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.
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.