Saturday, June 19, 2010

New York midwives and written practice agreements

A few days ago, The New York Times published this article about the current status of NY midwives: Doctors’ Group Fights a Bill That Would Ease Restrictions on Midwives. Since the closure of St. Vincent's, half of NYC's home birth midwives have been unable to obtain practice agreements. All midwives, hospital or home-based, currently need a signed practice agreement with either a hospital or physician. So New York state's midwives sought a legal solution to this impasse. Here's what happened:
A week ago, a bill that would repeal that requirement breezed through Assembly and Senate committees, and its champions expected it to pass the full Legislature within days. Then it hit heavy opposition from the American Congress of Obstetricians and Gynecologists.

In a memorandum, backed by a press conference in Albany on Thursday, the congress challenged the safety of midwife-attended births and suggested that the bill was a ploy to allow midwives to expand their turf and directly compete with doctors. “While this legislation does not intend to extend a midwife’s scope of practice, it has the ability to pave the way for midwives to open their own independent birthing centers,” it said.
Heaven forbid that midwives compete directly with physicians.

But wait--it gets even better. ACOG's reason for requiring written practice agreements is that without a practice agreement, giving birth with a midwife, including hospital-based midwives, will become terribly unsafe. The only thing standing between the laboring woman and disaster is this piece of paper. Here's how:
The obstetricians’ group has argued that written agreements are needed to keep women safe. Suppose a woman is giving birth in a hospital, attended by a midwife without a practice agreement, and the woman starts to hemorrhage, Donna Montalto, executive director of the New York division of the congress of obstetricians, said Thursday.

“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,’ ” Ms. Montalto said.
Yes, in the absence of a signed agreement, physicians will be asked to come in from their children's sport games and attend to an unknown woman. Gasp. As if unknown women never go into labor when a physician is on call. As if attending physicians know all of the women they deliver personally--except for those pesky midwife patients.

Not only is this totally ridiculous--on-call physicians attend to whoever goes into labor, known or unknown--it distorts what would actually happen if a woman giving birth in a hospital with a midwife began to hemorrhage. The midwife would administer the same anti-hemorrhagic medications that a physician would! She wouldn't be calling a physician in from his son's baseball game to give her patient a shot of Pitocin or methergine.

I'm calling this one...

Code Mec!


  1. Not to mention...isn't there something in the Hippocratic oath about helping people no matter what? I mean, does the cardiologist on a plane where someone is having a heart attack say "Sorry, I don't have a written agreement with this airline to provide care for you"

    Total crap.

  2. What a bunch of BS. The whole situation infuriates me.
    And to the above commenter, Amy- we're not the ones worrying over OBs losing money. In truth, I don't think midwifery hurts them financially much at all. If only THEY could get that through their heads- or whatever it is that makes them see midwifery as such a threat, cause they sure haven't proven it's not safe.

  3. It's amazing how the US OBs speak of attending an unknown woman's birth as an appalling concept. In Germany, where I had my daughter, all of the birth's are handled that way unless there is some kind of planned circumstances. Midwives are there, and the doctor on call is only called in for complications.

    I met the doctor who 'attended' the breech birth of my daughter about five minutes before delivery (she sat at the edge of the birthing table with her hands folded and let the midwives support me).

  4. I thought the same thing about the hemorrhage thing at first--an obstetrician isn't necessary for treatment of postpartum hemorrhage, but then I thought maybe she meant hemorrhaging during labor, which could indicate a placenta previa or other complication? But if that's what she meant, she didn't explain it very well, because the way she said it, it sounds like midwives are powerless against PPH, which is ridiculous.

  5. Am I understanding this correctly? Are they insinuating that when doctors don't know the patients they're treating it makes birth more dangerous?

    Would they prefer women choose unassisted birth or just come into the hospital at the last possible minute because they want to avoid unnecessary interventions? I believe this would cause MORE liability issues for doctors.

    I'm concerned about birth options (read: freedoms) being taken away. If women want to birth at home, give them the support they need to do so safely.

    I seriously doubt safety is the real issue here. I believe liability to a certain extent, but even that impacts the doctors pocketbooks.

  6. That statement hits at least two of the anti-homebirth bingo squares:

  7. Dr. Amy, you know that you are not allowed to post here and that all your comments will be deleted. Please respect that. Thanks.

    As to the question of whether or not there's a turf issue at stake (because remember, this legislation refers to all NY midwives, not just ones who attend home births), refer to the original article, which stated "suggested that the bill was a ploy to allow midwives to expand their turf and directly compete with doctors."

  8. “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,’ ” Ms. Montalto said.

    This is blatant discrimination. If an OB is on-call, they should be responsible for any hemhorrage that needs a doctor's attention, not just those of women who are not patients of midwives. She is implying that a baseball game is more important than providing medical care to a woman facing a life-threatening complication.

  9. Written agreements?!? Is the US taking lessons from Australia in 'How to wipe out homebirth entirely'? If so, it will not end well. :( Good luck with that.

  10. Sometimes I wonder if ACOG even understands how foolish they make themselves look when they pull stunts like this. If homebirth midwifery without physician partnership is sooo dangerous, doesn't it make logical sense to PARTNER WITH MIDWIVES?? No, instead, we'll just wipe out midwives entirely. Sure, it'll lead to even worse outcomes, but heaven forbid we stoop so low as to associate ourselves with such woo! Women will die, but our saintly reputations will be intact! (at least among the old boys' club, I doubt many mothers will respect them!)

    Compete with doctors indeed. Homebirth rates stand at 1-2% at most. I guess 99% is just not enough. It really is all about money, isn't it, and this proves it quite clearly.

  11. This comment has been removed by the author.

  12. I'm deleting all comments by and relating to Dr. A. Now let's get back on topic...

    Regarding the issue of liability, it's a huge problem in every branch of medicine, obstetrics especially. See my earlier post (June 2 2010) "What explains physicians' beliefs about home birth" for more discussion of this.

  13. Another piece (not really saying anything new) on the topic of NY state midwives:

  14. it's ridiculous to think that many ob's even know their patients well in the first place! In the practice I saw there were 7 doctors! I only saw each of them once, a couple I saw twice, for what....5 minutes a piece during my prenatal care. Are they really going to be able to do anything more for me if there was a problem than any other Completely Unknown woman? Not really.

    Obviously the argument is BS and I sure hope the lawmakers can see through it.

  15. In my community it is common practice for small groups of OB doctors to share call on the weekends. There are 3 different practices with 2-4 doctors in each group that rotate calls on the weekends. Each one is on call every 7th or 8th weekend. So even if you chose your group very carefully, you may still have an OB that you never met. How is this any different?

  16. This NY stuff is stressing me out. Things in Oregon are looking kind of rough on the midwify front and it just terrifies me. I feel so bad for the women in NY who have lost their midwives or who havne't found some willing to birth them anyways. This just sucks, it really sucks.

  17. It doesn't suck anymore because we pushed the bill through!!!!!!!!!!!!!!! I am the web moderator of, the NY consumer group who gathered in response to the statewide crisis and I found you via links. Great blog!

    We're just waiting for the governor to sign. HUGE win for the mothers and midwives of NY and ACOG was really seen for what they were--self-serving.


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