came in extra to cover because there were too many people in labor. And we do that for each other, which is, you know, to provide a woman with care. And it was their second baby and she had decelerations in the birth center baby's heart tones, I rushed her to the hospital. And if I didn't have my privileges, after July 1, I would have packed her in an ambulance and said, See you later. And instead, we went to the hospital, got a baby out with thick meconium and decelerations. And but a vaginal delivery. But she would have not had that midwife care. And after July 1, she won't for at least a short time. It's it's just making me insane. It really is for both my patients and for us. But there's also a little more to the story. If you want to hear just a little more, absolutely. This midwife had her hearing in front of the medical executive committee on I believe it was the the third Tuesday of May. Prior to that meeting, there was a Monday at Department of OB GYN business meeting. I'm part of the medical staff. So are the other midwives. And we attend these meetings because it relates to the department. And it's a Zoom meeting, like we're having now and the department chair had a very short presentation and the short presentation was to all these 2530 people who were there to say that the department was going to do a voluntary audit with a cop, it's actually a really good thing. You have an audit, an auditor, you asked for an audit to come in, you pay them I don't know how much money and they come in and look at your statistics. They talk to people on the unit, what can we do better? What are we doing good. I've participated many times in the past. It's really a very productive meeting. So the next slide that came up said who's going to participate? And the participation was a physician from each of the three big practices, all the residents, the department chiefs, the nurses, and some of the opposite the hospital staff. And I'm going up, I unmuted myself and said, I see that there are no midwives involved. Is that an error? And he barked back at me. No, Kathy, it's not an error. We are not allowing midwives to participate in this audit, we are doing a deep dive into our midwifery program. I was shocked, I think I said, a deep dive about what and that was it. My time was over. The next day is when this midwife went before the medical executive committee. And she actually thought that the hearing she's not allowed to have anybody with her no counsel, no support person. The bylaws allow them to quiz her about what happened in my office. And so they did. And she came to my house for supper after and she said I feel really good about it. The obstetricians who are there made sure that the people in the audience from the committee who are not obstetric knew that this was a pre viable gestation, they knew that there was nothing that could have changed the course, I got to say that I didn't have to have, you know, licensing or credentialing for ultrasound. So she was great. Wednesday morning comes and they call her back and told her you're a horrible practitioner, you should never be allowed to participate at the hospital, you shouldn't be allowed to take care of women. You're just horrible, horrible stuff. And so they told her, You will either resign from the medical staff yourself voluntarily, or we will do it for you. Which is really not a choice. But there you go. So
what did they want her to do differently? Like? They did they tell her anything that how could they call her a horrible practitioner? She did everything?

I don't know he was supposed to do. I really don't when I tell the story, I always have people saying she must have done something else. There must be something more to it. There's not there is nothing more to it. Other than she's either human and she missed heart tones on a baby, which I suppose could be possible. But she's got 20 years experience, or the patient didn't believe she saw heart tones. And the medical executive committee believed her and not the midwife with 20 years experience, which is actually what they said that she falsified records and they're sure that there were no heart tones. And I'm like, based on what you
anyway. It's like it sounds like gaslighting. Oh, yeah, yeah. When it feels like a piece of a story is missing and that when there isn't a piece missing?

Yeah. Which is exactly why we've hired counsel, we we need some. We need help.

How are you affording that?

We do have a GoFundMe page where it's one of our patients started it for us. It has a small amount of money in it, which is fine. The owners of the practice are two physicians who are very, very Are you involved in making sure this midwifery practice goes well and carries on? They're the owners of the birth center for the last 25 years. So they have a very invested interest in us succeeding. So what are they saying with these doctors in this hospital administration? How's that conversation going between the the obstetrician to own the birthing center and the hospital?

Well, one obstetrician is a retired obstetrician. He does not have privileges at the hospital anymore. So I don't think they could care less what he says, yeah, he's lost his power, his luck. Yeah.

And the other obstetrician, she's very, very supportive. But she's not on the medic set committee. And she really has very little influence over what goes on at these meetings. And what happens. And the part that's even worse for me of all this is that I have since heard, and I can't give names because that would not be real legit for me, of doctors, I have one doctor come up and go, did she really just get let go for that? Because here's what I did in my office. And nobody even blinked and I've had at least three or four different physicians from the OB department come up and tell me it's impossible that they're letting her go just for that.

It doesn't make sense. So it has to be that there is some targeted motive here to get rid of the midwives at the Danbury hospital. Are you guys the only midwives who practice at Danbury hospital? Yes. And is this something that? Is this something that you are noticing is a trend across the country? Is this happening to other birth centers, specifically, or just midwives in general,

I'm hearing it more and more. I believe in Massachusetts, the Beverly birthing center, the North Shore birthing centers, both are hospital owned, so it's a little bit different, are in big danger of being shut down by the hospital because you know, they don't make that much money. They're not that important to the community. Happily for us, our birthing center is privately owned, and we serve as quite a few women, we also do a big GYN practice. So we will stay in business, but to not have that continuity for the hospital. It's huge for me, in my practice and in the community. Yeah, I remember when I came to give birth there and I met you in 2004. Kathy, How reassuring that visit was. And one of my questions to you was, what happens if I needed a hospital transfer? I mean, I don't know if I would have felt I could make that decision to switch because I was so uninformed at the time. And I was so driven by fear and all the rhetoric that I had been exposed to in my life, and I was coming from such a high intervention doctor that had messed with my head, so much. So I didn't know a lot back then. And I needed all the reassurances because I still perceive that as a very important part of the safety, but it is that plan B to have a doctor or a C section or the internet that we need that plan B there. And if Plan B is well I put you in an ambulance, and I have to bid you goodbye at the door of the ambulance. That's really scary because you develop a relationship with your midwives, and you look at them, and you start to feel safe with them and you envision your birth with them. And to think that there's any scenario where they will not be with you is is enough to make women opt out.

Absolutely, we're not really seeing that yet. But of course, this is new that we're pulling out of the hospital, at least temporarily. Our plan B, first of all, most birth centers do not have midwives who are privileged at their hospitals, and most homebirth midwives are not privileged to hospitals. So there has to be some sort of a plan for us now, what are we going to do when we are unable to be at the hospital? And you know, I said this earlier, the physicians residents and nurses that we work with, I think are very cognizant of the fact that these women are not looking for, Do this, do this do this routine, standard care, they're looking for choice, they're looking for options, and they're looking for more holistic care. But if they do get sent to the hospital for a reason, it's generally because something is not going according to plan. So if something's not going according to plan, you're probably going to have an intervention that maybe you didn't want in the beginning. But it may be something that's safer for you and for your baby. So no, I don't want to put a woman either in an ambulance or her own car who, who needs an intervention or wants an intervention that she didn't think that she wanted to send them without us. But that's going to be our plan at this point. I know that you may or may not know we do work fairly closely with the residents. We're teaching them all kinds of things. How do you somersault a baby through a chord instead of clamping and cutting it? Can we really deliver on our hands and knees? What's a lotus birth? So we're we're helping get this whole new generation of physicians trained and not just the flat on your back with your knees pulled by your ears. So hopefully, these these physicians and the attending physicians and the nurses will continue to treat our patients with care and dignity that that we do and you're Putting them in an ambulance and they're going across the street to Danbury hospital where you are at risk of losing your rights. They're just we're not we're not at risk of losing our privileges. We I mean, in the future we may be we are going to voluntarily take our privileges on hold. So we're not getting kicked out of the hospital other than this one, midwife? I because I think people don't understand that the reason we're not going to be there is by choice, because, one, we need to stand in solidarity with this midwife. But more importantly, I don't have enough staff to safely cover the birth center in the hospital.

But that is a fear that they could remove the privileges in the future. That's a big concern, isn't it? Okay.

It is a very big concern. Yeah.

So Kathy, can you speak a little bit to what your thoughts are on what is behind it? What is behind the hospital administration? Wanting to not have midwifery care? Under their roof?

Yeah, I have a theory. I don't know if it's right, because nobody will talk to me, despite the fact that I have tried talking to people in the administration a couple of months ago. And for the life of me, I can't remember who said it was probably when I was a little bit tired, said, You know, we don't like some of the kinds of patients you bring here. Well, you know, that story, you know, the more informed and empowered the more of a problem they are, the less compliant they're likely to be.

Right? That's the, that's where they want a choice. So you broke your water. I think that sometimes that upsets the administration that well, the safest thing is to get induction going. And that's not necessarily the only option for sure. And you all know that until Labor starts giving time to go into labor alternatives. And then you've got how to do an induction if it comes to that, or how to well, the women who are coming in with choices and preferences and knowledge and empowered decision making complicate their policies and protocols. Because when a woman declined something, now they have to figure out how to chart differently and who's responsible and who's liable. And there's the word right there. That's the word there. I believe that the administration again, I don't know this for a fact, it's my hunch, I believe that they are just waiting for something that's liable to happen. Some baby gets septic, some something happens, because they didn't intervene in the way that they felt that we should intervene. But again, I don't know. I don't know maybe when they do the deep dive, and they tell me what, you know, the results of the deep diver, I think the thing that's so upsetting to so many of us who are really inside this industry, and I've been secondhand to a couple 1000 births, so I'm not in the room like you are which you have so much awareness and knowledge that I don't have at all, but I have so much secondhand knowledge. And I have heard of extreme and severe obstetric abuse at any hospital in Connecticut or New York and some far beyond. And I could tell you a story where the first thought is, did that doctor lose their license? And here we are having this conversation over over this. It's like, it's not at all commensurate with how they're treating actual negligence and abuse.

Absolutely. And we are not held to the same standard or the physician or physicians are held to the same standard we're held to. It's just crazy. And the really crazy thing is everyone knows globally midwifery care by default, is safest. I mean, I mean, that's the first thing I teach my clients. I said it last weekend, when I was teaching, I said, Listen, you always have to hire the right provider interview them. It's not to say every midwife on the planet is a better choice than every obstetrician on the planet. But if you're blindfolded and throwing a dart, and you land on a midwife, your odds of having a safer birth outcome are much higher. That's just a reality. So what where's this? I have this very uncomfortable feeling like before we started recording, I said, I have a feeling this is happening everywhere. And you said it is I have a feeling that pharmaceutical is somehow behind this. They have the same lobby as the hospital lobby. Is there anything to that I know they've established to lobbyists in every state in recent years, so many things are changing. So many rights are being removed. There's all these disturbing things happening. Like even here in Connecticut, our governor wants to pay someone $150,000 a year, of course, taxpayer dollars to have a fact checker. It's like, Yeah, sure. So that's all the work of lobbyists. And you know who these fact checkers are. I mean, Reuters is a fact checker for many organizations. It's a name I used to trust. The Reuters is the see as it is on the board of Pfizer. They're all connected the media, the hospital lobby, pharmaceuticals. This is fact my suspicion is just my suspicion that they're behind all this. What do you think about that? Where is this force coming from? And why is it happening all over the country or at the same time? Who's behind it?

I really wished I knew. I know Connecticut has a V very, very strong Hospital Association. So I think you're right with that. And in my heart, I still think it's about money. And I think that there are a lot of administrators who are looking and going, Wow, midwives at Danbury hospital, we brought in 278 patients last year. And we didn't deliver all of them because some ended up with a C section some ended up with a vacuum or things that we weren't involved in. But they came to us 278 women, Danbury hospital, I believe does about 22 to 2300 deliveries a year, we're over 10%. And the average has been 10% for a really long time. So I think when midwives start to have a larger piece of the pie, you know, we gotta get control. Well, not only are you taking their space, but you're also potentially making them more more liable bringing in these empowered women who are, you know, so it's to them? It's not, it's like, well, we're just going to take that back so we can keep them under our foot and keep things controlled and make more money. Yeah, and reduce our liability. I mean, it it really comes down to that it has to, I think one of the toughest things about the the clients that are complaining about coming in the patients that they're complaining about. It's Yes, liability if something goes wrong, but I happen to think first of all, we can't ignore that egos are a big part of this industry. And when you have clients coming in who know their rights, because no American no general American walking around, if they're not if they don't work in healthcare, like you guys do, if they don't work in litigation, most incredibly educated, otherwise educated Americans have no idea they have the right to informed consent. So when you finally get a client in there, who's turns down something we can't ignore that a lot of doctors are like, done nerve of you? Who do you think you are to say no, to a routine IV. And I remember Kathy, I've told this story about you that I once had a client who had twins and was going to birth at Yale. And I remember, they, you know, you know how it is with twins, when a woman has twins, they terrify her every week of the pregnancy. Like, we hope you keep the babies in, keep the babies and keep the babies in and the day, she's 35 or 36 weeks, they're like we got to get those babies out. So she doesn't have a moment of rest. And this client was so concerned about the pressure they were putting on her to induce her at 36 weeks and not quote letting her go later. I remember saying let me call Kathy and just see what they do at the birthing center. And without getting into your policy. I remember so distinctly you saying to me, Well, this is what we recommend. And this is why but of course, it's ultimately her choice. And it's like ding ding ding ding like this. isn't that complicated? You were clear about your recommendation? You were clear about why? And you were clear it was her choice.

It's always the woman's choice. Always. It's just people don't see it that way. Because, well, what did ACOG just come out with? Don't coerce your patient? They did. Yeah, there's a statement, you have to look it up. It's about coercion. And honestly, it isn't that I see a lot of coercion because I really don't, because these women are so informed that they don't need to be coerced, they need to know what are my safe options?

I see a lot of coercion, of course, I'm sure you can, because I see more obstetric work through my clients than you because you're a provider who isn't doing that kind of work.

Right. But there's but there's always a choice. There's always a choice, even if it's not a choice that I appreciate, even if such I think is the safest thing. It's not my choice, right.

I'm sure you see that a lot, too. Yeah, yeah, we do. We tell me, we always say to women, you don't want to get hell bent on one course of action. And you must see the women who come in and they're hell bent. Sure, right. And that's also difficult. It is, but you know, a piece of that, and I'm sure you guys see this, as well as the more trust that you gain with a family with a woman and her family. And the more you talk to them about what do you really want off of this birth? Where do you want this to go? I know we're getting a little off track. But the reality is, if you can gain that trust, then people really do listen to what you have to say. And they feel more comfortable going well, I didn't really want to do that. But now that I've talked about it, with my midwife with my provider, I feel like it's a better thing for us, or at least I understand why they're recommending something.

That's that's absolutely true. I mean, it's not very often as a midwife, you're not in that situation very often where a woman is declining, something that you know, in your heart is the right thing. They're agreeing with you and they're going along with it because they trust you. Right.

And there's also ways to present things but anyway, but that's where I think it's it's really coming from, did you have more to add about where this concerted effort is coming from?

I wish I did. No, really? I wish I did. There is nobody who will talk to me obviously now especially that we have counsel. And but are we seeing this elsewhere in the country? You were saying it is happening? What's What do you know about that?

Mostly? About the birthing centers that are close to us, if you go on to the, the ABC, the American Association birthing centers, there's birth center after birth center listed as being closed down, closed down, closed down. I don't know all the particulars about why other birth centers are being closed down. But I will tell you that the average life, from what I've heard for a hospital own birth center is about four to six years.

Oh, my gosh, it's crazy. How is that possible?

Well, so in the case of a privately owned independent birth center, you're not necessarily making the hospital money, you're you're having your own your practice.

Not true, though, because we bring them so many women from outside the service area of Danbury hospital, we have women and you you guys both know this, from Brooklyn, from New Haven, from Hartford from Stanford from Darienne. They would never come up this way, if it weren't for the midwifery practice. And not all of them want a birth center delivery, they've heard of our reputation, they're coming up because they want to deliver with us, even if it means it has to be in a hospital setting. So statistically, they're high risk, or if they're whisked out the father population.

Absolutely. And statistically birthing centers bring a hospital five to 10% increased revenue for their OB GYN department. And I actually think it's more for us, because so yeah, so even if you're privately owned, that is, okay.

Absolutely. Plus, we have referrals. We do a lot of GYN, so women who come to us for their OB care, a lot of them will continue to come for their GYN care. And occasionally, they need a surgical consult, or there's an issue that a midwife can't handle easily in the office. And so they're making referral from so yes, the answer is, people are making money off of us and our patients. So I don't think it's I don't think it's that so much.

I don't know. Well, I what you said in the beginning there, it seems to be targeted something against midwives and against birth centers and against choice.

That's it. And not only the midwives, but also over the patients, which I think is absolutely ridiculous.

What do you want people to know?

I want people to know that one, we won't stand for it. We're going to fight this to the bitter end. We are part of the Danbury area, the greater Denver area community, and we are not just going to go down. You know, going sure whatever you don't want us we'll walk away. We have to pull up for right now as we've talked about, but we're not terminating our privileges of the hospital. We are working very hard to get this midwife her privileges back and come back full force. I want them to know that the more support that we have, we picketed a couple of times in the last month. We've got to change.org page, I'm trying to remember all these. I'm old for the internet, but change well link it will link to it. Kathy, don't worry about that. Yeah, that kind

of stuff. It speaks people are hearing it. I'm hearing from patients who are you know, wanting to donate money wanting to donate time. And those kinds of things mean a lot. I mean, we're still trying to run a very busy practice. So help is always wonderful.

That the takeaways so much that the one population of professionals who's providing the safest and most satisfying birth outcomes to women is being targeted and threatened right now.

That's exactly it. Cynthia just hit the nail right on the head. That's it.

Well, it's like Welcome to America. We see this in so many different areas in so many ways.

It's really, it's sad. It's sad, it's infuriating. At the same time,

it's no coincidence that it's happening at the same time that that same group of people, the both the women and the midwives are have grown in demand over the last two years. So it's no coincidence that this is coming at the same time that they are taking a stronger hold in the of the market.

Yeah, I agree with that. I really do.

Well, that's why they came down so much on parents who do like all like partial vaccination or not vaccinating. As soon as that population got a little bit large, they crashed down on it. And about 15 to 20 years ago, maybe over 20 years ago, they passed a law that no herbal or supplement company can claim to heal anyone from anything that like Congress passed a law that they're not allowed to claim to heal anything only drugs can heal. I mean, there's there's really deep pocket forces behind these things. And it looks local when we hear the stories but there are PR people behind this. There are deep pockets there are politicians, and scary and I guess where we are right now is awareness and advocacy for the rights of women and the providers who support them.

I believe that's true and people should keep their ears and eyes open. This is I think this is not the end of it. I think this is just the beginning.

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For women who are planning the birth center, I would say, still plan the birth center, you know, we have a very low transfer rate. If you're admitted to the birthing center in labor, you only have a 10% chance of not staying there and having your baby which is naturally it's about 14% we're a little bit lower. I don't know why we've always been a little bit lower, I'm happy with that. And we're still thrilled to take care of people. If somebody ends up risking out either before during or after the labor something happens, then the hospital is still right there. It's as close as you're ever gonna get to, you know, being next to a facility they can take care of you. And I do think they provide wonderful care, the nursery is a level to be which is great for the women who've had trouble with with infants either from the birth center, which is pretty rare, or if they deliver in the hospital. So it's a great facility and we're still open we're still going to I encourage people to you know, think about their options. They can email me they can come in for their visits and talk to a midwife. We're happy to give some extra time just to see what do they feel is going to be right for them.