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. 

 

Comments

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Thanks for this post. It's easy to forget the larger picture of reproductive rights--esp as a non-birthing female. I often focus on contraceptives and abortion rights only, but just as important are birth-giving options.

so much happier at home

1 birth at St. Vincent's , 2 at home (with Cara!)

much happier at home than hospital, however St. Vincent's being a few blocks away was a comforting factor in my home births

many midwives had St. Vincent's as their hospital - with its closure, home birth is that much more difficult in NYC

I gave birth in Canada last

I gave birth in Canada last fall, in a province that funds midwife care. It's amazing what that normalization does for the entire birthing debate and experience. Ontario, where I live, funds midwife deliveries in both home or hospital, so in my case, we chose the hospital (we weren't comfortable doing it at home). But, until we actually went to the hospital, the midwife stayed with us at home, and then we were back home within a few hours of the delivery. The guidelines are fairly strict as to what midwives can and can't do, but somehow, it all just felt much calmer. That normalization takes away the need for the radicalism that I find is prevalent in the US. It's still not totally accepted, but it's far more accepted.

There was no overwhelming horror of being transferred to the hospital - it's obviously not the ideal route, but I also didn't feel like the relationship b/w the hospital and my midwife was very antagonistic. So, she felt quite comfortable being able to tell me when I needed more assistance than she could provide, b/c it didn't threaten her position and it didn't negate the validity of her care. I ended up being transferred to hospital care, but the midwife stuck around and helped throughout and then did all the after-care, including coming to my home for visits.

In the end, I felt like I got the best of both worlds - the midwife route, but with all access to 21st-century medical intervention should I need it (and I did, it turned out), without any hassles and fuss. It wasn't perfect, and we still have a long way to go in standardizing midwifery care, but when I read accounts from the US, I feel very lucky. Now we just need enough midwives to cover the demand. That, and help more women understand that birth is normal and that most of the time, a midwife is all you need.

A Tree Grows in Brooklyn

It's fascinating this debate about medicalization. In 1905, A Tree Grows In Brooklyn was a controversial novel in which, among other things, a woman was saving up her money so that she could give birth in a hospital in hopes that she would not lose another baby. Some relatives worked in a condom factory. Oh how times have changed. Would anyone at all be shocked today? No. What's shocking is the reversal of the trend of having babies with medical experts available. It's quite possible that the modern midwife knows far more today than the average doctor knew 100 years ago. Let's hope so.

Since midwifery has been

Since midwifery has been around for thousands of years and modern medicine (you know...where we weren't bleeding people twice a day for a cold because we had to get the evils out of your non-blood circulating body) is only about 175 years old, i'd say the midwife knows what she's doing.

And midwives are, and have always been medical experts. It wasn't until the the late 1700's when ALL MALE Medical Societies formed and regulated who was allowed to practice in their state by pushing for legislation that required all medical practitioners to get a license to practice from the Societies.

Home birth

Check out some current stats. Even NM are trying their own home births and ending up with tragedy.

http://skepticalob.blogspot.com/2011/12/homebirth-2011-deaths.html

Home birth

Check out some current stats. Even NM are trying their own home births and ending up with tragedy.

http://skepticalob.blogspot.com/2011/12/homebirth-2011-deaths.html

Home birth

Check out some current stats. Even NM are trying their own home births and ending up with tragedy.

http://skepticalob.blogspot.com/2011/12/homebirth-2011-deaths.html