A bill pending in Albany would end the requirement that midwives have agreements with doctors or hospitals to step in if patients develop complications.
View full sizeIndependent licensed midwife Linda Lovig uses a sonogram to see the position of Tawny Birmingham's baby Thursday. Birmingham, of Mattydale, is expecting a girl. Syracuse, NY -- Licensed midwives in New York can deliver babies in hospitals, birth centers and homes without supervision by a doctor. But they must have a signed written agreement with a doctor or hospital willing to step in to provide emergency services if a patient develops problems the midwife cannot handle.
Sometimes, getting such an agreement can be difficult. Midwives see the written agreement as a barrier to their ability to practice independently. Doctors see it as a tool to ensure patient safety.
A bill pending in Albany that would remove the requirement has some midwives and doctors at loggerheads. The bill has been approved by the Assembly and Senate higher education committees and could come to a vote by the Legislature next week.
Kate Finn, a licensed midwife from Ithaca who specializes in home births, said some doctors in rural areas will not sign these agreements because they view midwives as competitors or they fear doing so will increase their liability. If an independent midwife has an agreement with a physician who retires or dies and the midwife cannot find a replacement, the midwife is out of business, she said.
“There is no other profession where you have to ask permission from someone who is a competitor in order to practice your trade,” said Finn, a member of the board of the New York State Association of Licensed Midwives.
Law recognizes midwives in 1992
A state law passed in 1992 recognizes midwives who have completed graduate level education programs as independent practitioners qualified to manage normal pregnancies, childbirth, postpartum care and primary preventive reproductive health care. They also can prescribe drugs.
Facts about midwives
• There are 1,017 licensed midwives in New York state and 37 in Central New York.
• Most locally are employed by doctors and deliver babies exclusively in hospitals.
• Midwives delivered nearly 15 percent of the 7,237 babies born last year at Crouse, St. Joseph’s and Community General hospitals in Syracuse.
Midwives say repealing the written practice agreement requirement is a logical next step. Fifteen states allow midwives to practice without written practice agreements.
The New York chapter of the American College of Obstetricians and Gynecologists opposes the bill. “We are concerned about patient safety,” said Donna Montalto, executive director of that group. “We are concerned that if a woman has an obstetrical emergency during labor and if there is no relationship with an ob-gyn or a hospital, patient safety will be greatly jeopardized.”
The written practice agreement is not just a concern for rural midwives. It has become a hot issue in New York City after the recent closing of St. Vincent’s Hospital, in Manhattan. That’s because St. Vincent’s was the only hospital in the city willing to sign agreements with seven midwives who do home births in the city. Other doctors and hospitals in Manhattan, who have misgivings about home births, will not sign agreements with them.
Linda Lovig, an independent licensed midwife in Syracuse who delivers babies at St. Joseph’s Hospital Health Center, has written practice agreements with several local doctors, including Dr. Richard Waldman, who was recently named national president of the American College of Obstetricians and Gynecologists.
Lovig said she has a good working relationship with those doctors. But she believes midwives can develop those referral and consulting relationships without a written agreement, the same way other primary care providers do.
A family doctor caring for a pregnant patient who develops complications and needs a Caesarean section can refer that patient to an obstetrician without having a written practice agreement, Lovig said. Doctors refer patients to specialists without having written agreements all the time, she said. A midwife should be able to do the same thing, she said. “It’s really a matter of bringing what I do as an independent practitioner, clinically, into the 21st century,” Lovig said.
Lovig has worked as a midwife 20 years. She opened her independent practice six years ago, after the doctor she worked for died.
Quality service, less expensive
Midwives in New York perform about 15 percent of the non-Caesarean deliveries. Midwives provide high quality care with outcomes that are better or comparable to those achieved by obstetrician-gynecologists, according to the American College of Nurse Midwives. That group says midwifery services tend to be less expensive because they involve fewer unnecessary, invasive and expensive technologic interventions.
“We are not worrying about when our next gyn surgery is or the triplets in the next room,” Lovig said. “This is an important time in women’s lives, and they want that focused care. We are really good at it.”
Dr. Richard Waldman, chair of obstetrics-gynecology at St. Joseph’s Hospital Health Center, in Syracuse, said doctors might drop their opposition to the bill if the language in the proposed law makes it clear midwives still need to establish collaborative relationships with doctors or hospitals.
“You don’t want to establish a collaborative relationship at three in the morning when you’ve got a patient in an extreme situation,” he said.
Contact James T. Mulder at 470-2245 or jmulder@syracuse.com.