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Friday
Jun182010

Six Months of New York Birth Politics in the Media

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By Jill—Unnecesarean

 

December 15, 2009

Choices in Childbirth publicized cesarean rates for the New York metro area. Dr. Mitchell Maiman offered the following statement for their press release:

“The rising c-section rate, both locally and nationally, is extremely disturbing,” said Dr. Mitchell Maiman, chairman of obstetrics and gynecology and director of gynecologic oncology at Staten Island University Hospital. “Every effort must be made by physicians, hospital administrations, and medical leadership to aggressively lower this trend. Potential interventions should include strict criteria for inductions of labor, support for vaginal birth after c-section, incentives and disincentives based on c-section rates, condemnation for c-section section on demand without medical indication, and mandatory serious and effective quality assurance programs in every obstetrical department. Patients must be made aware of the relationship between c-section rate and quality of care.”

 

March 10, 2010

The New York Times covered the new NIH VBAC recommendations in the article “Panel Urges New Look at Caesarean Guidelines.”

“We take N.I.H. consensus panels seriously, and would engage with them to see if there are opportunities to improve the care of laboring women,” said Dr. Alexander Hannenberg, president of the American Society of Anesthesiologists, who practices at the Newton-Wellesley Hospital in Massachusetts.

Dr. Jeffrey Ecker, an obstetrician at Massachusetts General Hospital and vice chairman of the committee that issues practice guidelines for the American College of Obstetricians and Gynecologists, said the committee would consider the recommendation at its next meeting.

Women’s health advocates said they were pleased with the panel’s findings. Debra Bingham, president-elect of Lamaze International, said it was important that the group had recognized that the lack of access to vaginal birth after Caesarean and even to unbiased information about it was a problem for many women.

 

March 23, 2010

The New York Times article, Caesarean Births Are at a High in U.S., was written after the CDC NCHS publicized its report, Recent Trends in Cesarean Delivery in the United States, which analyzed the final 2007 birth data. From the article:

Dr. Macones said the panel’s advice made sense, but he added: “The first thing we should be trying to do is lower the primary C-section rate. Then we wouldn’t get into this trouble.”

Dr. Menacker said: “It looks as if this is a trend that is continuing. I don’t know what the future will hold.”

 

April 20, 2010

Another New York Times article covered Dr. Mitchell Maiman’s approach to keeping cesarean rates at bay.

Caesarean births are generally considered more prone to complications than natural births, so most hospitals at least pay lip service to their devotion to reducing them. But very few have pulled it off. What seems to have made the difference for Dr. Maiman’s department is building that goal into policy, even when it is unpopular with doctors — even, sometimes, when it may be unpopular with patients.

To start, Dr. Maiman and his colleagues do not allow unnecessary inductions for first-time pregnancies at any point before the 41st week, since they are a main cause of C-sections. They also do not allow C-sections for no reason other than the mother wants one.

C-sections are thought to be relatively lawsuit-proof, and they also let everyone go home on time. But such conveniences do not inform Dr. Maiman’s thinking. “You have to draw the line somewhere,” he said in an interview. “If you went to your doctor and said, ‘I want my gall bladder taken out electively,’ your doctor wouldn’t do that, probably.”

 

April 21, 2010

Public Citizen publicized its Guide to Avoiding Unnecessary Cesareans in New York via a press release with the headline “Cesarean Sections Are Overused in New York, Giving the State One of Highest C-Section Rates in the Country.”

 

April 30, 2010

St Vincent’s Hospital in Manhattan, the only hospital in the city that accommodated midwives who perform home deliveries, closed its doors.

 

June 5, 2010

Obese Mothers a Burden on Hospital Resources; Growing Obesity Increases Perils of Childbearing appeared in the New York Times. A shorter version of the article was in local papers all over the country this morning thanks to syndication by the New York Times News Service.

The article states that “medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections.” ANaturalAdvocate discussed the article here.

 

June 17, 2010

The American Congress of Obstetricians and Gynecologists held a press conference to protest the Midwifery Modernization Act and to call midwifery care that is independent of physicians “suboptimal”, “an absolute disaster”, and “a step backwards in patient safety”.

Ob/Gyns are speaking out against the Midwifery Modernization Act, saying allowing midwives to become independent of physicians will put patient safety in jeopardy.

“This is a step backwards in patient safety,” says Dr. Adina Keller.

“I see it as an absolute disaster for our women,” adds Dr. Ronald Uva.

Currently mid-wives must practice with a licensed Ob/Gyn with insurance and sign a practice agreement. However, under the proposal midwives would be declared independent professionals.

The answer can never be sub-optimal care,” says Dr. Keller. “If a patient is going in for a vaginal birth and there’s no obstetrician as a backup, that patient within minutes could require an emergency caesarian. If you’re in a rural area and there’s no Ob/Gyn, the patient or the baby could die.”

“It’s too bad for the people of New York State, that this bill has gotten as far as it has,” adds Donna Montalto, the executive director for the American Congress of Obstetricians and Gynecologists. “We don’t want this bill. If it does pass, women are going to suffer.”

 

Side note about the interviewed physicians: 

Ronald Uva is the Chief of OB/GYN at Oswego Hospital. His hospital has a 33% overall cesarean rate and a 23.2% primary cesarean rate.

Adina Keller attends births at Northern Westchester Hospital, which has a 39.5% overall cesarean rate and a 28.3% primary cesarean rate.

 

June 18, 2010

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

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.

 

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Reader Comments (11)

From the article, as quoted in the above post:

...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.

Honestly, if safety is your concern, why even bring up the competition issue? Who the heck cares? In most situations, more competition = good, while restricting competition = bad. This really makes them sound like they're more worried about people choosing a midwife and a birthing center over an OB and a hospital than anything else. If they're worried about safety, then don't bring competition into it.

Of course, I suspect that competition is the primary issue, at least for the ACOG, so I guess the idea is to bring safety into it to make the argument sound better.

And from the article itself:

"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'"...

What? Seriously? Maybe the one who is more concerned about a woman and baby's safety than his practice's safety? I mean, I do understand that he won't be familiar with the patient, and it's easier if he is, but if a woman is having an emergency, I would tend more to question What (kind of) doctor is NOT going to do what needs to be done to help that person?

At least, I'd like to think so, and tend to think so, based on the doctors I have met. That statement just makes doctors sound like a bunch of selfish jerks, and I truly don't think most of them are. What if that mom had been getting OB/hospital care all thru her pregnancy, but went into labor while she was out of town? Then it would be a case of a doctor being called in to see a patient he'd never seen before. Would he gripe about it then, too?

Somehow, I doubt it, unless he was, indeed, a jerk. I'd like to think he would see it as an unavoidable aspect of an unpredictable job.

If not, then maybe he needs to find another job.

June 18, 2010 | Unregistered CommenterLysana

The ACOG was mighty vague and blustery. Maybe because it has NO evidence base from which to make these claims about safety. Their's is a saw as old as witch hunts. Of COURSE it's about turf and money. I just can't believe they'd tip their hand so blatantly. It's all so diseased.

June 18, 2010 | Unregistered CommenterOrigamiGypsy

"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'"...

That quote also irked me. How is this worse than women who get NO prenatal care and then go to the hospital to deliver, which unfortunately happens with alarming regularity? When a woman without prenatal care shows up at a hospital with an obstetrical emergency-- or even just a normal labor-- do all the docs go "NOT IT!!!!!!!" to try to avoid giving care because they don't want to miss their kid's baseball game? Hmmm... Maybe they do. [sigh]

June 18, 2010 | Unregistered CommenterLori

You forgot something!

In November, 2009 New York State consumers started an online movement called Free Our Midwives that has served as a virtual home for supporters of the MMA. It has allowed busy moms/pregnant women to do amazing work after their kids have gone to bed and made sure the consumer voice has been heard every step of the way! www.freeourmidwives.org

April, 2010: NYSALM lobbied in Albany and invited Free Our Midwives to lobby alongside of them as well as hold a rally on the state capital. Hundreds of moms, babies and families drove across the state to speak with their legislators and rally with families. http://infinitelearners.com/new-york-families-lobby-for-midwives/

June 18, 2010 | Unregistered CommenterHillary

The purpose of licensing midwives is to protect consumers and to help consumers have access to legal midwives. Unfortunately, the NYS bill does nothing to address the total exclusion of CPMs from practice in New York State that has existed since the early 1990s under the current law. Only CNMs and CMs can practice under the existing law, because it was written in a way that requires candidates for licensure to take the ACNM's certification examination. The same midwifery board that licenses the midwives who belong to NYSALM also prevented CPMs from practicing by issuing cease and desist orders to them. CPMs practice underground in New York, if at all. The Big Push reached out to NYSALM, Choices for Childbirth, and Free the Midwives on several occasions, offering to work with them if they would add provisions to their bill to increase consumer access to more midwives by adding the NARM exam, but NYSALM declined. That's why the Big Push has to sit this one out.

June 18, 2010 | Unregistered CommenterSusan Jenkins

“If a patient is going in for a vaginal birth and there’s no obstetrician as a backup, that patient within minutes could require an emergency caesarian. If you’re in a rural area and there’s no Ob/Gyn, the patient or the baby could die.”

Someone always has to pull the "dead baby" card. Just how rural is this area where a woman is birthing and could not transfer to a hospital or already be in a hospital where there is some kind of surgeon available?

June 18, 2010 | Unregistered CommenterKK

Oh yes, I was much safer without a midwife in Brooklyn, so safe I was pressured into a c/sec I didn't need, done by a surgeon who started cutting before I was numb, who left tissue inside that caused me to hemorrhage 10 days postpartum.

Yeah. Safer.

June 18, 2010 | Unregistered Commenteremjaybee

"The answer can never be sub-optimal care,” says Dr. Keller. “If a patient is going in for a vaginal birth and there’s no obstetrician as a backup, that patient within minutes could require an emergency caesarian. If you’re in a rural area and there’s no Ob/Gyn, the patient or the baby could die.”"

So, the obvious answer is, PARTNERING WITH MIDWIVES to prevent this. But oh wait, I forgot, competition. Better just wipe them all off the map and call it a day.

Not that a midwife would transfer a client to a hospital without an OB anyway...isn't that the point of going to the hospital for a birth?

June 18, 2010 | Unregistered CommenterJill P.

@Susan Jenkins: Free Our Midwives did work with and was in contact with The Big Push. TBP helped us prepare our consumers for lobbying and we are so grateful for the guidance received and felt there was a mutual relationship of respect.

We are not midwives and do not represent NYSALM in any way. We are consumers jumping on board a last minute perfect storm that will help widen access for women immediately. We got involved much after the legislation was written and introduced.

Free Our Midwives has immense respect for The Big Push. We are a consumer-based and volunteer-run working group that advocates for women and their families in order to protect the availability of birthing options. We definitely want CPM's in New York and we look forward to a fruitful collaboration with TBP in the future.

June 21, 2010 | Unregistered CommenterHillary

Hi Hilary,
When Free Our Midwives is ready to work for adding CPMs to the NYS law, we will be delighted to welcome you into the Big Push. I personally look forward to working with you, and I know all our other PushStates would open their arms to you. I would hope that NYSALM would also join in on efforts for such a bill but, whether they do or not, we would be most honored to work with Free Our Midwives. A large part of my concern, however, arises from the fact that the mandatory master's degree requirement -- which will further eliminate most CPMs -- might go into effect before an entirely-new bill can be developed and lobbied.
What are folks in New York thinking about this issue?
Warm regards to you,
Susan

June 21, 2010 | Unregistered CommenterSusan Jenkins
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