… 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.