New York midwives lose right to deliver babies at home

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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… New Yorkers can have anything delivered to their door at any time. They can have their hair cut in the living room, have champagne and caviar rushed to them on a whim, enjoy a shiatsu massage in their own bed or invite a clairvoyant to predict their future from Tarot cards laid out on the kitchen table.

But there is one thing that is currently unavailable for delivery to those who live in this most can-do of metropolises. Women can not legally give birth at home in the presence of a trained and experienced midwife.

This city … now lacks a single midwife legally permitted to help women have a baby in their own homes …

The collapse of New York’s legal home birth midwifery services has come as a result of the closure two weeks ago of one of the most progressive hospitals in the city, St Vincent’s in Manhattan. When the bankrupt hospital shut its doors on 30 April the midwives suddenly found themselves without any backing or support.

… under a system introduced in 1992 [midwives] are obliged … to be approved by a hospital or obstetrician …

St Vincent’s was prepared to underwrite their services, but most other doctors and institutions are not, and they now find themselves without the paperwork they need to work lawfully.

… Jitters are spreading among the tiny community of home birth midwives … one of them has already been shopped to the authorities by an obstetrician at a hospital where she transferred one of her clients in need of medical attention.

The crisis of home birth in New York city is an extreme example of a pattern found across America. Fewer than 1% of babies are born at home in the US, and in New York that figure is as low as 0.48% — about 600 babies every year out of 125,000. That compares with a rate of about 30% in the Netherlands.

In much of Europe, midwives play the lead role in assisting most low-risk and healthy women to give birth, handing over to a specialist doctor or surgeon only when conditions demand. In the US, that relationship is reversed.

Obstetricians, who are trained to focus on interventionist methods and often have never even witnessed a natural birth, are in charge of about 92% of all cases. As a body, they are fiercely resistant both to midwives – who under the private medical system in America are their competitors – and to women choosing to remain at home.

In 2008 the American Congress of Obstetricians and Gynaecologists put out a statement effectively instructing its members to have nothing to do with the “trendy” fashion towards home births. Yet despite Acog’s stance, and despite the fact that the US spends more money on pregnancy and childbirth-related hospital costs than any other type of hospital care ($86bn a year), the country has the unfortunate distinction of having one of the highest rates of maternal mortality in the industrialised world. Its rate stands at 16.7 maternal deaths per 100,000 live births, compared with 7.6% in the Netherlands and 3.9% in Italy. Britain’s rate is 8.2%.

On top of that, about one in three pregnancies in the US end in a caesarean section — a product, critics say, of the highly interventionist approach that includes frequent induced labours …

… Midwifery organisations are scrambling to persuade other hospitals to take over St Vincent’s role by signing the so-called “written practice agreements” the midwives need to be legal. So far 75 hospitals have been approached; not one has replied.

Meanwhile, a bill is sitting before the New York state assembly that would scrap the system of practice agreements and allow the midwives to offer their services free of the control of obstetricians. But the bill may not be put to a vote at all this year …

In Australia, private midwives will be required to have collaborative agreements with obstetricians in order for their clients to access medicare benefits for their services and also for midwives to be eligible for the government insurance that will cover hospital birth. I hope that what has happened in New York will not happen on a large scale in this country.

Melissa Maimann, Essential Birth Consulting 0400 418 448

2 thoughts on “New York midwives lose right to deliver babies at home

  1. http://www.mybestbirth.com/profiles/blogs/midwifery-care-in-germany-is

    Midwifery Care in Germany is at risk
    Posted by Izzy on May 5, 2010 at 3:00am

    Hey there,

    I’m a midwife from Germany and just wanted to let all of you know that midwifery care over here is highly at risk at the moment. Especially midwives from birth centers and home birth midwives may not be able to practise any longer as insurance costs will be at an all time high of nearly 4000 euros (approx. 5200 USD) per year!
    In Germany every birth has to be attended by a midwife (the law says so – at least for now). With such a massive increase of insurance costs many midwives are thinking about giving up their jobs. As a result, women will no longer be able to give birth to their babies at home, in a birth center or with a trusted midwife in a hospital and will have to go to big hospitals (lack of staff…) or give birth to their baby alone.

    We tried to approach the politicians, insurance companies etc. – without success (no wonder). This is the reason why we started an online petition. It started today actually and we need at least 50.000 signatures in 2 weeks so that the German government hast to deal with this problem.
    If there’s anybody here who speaks or understands German or knows anybody who does and is willing to support us, you’re more than welcome to sign our petition here:

    https://epetitionen.bundestag.de/index.php?action=petition;sa=detai

    you have to register first to take part but this will take you a max of 5 minutes.

    THANK YOU!!!!

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