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.
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.