Bearing in Mind

Welcoming You to the World Dept.: When I wrote the piece below, my wife was beginning her seventh month of pregnancy with our only child. Because she had turned 40, her gynecologist insisted that Susan was “high-risk” and would require all manner of tests and technology to facilitate her delivery. Instead, my wife turned to a community of midwives whose knowledge and experience was unrecognized by New York, and we planned what turned out to be a spectacularly successful home birth. The impediments faced by direct-entry midwives have eased since 1996, but as long as our culture continues to view birth as a medical emergency and view obstetricians as godlike, the denial of natural childbirth will remain a frustrating component of the marginalization of women.

                                                                                             

Birth rights: Protestors at the Governor’s
Mansion call for legal recognition of
direct-entry midwives. Photo by Scott Gries.

AMONG THE CROWD OF ABOUT 150 who jammed the sidewalk in front of the Governor’s Mansion on Monday were more than 50 distinctively garbed Amish people. They had traveled from Montgomery County to make a rare public appearance with the New York Friends of Midwives to support the legal recognition of direct-entry midwives – experienced midwives without formal medical training. For the Amish, midwife-attended home births are a way of life, but it’s not a legally recognized option in New York State.

Earlier in the day, Syracuse-based midwife Roberta Devers-Scott was sentenced to three years of probation and a $900 fine after being found guilty of attempted practice of midwifery without a license. She spoke at the Albany rally, promising to continue her fight against a state licensing practice that certifies only registered nurses as midwives.

“Let’s not kid ourselves,” she said. “Direct-entry midwives exist. We need to get licensing and put an end to this system that excludes a vital profession.”

Direct-entry midwives are recognized in neighboring Massachusetts, Vermont and Connecticut, states that also have lower infant-mortality and low-birth-weight rates than New York. As Friends of Midwives co-chairwoman Tisha Graham pointed out, New York ranks 30th among the 50 states in infant mortality and low-birth-weight statistics – and the U.S. ranks 25th among industrialized nations in terms of those same statistics.

“Because they don’t work in a busy medical system, direct-entry midwives are able to provide more attentive prenatal care than nurses and obstetricians,” said Graham. “And they don’t impose delivery schedules on laboring mothers, so they’re much less likely to call for invasive measures.”

Ironically, New York’s midwives helped fight for the passage of a law in 1992 that they hoped would put in place a mechanism for licensing of direct-entry midwives. When the state’s Board of Midwifery was assembled, however, it ignored the recommendations of the national Midwifery Education and Accreditation Council and the North American Registry of Midwives and turned over licensing procedures to the American College of Nurse-Midwives, which had no experience with the practice of direct-entry midwives.

“What is it about this midwifery model that so threatens corporate and institutional power?” asked Archie Brodsky, a Harvard Medical School writer and research associate. “Is it people deciding their own fates, learning together, gaining strength from one another?” He also pointed out that what’s a felony in New York is now a part of Ontario’s healthcare system.

As Faith Gibson, a California-based midwife, observed in a prepared statement, “Midwifery is not the practice of medicine.” Nevertheless, she said, “hospitals make 38 cents profit for every dollar charged for maternity care but only 5 cents per dollar received for cardiac surgery.” And maternity is the most frequent reason for hospitalization in the United States, she added.

According to Lawrence Mokhiber, executive secretary of the State Board of Midwifery, the board is doing exactly what its legislative mandate requires. “The problem we have is in the definition of a direct-entry midwife,” he said. “The law does not allow us to recognize apprenticeship or preceptor training.”

New York’s certified nurse-midwives are in a better position to deal with their patients than midwives in other states, “because we allow them to do things like order controlled substances and perform diagnostic tests without having to run to a physician,” Mokhiber said. “In that sense, they have the broadest range of practice.” He acknowledged that direct-entry midwives would be able to have their experience recognized only through a change in the law.

Following the speeches, rally participants held lighted candles and picket signs as they walked by the governor’s gate, pausing to drop letters in a box that was later delivered to the gatehouse. Devers-Scott announced her plan to appeal her conviction, and future Friends of Midwives events will be scheduled to coincide with the appeal.

– Metroland Magazine, 7 November 1996