Doctors’ Group Fights a Bill That Would Ease Restrictions on Midwives

Doctors’ Group Fights a Bill That Would Ease Restrictions on Midwives
By ANEMONA HARTOCOLLIS
Copyright by The New York Times
Published: June 17, 2010
http://www.nytimes.com/2010/06/18/nyregion/18midwives.html?th&emc=th


Amy Paulin, now a New York State assemblywoman pushing for more independence for midwives, was 27 when she became pregnant with her first child and started doctor-shopping in New York City.

One hospital mistakenly told her she had the Tay-Sachs gene, and one doctor counseled her against eating pizza, she recalled on Thursday. Irked, she ended up having her daughter, now 26, with a midwife in a Bronx hospital. Her next two children were born at her home in Scarsdale, also with the help of midwives.

Although her last two midwives were affiliated with a hospital in the Bronx, she said, it was a formality. “I knew, and the midwife knew, that if there was a problem with my birth, I wasn’t going to make it to the Bronx,” Ms. Paulin said. “I was going to go to White Plains Hospital,” five minutes away, she said.

So to Ms. Paulin, New York’s requirement that midwives have a “written practice agreement” with a doctor or hospital seems like an unnecessary hurdle.

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.

Laura Sheperis, president of the New York Association of Licensed Midwives, said that New York State had 800 to 900 practicing midwives, more than any other state, and that about 10 percent of them were having trouble getting written practice agreements, which must be renewed every year.

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.

The bill’s supporters said that most midwives, who handle low-risk births, have relationships with doctors, whether in writing or not, in case complications develop. If they deliver babies at a hospital, they have admitting privileges there, and the hospital’s attending physician will back them up.

The bill gained urgency among its supporters when St. Vincent’s Hospital Manhattan closed. The hospital had practice agreements with 7 of New York City’s 13 home-birth midwives. The midwives are still searching for doctors or a hospital to back them up, Ms. Sheperis said Thursday.