VASHON ISLAND MIDWIFERY

Vashon is a moderate sized island, spanning approximately 37 square miles, and home to upwards of 11,000 year-round residents. Vashon Island is accessible by ferry commute only, via two ferry access points; one in Seattle and one in Tacoma (both metropolitan areas). The ferry commute is anywhere between 15-50 minutes in duration, and the ferries have limited spaces on the vessel to commute individuals and cars to and from the island. There is a gap in coverage overnight when no ferries are running. Barriers to accessibility include a limited and changeable schedule, financial and transportation limitations for those without personal transportation or the ability to pay for the ferry fees. The ferry service has been known to deny access to people in labor, demanding that they use the already overburdened EMS system. Vashon is designated within a metropolitan county (King County). The racial demographics within the community consist of 92.3% white, 4.9% hispanic, 1.5% asian, 0.5% indigenous, 0.6% two+ races, 0.2% black, and 0% other. According to the 2018 census, Vashon is a community with 6.9% fertility, indicating approximately 115 individuals gave birth in 2017. Vashon has historically been designated as a Medically Underserved Area (MUA), and today stands as a Health Professional Shortage Area (HPSA), according to the Health Resources and Services Administration. Vashon is again threatened with becoming an MUA with the impending departure of its main primary care facility, Neighbor Care Vashon. This overall picture of Vashon Island and the specific demographics are vital when considering the landscape of need within our community. Today, we are the only perinatal healthcare providers on the island who service comprehensive prenatal, childbirth, postpartum and newborn care for the residents. Our resident’s only alternative options are resourced in neighboring communities, off island via this limited ferry commute described above. Historically, Vashon has housed resident midwifery providers who have been able to beautifully serve the community both short and long-term, although not without personal sacrifice, and for many, the inevitable closure of their practice. While it has not always been sustainable for a licensed midwife to maintain a viable practice due to the economic and overall population demographics on Vashon, community midwifery care itself has always proved to be an incredible resource for the community. The midwifery model of care has proved pertinent for the safety and wellbeing of the perinatal community overall. The last, long standing midwifery practice on island served for 20 years, and serviced approximately 30% of the population. This collaborative, community-based approach to healthcare is similar to successful rural models. While Vashon resides in a busy urban county, currently practising healthcare providers in this area find that the best method of providing health management on Vashon is with a rural community approach. The rural quality of Vashon is evidenced by a lack of resources that pose challenges to meeting the community standards of practice. It is the midwifery community standard to have access to higher level facilities in a reasonable time frame, to have at least two qualified attendants at every birth, and to have access to specialist back up support. Vashon has no higher level care facilities, access to higher level of care depends on a fallible ferry system, and the relatively small number of birthing people on the island make sustaining multiple providers cost prohibitive. The challenges of providing sustainable perinatal healthcare and education on the island are also rooted in the larger context of perinatal health care in the United States. The United States is currently experiencing a perinatal health care crisis, with one of the highest maternal and infant mortality rates in the developed world, and epidemic levels of perinatal mood disorders (PMD). Culturally relevant, client centered midwifery care has been shown to reduce maternal and infant morbidity and mortality, increase positive outcomes for families and communities and identify and access care for those experiencing PMD. Vashon Island Midwifery seeks to address these issues to ensure our population has access to safe and reliable perinatal, reproductive, newborn and child healthcare on island. We are doing something that has never been done before, with regards to this form of health and education that our community so clearly needs and deserves. We have created a sustainable model of perinatal and reproductive health and education services on Vashon.