Saturday, June 19, 2010

The Status of NYC Midwives

This summer I am living in NYC before I begin graduate school in the fall. I have been keeping an eye open to see if any area doulas with clients in July need back up, or any women with July EDDs want cheap doulas, but I haven't gotten a lot of feedback. So I may be on a summer hiatus from doula-ing :( 

Being in New York does make me even more intrigued by all the news that has been going on with the Midwives vs. Obstetricians battle. I was going to post an article or write up a synopsis, but then I found that Stand and Deliver had already done so! And so I am simply going to refer you to hers:

A few days ago, The New York Times published this article about the current status of NY midwives: Doctors’ Group Fights a Bill That Would Ease Restrictions on Midwives. Since the closure of St. Vincent's, half of NYC's home birth midwives have been unable to obtain practice agreements. All midwives, hospital or home-based, currently need a signed practice agreement with either a hospital or physician. So New York state's midwives sought a legal solution to this impasse. Here's what happened:
A week ago, a bill that would repeal that requirement breezed through Assembly and Senate committees, and its champions expected it to pass the full Legislature within days. Then it hit heavy opposition from the American Congress of Obstetricians and Gynecologists.

In a memorandum, backed by a press conference in Albany on Thursday, the congress challenged the safety of midwife-attended births and suggested that the bill was a ploy to allow midwives to expand their turf and directly compete with doctors. “While this legislation does not intend to extend a midwife’s scope of practice, it has the ability to pave the way for midwives to open their own independent birthing centers,” it said.
Heaven forbid that midwives compete directly with physicians.

But wait--it gets even better. ACOG's reason for requiring written practice agreements is that without a practice agreement, giving birth with a midwife, including hospital-based midwives, will become terribly unsafe. The only thing standing between the laboring woman and disaster is this piece of paper. Here's how:
The obstetricians’ group has argued that written agreements are needed to keep women safe. Suppose a woman is giving birth in a hospital, attended by a midwife without a practice agreement, and the woman starts to hemorrhage, Donna Montalto, executive director of the New York division of the congress of obstetricians, said Thursday.

“What obstetrician who has never seen the patient, doesn’t know the midwife, and happens to be at home at their son’s baseball game is going to say, ‘Sure, I’ll come in and take care of your patient,’ ” Ms. Montalto said.
Yes, in the absence of a signed agreement, physicians will be asked to come in from their children's sport games and attend to an unknown woman. Gasp. As if unknown women never go into labor when a physician is on call. As if attending physicians know all of the women they deliver personally--except for those pesky midwife patients.


  1. I suggest you check out the Doula Project for volunteer doula work! They are awesome. And sign up for the Metro Doula Group listserv. They sometimes have postings looking for volunteer doulas. NYC is a great place to get involved with birth stuff!

  2. Yup, I've done all of that!

    The Doula Project only takes volunteers who can commit to a year in NYC. :(

  3. This comment has been removed by the author.

  4. Hey-- just to offer the other side of this "written agreement" stuff:

    If there were even just a bit of tort reform and more protection for doctors who take on risky patients, there would be no issue of attending to unknown patients with complications or risky situations. Currently, doctors are blamed for anything that ever goes wrong with patients, even if they are direct results of genetic abnormalities. Not many judges or juries are well enough medically educated to distinguish between malpractice, gross negligence, malificence.. and risky complications.

    That aside, doctors on call would be obligated (morally and professionally) to come in and attend to such patients, especially if the patient is in a special risk. I don't know much about the amendment or either side, but from what I'm reading in your post, I would agree that midwives working in a hospital should have agreements with obstetricians; however, those working at home or in birth centers should be protected from this kind of legal bureaucracy. Although it would comfort me to know that the birth center has agreements with doctors/has doctors always on staff in case of emergency...


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