‘We’re not the bad guys’

“I am very hurt by the way the midwifery story is being perceived,” began Dr. Leslie Ballard during a recent interview she requested with the CN&R.

Ballard, a private practitioner who is the only female OB/GYN in Chico who delivers babies, was referring to the Feb. 26 News story, “Chico’s first nurse-midwife jumps ship.” The article was about longtime Chico nurse-midwife Lisa Catterall, who had decided to discontinue her 25-year association with Enloe Medical Center; instead, Catterall will begin delivering babies at Feather River Hospital in Paradise on May 1.

Catterall cited financial reasons for her move, as well as Enloe’s refusal to put her busy practice under its umbrella after a vote of eight local obstetricians came out against supporting her.

“I got the perception that the article said that greed was implied, and voting out the competition,” said Ballard, referring to Catterall’s characterization of the motivations of the group of obstetricians, of which Ballard is one.

Making it clear that she was representing herself only and “not speaking for Enloe or other practitioners,” Ballard—who moved to Chico two years ago from Tacoma, Wash.—said she is particularly concerned that public opinion has been affected by letters to the editor in response to the article, and in support of midwives and home birth. The letters have portrayed, in Ballard’s opinion, “physicians as the bad guys and midwives as the good guys.”

“There are two sides to every story,” said Ballard, who also stated that she has “nothing but good things to say about Lisa’s care and her manner and her practice. Her patients love her.”

Ballard agrees with Catterall that “the nature of having a small practice in this medical environment is difficult for everyone.” She added that the cost of malpractice insurance is even higher for OB/GYNs than for mid-level practitioners such as Catterall, because OB/GYNs, who can perform surgery, also take on high-risk maternity patients.

Ballard disputed claims such as those made by recent pro-midwifery letter-writers (“One of the easiest ways to reduce the rate of cesarean surgery is to have more midwives,” Letters, March 5) that midwifery is a less invasive, more nurturing, woman- and family-centered model for maternity care than what is offered by the medical model of OB/GYNs.

Ballard referred to the perceived gulf between the philosophies of midwives and OB/GYNs as “inaccurate,” and said that they are being portrayed as “two extreme ends of the spectrum,” while she believes that they are not all that different.

“There is nothing more fulfilling for me than to take care of a woman, of a family, through their birth process, to have a vaginal delivery without intervention,” Ballard said. “We do not take cesarean sections lightly.

“I don’t think the sex of the provider is an issue,” she added. “It’s more about the personality and the style of the provider—not the gender or the initials after their name.

“Physicians and midwives are not enemies,” Ballard stressed. “We both want what’s best for women in obstetrical and gynecological care. Our goals are the same. It doesn’t have to be adversarial.”

Ballard is concerned that “because of all this being discussed so openly [in the media] … folks will seek home birth and home care that may not be appropriate for them…. Now that the letters have been written, I am concerned that people are making health choices that may be unsafe—that they may not be making arrangements for care in complicated situations.”

Cheryl Struve, a certified nurse-midwife and nurse practitioner at Paradise Midwifery Services, offered a different view. She’s one of three nurse-midwives with whom Catterall will be sharing call at Feather River and has delivered babies at Feather River Hospital for the past 20 years, working alongside Paradise OB/GYNs.

“At Feather River, we have a team approach,” explained Struve. “We work in collaboration with the physicians at Feather River Hospital, and they understand clearly the value of midwives. And I understand clearly the value of physicians.”

“To say that what we do is not different is not true,” Struve continued, pointing out that, for one thing, the average prenatal visit with an OB/GYN is 15 minutes versus 30 minutes with a nurse-midwife, who is also trained to address her patient’s psychosocial, nutritional and family needs, whereas an OB/GYN focuses on the medical.

“Leslie Ballard is correct that it isn’t a gender issue,” said Struve. “It’s a focus issue. Our training, our focus, is broader. …

“I don’t think the physicians at Enloe understood what Lisa did differently, so it became adversarial. At Feather River, the physicians understand the need to have midwives, and appreciate them. What we both bring to the patient—that’s the difference. It’s a team approach with the focus being the woman.

“It’s incredibly sad that Enloe didn’t value Lisa. … They just don’t get it.”