Birth Story

A new study, the subject of a story by Nicholas Wade in The New York Times this week, reveals a little more of the magic of breast milk. It turns out that complex sugars in human milk encourage the growth of "good" bacteria that form a lining in a baby's gut, protecting her from dangerous microbes.

The baby can't digest the complex sugar, but the bifido bacteria can. In an article in the Proceedings of the National Academy of Sciences, Bruce German, Carlito Lebrilla and David Mills and colleagues describe the "intriguing strategy" lactation represents — to nourish microbes that can in turn protect a baby who has not yet developed an immune system of his own.

Dr. German told Wade, "We were astonished that milk had so much material that the infant couldn’t digest. Finding that it selectively stimulates the growth of specific bacteria, which are in turn protective of the infant, let us see the genius of the strategy — mothers are recruiting another life-form to baby-sit their baby."

The researchers used mass-spectometry-based tools to examine the structures of the complex sugars in breast milk. Their findings made the researchers think that milk holds even more secrets, even perhaps some that could help struggling newborns or even older humans.

Said Dr. Mills, "It’s all there for a purpose, though we’re still figuring out what that purpose is. So for God’s sake, please breast-feed."

Last Friday, New York's Gov. David Paterson signed into law A8117b-S5007a, the so-called Midwifery Modernization Act, which removes the requirement for midwives to obtain a written practice agreement from a physician or hospital to practice in New York State. The bill will take effect in three months.

Paterson's signature was by no means a sure thing — the Democratic governor, who is not seeking re-election in the fall, vetoed thousands of bills this summer, and he waited until the very last possible day to sign the midwifery bill.

Not only that, but the American Congress of Obstetricians and Gynecologists, the new political arm of the American College of Obstetricians and Gynecologists, lobbied against the legislation. The group argued that it would make midwife-assisted birth less safe, as midwives who did not have formal relationships with doctors might not be able to access medical care in an emergency. WPAs have been a condition of practice for midwives in New York since 1992.

But old certitudes and worst-case-scenarios fell flat in Albany this summer.

The closing of St. Vincent's Hospital in New York City last spring created a crisis for those relatively few women seeking home birth with midwives, and provided an object lesson in the difficulties the requirement for a written practice agreement could create. By June, seven midwives who had had WPAs with St. Vincent's were still scrambling to find doctors willing and/or able to formally partner with them, and hundreds of mothers who had been planning to deliver at home were in a state of limbo.

Beyond the immediate concerns, though, the ease with which the bills sailed through the New York legislature — the vote was unanimous in the Senate — suggests that midwifery has attained a mature level of acceptance in New York, which has perhaps 900 midwives, more than any other state.

Assemblywoman Amy Paulin, for example, one of the bill's sponsors, had her children with midwives, including two home births.

Groups that represent midwives emerged as effective lobbyists for the bill, mustering thousands of calls, emails and signatures on petitions.

Meanwhile, ACOG's efforts were notable for gaffes like a quote in the New York Times from Donna Montalto,  executive director of ACOG's New York division, who said physicians might balk at providing emergency care without a WPA.

“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,’?” Montalto said.

Perhaps most importantly, the new act affirms the view that birth is a natural event, and not necessarily a medical one. New York legislators have given midwives a vote of confidence, one that could portend a significant shift in attitudes about childbirth.

"Pregnant Graffiti" by Petteri Sulonen