Midwife crisis: No home births, please, we're New Yorkers
Since we're already piling up the posts about both mothers and pregnancy, now seems like a good time to issue a call to action on an issue that doesn't usually come up when we talk about reproductive rights: home birth.
The 2007 documentary The Business of Being Born was, for many women (and men) an eye-opening look at the increasing medicalization of birth in America and a compelling illustration of the way midwife-assisted home birth can be a powerful alternative to the standard hosptial delivery. The film—which was produced by home-birth advocate Ricki Lake—along with books like Jennifer Block's powerful and well-researched Pushed: The Painful Truth About Childbirth and Modern Maternity Care, brought the subject of home birth out of the fringes and into the mainstream. Soon enough, home birth was a hot topic in the pages of the New York Times, Ricki Lake and BoBB director Abby Epstein's book Your Best Birth was published, celebrities like Cindy Crawford, Demi Moore, and Lisa Bonet were testifying to their own home-birth experiences, and birthing tubs were flying off the Internet's virtual shelves.
Naturally, there was some backlash. A New York magazine profile of Cara Muhlhahn, a New York City midwife featured in The Business of Being Born, painted her as a kind of renegade of home birth, shunning malpractice insurance and pooh-poohing one husband who expressed concern that perhaps his wife's 72-hour labor was the sign of a problem. The piece, titled "Extreme Birth: Is Midwife Cara Muhlhahn Too Fearless in Her Home-Birth Advocacy?" painted midwives as a kind of hippie-dippy thorn in the side of the city's hospitals, since patients whose home-based labor hit obstacles end up being transferred to the hospital with which their midwife has signed a written practice agreement, or "backup" agreement. And though the piece garnered dozens of comments from women and men who had successfully labored and birthed at home with the help of Muhlhahn or other midwives, it added animosity to an already-brewing clash between home-birth advocates and hospitals.
It's somewhat ironic that with all the mainstream press home birth has gotten in the past few years, it's now, at least in New York City, headed back to the margins. St. Vincent's, the NYC hospital that had backup agreements with more than half of the city's home-birth midwives, closed on April 30 due to bankruptcy. New York State law requires that all practicing midwives have WPAs with hospitals, but due to a variety of factors—malpractice fears/costs, skepticism over home-birth safety, and more—doctors at those hospitals have so far declined to negotiate new agreements with midwives. The result is that home birth in New York City could effectively become illegal almost overnight. The clients of these midwives are now forced to choose between two deeply insufficient options: Show up at their local hospital when they go into labor and be attended to by whatever provider happens to be on call, or have their babies at home, as planned, with a midwife who stands to lose her license if the birth ends with a trip to the hospital due to complications.
I'll say right now that I had exactly zero interest in having my baby at home. To be completely crass, it sounded like a lot of extra laundry. And I knew myself well enough to know that I would want that epidural eventually (after 20 hours of labor, it was indeed awesome). My hospital birth was not ideal—there were monitors strapped to me, there was Pitocin, there was the dreaded episiotomy. But there was also a big tub to labor in, a big-screen TV on which to watch Saturday Night Live, and an endless supply of ice chips. I was happy there; many women are happy at home, in their own beds or a warm tub in their living room. The point is, choosing how one wants to give birth is an essential piece of the larger picture of reproductive rights, and for many women giving birth at home is both personally meaningful and a mindful effort to avoid the snowball effect of medical interventions that often result from minimum-risk hospital deliveries like the one I had. (This also seems like a good place to link to one of my favorite comics ever, Christen Clifford and David Heatley's "My Home Birth: A Graphic Graphic Memoir.")
As Miriam at Radical Doula points out, New York City's midwife community is not the only one at risk for this situation: Miami's midwife-friendly Jackson Memoiral Hospital is also currently in danger of shutting its doors. If you're interested, join Choices in Childbirth in urging the New York State legislature to adopt the Midwifery Modernization Act, which eliminates mandated WPAs between licensed midwives and physicians. And RH Realilty Check has a roundup of other ways you can stand up (or, you know, squat down) for midwives and the families they serve.
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