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!