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Free
the Midwives
I
am typing this with my one-and-a-half-week-old daughter sleeping
on my chest. This morning she went to her first ever political
action—a rally to support the Midwifery Modernization Act,
which would remove the bizarre requirement that fully licensed
midwives in New York state need a “written practice agreement”
with an OB in order to practice.
Though Molly obviously had no idea of what was going on, the
issue was directly relevant to her. She was born more than
two weeks after her official due date. When she came out,
however, all the physical signs said she was no post-due baby.
She was on the small end of average, covered in vernix (a
waxy moisturizing substance on babies’ skin that disappears
if they’re overdue), and the placenta was totally healthy.
In fact, a nurse at our pediatrician’s office said her skin
actually reminds her of babies who are early. So much for
official due dates. They are arbitrary—calculated based on
first day of last period—and for someone like my wife, with
long, irregular cycles, not very accurate.
And yet, in most obstetrical practices, and even many midwife
practices that have to answer to an OB who controls their
ability to practice through the WPA, we would have faced heavy
pressure to induce labor earlier, effectively forcing our
baby to be slightly premature. I know people whose doctors
start talking about inductions before due dates are even reached.
I have friends who actually lied about dates with their third
kid in order to get a later official due date and not face
those pressures any more.
See, induced labor, especially when the baby or mom really
isn’t ready, carries increased risks of interventions and
complications, especially a higher rate of c-sections and
their accompanying risk of infection, injury, and breastfeeding
issues. In fact, Amnesty International just released a report
tying the United States’ abnormally high rate of c-section
to our too-high and rising rate of maternal mortality. We’re
talking safety here, folks, not just feel-good birth experiences.
C-sections are important for emergencies, but according to
the World Health Organization, in a functioning maternal health
care system, they should be about 10 percent of births, not
our national rate of 32 percent, New York state’s rate of
34 percent, and certainly not Albany Medical Center’s astronomical
43 percent.
My first daughter attended the rally with us as well, wearing
a sign that said “My midwives knew what they were doing.”
In her case too, this was more than mere rhetoric. After months
of being in a perfect head-down position, she took it in her
head to flip breech the night before I went into labor. Had
I been in an OB’s care, this would have been a recipe for
an instant c-section, since somewhere along the line, medical
schools stopped teaching doctors how to deliver breech babies.
Instant, and totally unnecessary, since our midwives did
know what to do. It was an uncomplicated, picture perfect
vaginal delivery.
I know one person who refused a c-section that was being pushed
on her because her baby was breech. Despite the stress of
the situation, she delivered a perfectly healthy baby, quickly
and easily. And the hospital, widely known as the most friendly
of the region’s hospitals to the evidence-based midwifery
model of care, refused to accept her as a patient for
her third child. And people wonder why women turn to home
birth. In cases like this, they are driven there. As more
and more hospitals refuse to allow women to try for a vaginal
birth after a c-section (something that is successful for
60–80 percent of women who are allowed to try it, and associated
with better birth outcomes), that’s only going to get more
true.
The Midwifery Modernization Act would help. Midwives are already
independently licensed professionals in the state of New York.
But parents don’t have sufficient access to them, because
too few doctors have been willing or able (due to their own
malpractice insurance) to sign these practice agreements.
And why should they have that sort of control anyway? OBs
are not the experts in normal birth. Midwives are. OBs are
surgeons, trained to address complications and deal with high-risk
pregnancies and births. They are two separate specialties,
and they should be working collaboratively, not in a hierarchy.
Midwives already collaborate with and make referrals to OBs
when it is indicated, just like family physicians refer patients
to specialists without the need for a contract with each specialist.
The midwife model of care has been shown time and again to
result in better outcomes and fewer interventions for less
cost for low-risk pregnancies. Given this, the practice agreement
requirement has damaging consequences for maternal health
care across the state. Women in rural areas far from hospitals
don’t have access to care. Medicaid can’t save money by encouraging
low-risk women to be seen by midwives. Parents’ abilities
everywhere to make choices about their care based on research
about outcomes is restricted. It’s high time to free the midwives.
—Miriam
Axel-Lute
www.mjoy.org
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