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OBs and Midwives Battle For NYC's Births

By Sierra Black |

Obstetricians don’t like competition. This week in New York, the American Congress of Obstetricians and Gynecologists came out swinging against a bill that would have made it easier for women to choose home birth.

Having a home birth isn’t illegal in New York, but the legal hoops the state requires midwives to jump through make it all but unavailable to many Big Apple mamas.

Rather than regulate midwifery directly, the state requires midwives to have written “practice agreements” with obstetricians at nearby hospitals. The obstetrician has to agree to take over care of the midwives patients should an emergency occur.

The state legislature moved to do away with the “written agreement” rule this week, and was met with strong opposition from OBs.

The move has special urgency for New York City midwives. The city has only 13 home birth midwives, and 7 of them are currently not allowed to attend births since the hospital where they had their practice agreements closed last month.

Home births attended by trained midwives are no more risky than hospital births in the U.S. A large scale study of home births in the U.S. found that only 12% transfer to hospitals, and only 3.4% of those transfers are urgent. No maternal deaths have been reported by home birth midwives here, and the infant mortality rate is the same as in a hospital.

Do you think home birth midwives should be free to practice their trade in NYC, or do the OBs have a point?

Photo: eyeliam

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About Sierra Black

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Sierra Black

Sierra Black lives, writes and raises her kids in the Boston area. She loves irreverence, hates housework and wants to be a writer and mom when she grows up. Read bio and latest posts → Read Sierra's latest posts →

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0 thoughts on “OBs and Midwives Battle For NYC's Births

  1. Larissa says:

    Maryland had a similar written practice agreement required for CNM licensing and over the course of 3 legislative sessions, they were able to repeal the law. The first year a study was commissioned by a committee where the legislation had been introduced. I assume the 2nd year there was a report on the study and this year they changed the law. There was continued advocacy and support by consumers, midwives and advocating legislators in order to make it happen. Good luck New York, I hope it happens for you too!

  2. HJB says:

    This is also a very small picture of the situation New York State faces as a whole. This is not even primarily a homebirth issue, because it affects all midwives practicing in all settings. Luckily, the NYC situation has opened the situation to a bigger audience, but the reality is state-wide.

    Women in rural areas find it virtually impossible to find a midwife at all. The written practice agreement *DOES NOT* ensure an emergency back up plan or even a working collaboration. It is simply a permission slip from their direct economic competitors. Midwives are bound by their profession to collaborate with physicians when their clients need care outside of their scope of practice. Doctors are willing to work with midwives–they are not willing to sign pieces of paper for many reasons–one of which is fear of litigation.

    This law does not change anything about the health of women in New YOrk State (except that more midwives means better outcomes for moms and babies). It simply removes a ridiculous piece of paper that stops women from receiving the excellent care midwives provide. In almost all the arguments I have seen against the Midwifery Modernization Act–it boils down being completely misinformed about what a midwife is and how her profession works. Midwives are already independent professionals as stated by New York law.

    I am currently 40 weeks pregnant and my midwife is loosing her written practice agreement because her supportive doctor is being forced to unsign by his insurance company. Explain that one to me. Midwifery is a legal choice for me as a New York resident. Why then can’t I receive midwifery care? Oh, because the doctors are refusing to work cooperatively within a whole health care system.

  3. Michelle, RN says:

    Comments
    Just wanted to clarify: New York DOES regulate midwives! They are licensed registered professionals. Many have advanced degrees, belong to professional organizations and participate in peer review processes. Also, the Midwifery Modernization Act would apply to the whole state, not just NYC. It has a special urgency in rural areas which have few OBs. This is an access to care issue across New York State! Free our midwives!

  4. JCF says:

    Midwives should ABSOLUTELY be able to practice safely and legally in NYC with willing backup OBs. Women should be able to choose where and with whom they give birth, and they need the resources to be able to do it safely.

  5. Jessica says:

    If you have ever had the delightful birthing experience of home birth with a midwife this would be a no-brainer. I did! Many, many, many hours of labor my midwife sat right with me. She was skilled and knowledgeable. I would have hated to do it without her.

    If I were to become pregnant again and could not do home birth legally with a midwife, I would choose to do it alone rather than go to the hospital.

    Lets follow the money – don’t the OBs lose if they can’t force midwives to work for them?

  6. Julie says:

    I traveled 3 hrs. round trip in New York State to get midwifery care. Two things get overlooked in this debate. Written practice agreements are difficult for midwives to obtain because malpractice insurers don’t want doctors to take on liability for patients they’ll likely never see. Also, midwives are already regulated by the licensing process in New York. They naturally collaborate with other healthcare providers as necessary, with or without a piece of paper signed by a doctor. New York State requires midwives to get a piece of paper signed by their possible competitors in the birth marketplace. Those docs who are supportive get pressured by malpractice insurers.

  7. joy says:

    The written practice agreement doesn’t provide the means to take care of an emergency complication during labor or birth during a home birth. We already have a federal law that provides for that. It is called EMTALA (Emergency Medical Treatment and Labor Act). Sad that we had to pass a law that provides for the emergency treatment for people whether they have the ability to pay or not or whether the doctor agrees with a woman’s right to choose a home birth. The written practice agreement doesn’t make birth safer, it just provides a means to prevent midwives from being licensed if there are no OB’s willing to sign this agreement.

  8. Susan says:

    Comments
    The study cites in this article, which was published in the British Medical Journal in 2005, examined birth data for care provided by Certified Professional Midwives, midwives who are specifically educated to provide birth in out-of-hospital settings such as birth centers or their clients’ homes. The great statistics cited in the article involve ONLY CPM-attended births. Nevertheless, the present New York State law that regulates midwives ONLY includes certified nurse-midwives and certified midwives, who were not included in that study and who are primarily educated in hospitals to provide hospital-based birth services. CPMs in New York State still practice on an underground basis, subject to cease and desist orders if they are caught. Unfortunately, the MMA bill being proposed by the New York State Association of Licensed Midwives (NYSALM) does not address the exclusion of certified professional midwives (CPMs), but will only help the few CNMs and CMs who provide home births. Most CNMs in New York work for hospitals or physician groups, so they have no problem at all getting these written agreements. New York’s citizens would be much better served if this bill would amend the existing law to permit ALL midwives to practice legally, without physician control, not just a small handful of midwives. NYSALM was asked to add provisions to the bill to help their CPM sisters, but declined to do so. I guess no one likes competition.

  9. GLewis says:

    Look at the research. Trust mothers to make the choice that is right for them. Homebirth is popular and safe in many first world countries, why not NY as well?

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