Midwives in Jeopardy

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As she nears the last month of her pregnancy, Piper Harrell is counting on giving birth to her second child in the same place she had her first, in her second-floor walk-up apartment ...

But this time, Ms. Harrell ... is afraid that if she insists on having her baby at home, she will make her midwife ... an outlaw.

Seven of New York’s 13 home-birth midwives ... had an agreement with St. Vincent’s Hospital Manhattan that its doctors would back them up in an emergency. But the bankrupt hospital closed on Friday, and those midwives have been unable to negotiate new practice agreements with other hospitals or obstetricians, as required by state law, leaving them in the position of risking their licenses if they choose to deliver babies.

The loss of that 25-year relationship with a sympathetic hospital has left some home-birth midwives not only fighting for the legal viability of their practice but having to justify their very existence. Officials at several hospitals said ... they were skeptical of the safety of home births and were concerned about the malpractice implications of taking over their clients in emergencies.

... “This is who we have to get a signature from — people who don’t believe in what we do and that we compete with,” ...

The 13 midwives attend about 600 births a year, and about 50 of their clients expect to deliver in the next month.

To them and their clients, having the option of a home birth is an affirmation of their reproductive rights. It is also a reaction against the highly medicalized climate of hospital births, which, they say, has contributed to a Caesarean-section rate of more than 1 in 3 births ... with some hospitals having rates above 40 percent ...

To the medical establishment, home birth represents a rash choice by women who refuse to believe that things can go dreadfully wrong in an instant ...

A large study of planned home births in the United States and Canada ... found substantially lower rates of medical intervention compared with low-risk hospital births (high-risk pregnancies rarely, if ever, culminate with a home birth) and a similar rate of infant mortality. No mothers died. About 12 percent were transferred to the hospital. The midwives considered the transfer urgent in 3.4 percent of all intended home births.

... written practice agreements with hospitals or doctors have been a condition for all midwives to practice in New York State since 1992. But obstetricians have become increasingly wary of signing with home-birth midwives since the Congress of Obstetricians put out its strongly negative statement in 2008 ...

... Fifteen other states ... allow midwives to practice without them ...

... midwives ... expected that at least some of their clients would insist on delivering at home even without signed hospital backup. (They can still go to an emergency room and be treated.)

Ms. Harrell, 33, said she trusted her midwife ... who delivered her first child ... she said she was leery of trying to build a relationship with a doctor so late in her pregnancy. But she worried about putting Ms. Leonard in an untenable position.

“I’ve never felt not able to make a choice about my body for myself and my family, and it’s a paralyzing feeling,” Ms. Harrell said ...

Melissa Maimann, Essential Birth Consulting 0400 418 448