Why New York Lags So Far Behind on Natural Childbirth – The New York Times
With their options limited, many women are drawn to a whisper network of mothers, doulas, midwives and supportive obstetricians to discuss alternatives for nonmedicated births. Tactics include switching from obstetricians to midwives late in pregnancy so most of the expenses will be covered by insurance; patronizing hospitals in New Jersey, where space (and alternative staffing) does not come at such a premium; and aligning with one of the city’s public hospitals that has formed an unusual partnership with a midwifery practice.
Midwives who work at birthing centers and hospitals approach pregnancy and birth as healthy life events, using medical interventions only when necessary. But a “healthy life event” doesn’t make a hospital money; medical procedures do. This partly explains why the national cesarean section rate is now at almost 32 percent, up from less than 21 percent back in 1996. According to one study, low-risk women who aspired to deliver naturally at a birth center — even if they resorted to an epidural or other medical assistance — had a C-section rate of just six percent.
The natural birth movement, a reaction to “twilight sleep” injections, routine episiotomies and other interventionist hospital practices, began in New York in the 1960s and took off with the opening in 1975 of the city’s first birth center, the Maternity Center Association Childbearing Center on East 92nd Street, said Dr. Laura Zeidenstein, the director of the graduate midwifery program at the Columbia School of Nursing.
By the early 2000s, things had changed. In 2003, the Elizabeth Seton Childbearing Center in Greenwich Village, the successor to the Maternity Center, closed. That same year, NewYork-Presbyterian’s Allen Hospital eliminated most of its midwifery services, and then later, the Morris Heights Childbearing Center also closed. In 2009, Bellevue closed its birthing center.
“I would say we are in a really big crisis right now, but I’m hopeful that it is a crisis of opportunity,” said Dr. Zeidenstein, who worked at the Maternity Center and helped found Elizabeth Seton. “Things that have long been true — racial disparities, high maternal and infant mortality rates, the disrespectful treatment of women in obstetrics — are finally coming to the forefront of public awareness and hopefully action will be next.”
When it closes later this month, the Mount Sinai West Birthing Center will be replaced with 13 neonatal intensive care unit (NICU) beds and 15 private postpartum rooms. “We are making critically necessary expansions of our NICU and postpartum rooms to address the growing volume of sick and premature babies,” the hospital said in a statement. “The decision to convert the birth center into NICU and postpartum unit was in no way driven by financial considerations, any suggestion otherwise is false.”
Jennifer Adair decided to leave the city to have her baby. “I loved my obstetrician, but as I got into my third trimester, there was a lot more talk about medical interventions,” said Ms. Adair, an assistant professor at Fairfield University who lives in Inwood. At 31 weeks, she switched to a midwife, but since she was so far along, her options were limited. A doula suggested that she consider giving birth in New Jersey.
“I found the level of care there was exactly what I wanted,” said Ms. Adair, who delivered at Pascack Valley Medical Center in Westwood, a short drive over the George Washington Bridge. The hospital doesn’t have a separate birthing center, but it does offer midwifery care, and Ms. Adair gave birth without medical interventions. “My insurance was accepted, and unlike the hospitals I saw in New York, you were guaranteed a private postpartum room at no extra charge.”
For those who would like to stay in the city, there is, perhaps, a new option. Two years ago, Jamee Gidwitz planned to give birth at Mount Sinai East on Fifth Avenue. But after touring the hospital, she said, she grew fearful that the staff there wouldn’t support her choices. When she told her doctors at Village Obstetrics, who are affiliated with Mount Sinai East, they suggested that she be the first of their patients to try a new model of care they were offering.
The doctors, George Mussalli and Jaqueline Worth, were opening Village Maternity, a private midwifery practice. It was to be a separate business from Village Obstetrics. Dr. Mussalli and Dr. Worth would continue delivering babies at Mount Sinai East, but Village Maternity midwives would deliver babies at Metropolitan Hospital, a public hospital in East Harlem.
Located on First Avenue and 97th Street, Metropolitan is a part of New York City’s Health and Hospitals Corporation. The majority of its patients are part of its pre- and postnatal clinic, which serves mostly lower- and middle-income women with either no insurance or public insurance.
There are several reasons Dr. Mussalli and Dr. Worth chose Metropolitan. The hospital has midwives on staff, and Dr. Mussalli did his residency there. Moreover, unlike most private hospitals in New York, Metropolitan offers private postpartum rooms at no extra cost.
“As private hospitals have gotten busier, the city’s hospital system hasn’t enjoyed the same increase in their volume,” Dr. Mussalli said. “It is a leftover reputation from the 1970s, when people wanted to avoid city hospitals. But I know firsthand that the city system has changed.”
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