Birth Story 2010

Following one topic, childbirth, for an entire year has given me an unusual perspective on what is happening on that front, both here in the United States and also globally.

If you ask me, the newly apparent muscle of the holistic birth community was the most important “birth story” of 2010. One sign of this was the passage of the so-called Midwifery Modernization Act in New York, which eliminated a requirement that midwives obtain a written practice agreement from a physician or hospital to practice in New York State.Pregnant Graffiti

Also, as we just discovered from a new report from the Centers for Disease Control, released last week, birth by Cesarean section reached a new high, 32.9 percent of births in 2009, up from 32.3 in 2008. The steadily rising rate — up every year since 1996, when the rate was 20.7 — has been a major story all year.

That CDC report also showed the birth rate for U.S. teen-agers hit its lowest level last year since records began to be kept seventy years ago — 39.1 births per 1,000 teens, down from 41.5 per 1,000 in 2008. The record low held true for all racial and ethnic groups.

A couple of other big birth stories of 2010, sadly, revolved around the fact that too many mothers are still dying in childbirth.

In March, Amnesty International called out the American childbirth establishment on a rising rate of maternal mortality in a report called “Deadly Delivery: The Maternal Health Care Crisis in the USA.” The human-rights advocacy organization pointed out that while the United States spends more on health care than any other country in the world, “maternal mortality ratios have increased from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006.”

Many other groups joined in that call for changes to improve birth safety in this country.

Meanwhile, in the developing world, the United Nations’ Millennium Goal 5, which aims to bring down rates of maternal mortality by three-quarters in places like sub-Saharan Africa and Southern Asia, is the subject of much scrutiny, with a major push in some places creating bright spots in what appears to be a generally gloomy picture with just five years to go.

Pregnant Graffiti by Petteri Sulonen / Wikimedia Commons

New York delivers for midwives

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.Pregnant Graffiti 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

ACOG vs. midwives in NY

A fight worth watching is shaping up in the New York State Legislature, where a bill that would ease restrictions on the practice of midwifery has attracted opposition from the American Congress of Obstetricians and Gynecologists, the new political arm of the 59-year-old organization that represents physicians who specialize in caring for women.

The bill, dubbed the Midwifery Modernization Act by its supporters, would give midwives the right to attend pregnant women without first obtaining a written practice agreement from a medical doctor.

On June 17, ACOG held a press conference in Albany to warn that the bill could compromise the safety of mothers and babies by exposing them to the risk of delivering without medical backup in the event of an emergency.

Midwives say that they sometimes have a hard time finding a doctor, say, in rural areas, willing and able provide a written practice agreement. And, they say, the problem is not confined to the boondocks.Pregnant Graffiti

After St. Vincent's Hospital in New York City closed last April, seven midwives who attend home births found themselves without a practice agreement, according to a story in the New York Times. St. Vincent's, a Catholic hospital, reportedly was uncommonly sympathetic to home births.

New York has as many as 900 midwives, more than any other state, according to Laura Sheperis, president of the New York Association of Licensed Midwives, in a separate story. Fifteen states so far do not require written practice agreements, which Sheperis has characterized as a "cumbersome and unnecessary barrier to health care and provider choice."

The bill would not prohibit doctors and midwives from creating written practice agreements; it would remove the requirement for them.

ACOG came out swinging against home births (along with the American Medical Association) in 2008 in response to "The Business of Being Born," a film that featured the home birth experience of actress/former talk-show host Ricki Lake.

"...Monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies," ACOG stated in 2008.

Obstetricians deliver about 70 percent of American babies, while midwives, mostly nurse-midwives, handled roughly 8 percent of births in 2004. Family physicians attend about 20 percent of American births.

"Pregnant Graffiti" by Petteri Sulonen