Tori's Blog

New York City Homebirth Midwives Lose Physician Backup

Thursday, June 3rd, 2010

Very recently, half of the New York City midwives who practice homebirth, lost their physician and hospital back up privileges. This was due to the closure of St. Vincent’s Hospital in Manhattan.

The first article I read about this, interestingly enough, came out of the UK and made it sound as though homebirth midwives were suddenly on par with complete outlaws, which definitely added to the dramatic effect of the article.“As residents of the world’s consumer capital, New Yorkers can have anything delivered to their door at any time… But there is one thing that is currently unavailable for delivery to those who live in this most can-do of metropolises. Women can not legally give birth at home in the presence of a trained and experienced midwife.”

The situation is much simpler than that. Fortunately, the New York Times published a more realistic article. There are 13 midwives who practice homebirth in the New York City area and seven of them had privileges with St. Vincent’s Hospital in Manhattan. According to New York law, a homebirth midwife must have back up privileges with a physician and a hospital. Regardless of law, this is the professional, ethical and moral responsibility of anyone practicing homebirth.

Certified Nurse Midwives who practice in hospitals or birth centers work within the context of a system. They provide complete prenatal care and manage normal, uncomplicated birth. They also have physician resources for known or unknown complications. In the case of the seven New York midwives, they had physician backup at St. Vincent’s who agreed to assume the care of those women who needed it.

These midwives have not found another physician practice willing to take over care in this situation. Without physician backup a midwife literally shows up on the doorstep of a nearby hospital with a mother and baby in the middle of a crisis situation. From experience, I can tell you that, very often, this is a disastrous situation. As one New York obstetrician accurately pointed out, “ By the time the mother arrives at the hospital, the situation is quite literally, a train wreck”.

This is exactly what happened with the birth of  Noa, who died as a result of the delay of medical care during a homebirth attended by Cara Muhlhahn. I have written numerous times about Ms. Muhlhahn, who openly states that she intentionally does not have physician backup due to the constraints it provides her.

Birth at home, in a birth center or in a hospital is normal and uncomplicated the vast majority of the time and I hope that these midwives in New York do find physician back up. Women should be able to choose to give birth wherever they wish. Where I always return however,  is the simple truth that birth is not ultimately about “the experience” but about a beautiful, healthy baby entering the world to a healthy mom.

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