This Tuesday, the New York Times published an article entitled Maternal Deaths Decline Sharply Across the Globe (Grady 2010). These new findings, published in the medical journal The Lancet, seem to support the notion that maternal healthcare is improving. We think we are doing better, and in some ways this is true. At the same time, many women don’t have access to the kind of maternal care that they want, or that they need. I am not saying that the statistics published in this study aren’t important. What I am saying is that such studies shouldn’t overshadow the fact that more women are having less options when it comes to childbirth. I firmly believe that all women should have the choice to give birth however they want, as long as its safe, and that choice should be supported.
Four days before Grady’s article was released, The New York Times published a different article, With the Closing of a Hospital, Women’s Childbirth Options Diminish (Dominus 2010). The hospital that the article is referring to is St. Vincent’s Hospital Manhattan. After a long struggle to stay afloat, the board of St. Vincent’s Catholic Medical Centers voted on Tuesday, April 6th, to officially close St. Vincent’s Hospital Manhattan. Sadly, with the closing of St. Vincent’s, the local community is losing some of its essential community services, and women all over the city are losing one of the most unique obstetrics departments in New York City.
The obstetrics department at St. Vincent’s Hospital Manhattan was well known for providing a full range of childbearing options for women. Women hoping to experience anything from a low-tech childbirth to a scheduled Caesarean could find care and support at St. Vincent’s. The department, run by Dr. George Mussalli, was exceptionally midwife-friendly and considered the hospital of choice for home midwives in the event that they needed to transfer a patient. Dr. Mussalli’s own obstetrics practice, Village Obstetrics, describes itself as committed to “minimally invasive obstetrics care” and a low caesarean section rate, in addition to working collaboratively with midwives and doulas. Even in a place like New York City, this kind of approach to childbirth is hard to find. Dominus writes, “In a city where you can live however you want, as long as it’s safe – and sometimes even if it’s not – it seems absurd that there are so few places where women can give birth however they want, as long as it’s safe” (2010). Women who want to have the option (and support from their doctor) of natural birth, or any other option that deviates from the standard/norm are not able to access facilities that can provide such services.
In fact, just this past November, another one of New York City’s natural birth clinics closed its doors. Like the obstetrics department at St. Vincent’s, the Bellevue Birth Center was a unique facility. In their article, Bellevue Natural-Birth Center, Haven for Poor Women, Closes, A.G. Sulzberger and Nick Pinto explain, “The Bellevue Birth Center was celebrated as a landmark for the natural-birth movement in New York City when it opened in 1998. The luxurious natural-birth center, designed to feel more like a home than a hospital, was the only one of its kind dedicated not to Manhattan’s trend-conscious set, but to poor, mostly immigrant women on Medicaid.” In addition, “the center gave healthy women the opportunity to give birth in a comfortable environment absent the frenetic bustle of a normal hospital delivery ward. Roughly 85 percent of the patients were Chinese- or Spanish-speaking immigrants, most of them referred through Gouverneur Healthcare Services on the Lower East Side. (All midwives were required to be fluent in either Mandarin or Spanish).” At Bellevue, expecting mothers were allowed to walk around and bathe in Jacuzzis to naturally reduce pain, and had the option to choose to forgo common but invasive medical techniques like induced labor and epidural blocks. “Unlike women who chose natural birth at home,” the authors write, “patients had immediate access to hospital facilities if there were complications.” Now, with the closing of Bellevue and St. Vincent’s, there are less than a handful of natural birth facilities available in New York City. If this is the case in of the United States’ largest cities, then it seems fair to assume that women who don’t have access to such metropolitan areas also don’t have access to very many birthing options.
The one exception that I know of (though I certainly hope that there are others) is the Tuba City Regional Heal Care Corporation in Tuba City Arizona, run by the Navajo Nation and financed partly by the Indian Health Service. In class, we read Denise Grady’s article Lessons at Indian Hospital About Births, and discussed the benefits of maternal care at a hospital like Tuba City, that “prides itself on having a higher than average rate of vaginal births among women with a prior Caesarean, and a lower Caesarean rate over all.” There are four other hospitals in New Mexico and Arizona, run by the Indian Health Service, that offer vaginal birth after Caesarean to healthy women. In general, “nurse-midwives at these hospitals deliver most of the babies born vaginally, with obstetricians available in case problems occur. Midwives staff the labor ward around the clock, a model of care thought to minimize Caesareans because midwives specialize in coaching women through labor and will often wait longer than obstetricians before recommending a Caesarean. They are also less likely to try to induce labor before a woman’s due date, something that increases the odds of a Caesarean.” Another interesting fact the article brings up, is that in the rest of the country, nurse-midwives attend about only 10 percent of vaginal births. Donna Rackley, a nurse-midwife in Tuba City said that in Tuba City, “if labor is slow but there is no sign of fetal distress and the patient wants more time, the doctors will wait.” In the rest of the United States, there are very few hospitals, and doctors, that can insure the same thing.
Elan McAllister, president of Choices in Childbirth, a non-profit organization based out of New York City, is cited in the article about St. Vincent’s as well as the article about Bellevue. According to their website, Choices in Childbirth “strives to improve maternity care by helping women make informed decisions about where, how, and with whom to birth. Through education, outreach and advocacy, we provide information to the public about women’s rights and options in birth.” McAllister said that Bellevue’s natural-birth center, “should be a model that the other city hospitals are looking to replicate… And now, if you are uninsured and want that, I wouldn’t know where to send you” (Sulzberger and Pinto 2010).
In all three models, St. Vincent’s, Bellevue, and Tuba City, natural childbirth is, or was, a choice offered that every mother had the option to make. As Dominus explains, “the range of options at St. Vincent’s, in Greenwich Village, was about as wide as any expecting mother could want. You need a scheduled Caesarean? By all means. You want to give birth at home on your futon with incense burning and monks chanting on your iPod? So be it.” Now that two of these three institutions that provided such overwhelming support for women are gone, what does this mean for women?
In his article, “How Childbirth Went Industrial,” Atul Gawande (2006) addresses this very issue. Gawande has a problem with what he calls the “standardization” of childbirth, which makes it easier for doctors to deliver babies but doesn’t necessarily consider what is best for the mother. Gawande doesn’t say that c-sections are always bad, but he emphasizes that they aren’t the only option. He believes that doctors should be taught a wider variety of practices and procedures to ensure that women have access to all options and that they understand that they have to (and can) do what is best for each individual woman and her baby. What is important about Gawande’s article is that he is pushing for women to have choices and access to information to make informed choices, throughout the entire process of pregnancy and childbirth.
Overall, what is at issue is the importance of choice, in all stages of pregnancy. In class we talked about how a wide range of options should be available for women. What if we were to combine resources, so that a woman could have a midwife or a doula and an obstetrician, all in the same hospital, in the same room? Choices in childbirth should be available to ALL women, regardless of class, ethnicity, language, or anything else. Unfortunately, with the closing of so many natural birth friendly facilities, choice is becoming less and less of an option.
Dominus, Susan. "With the Closing of a Hospital, Women's Childbirth Options Diminish." The New York Times. 9 Apr. 2010. Web. 13 Apr. 2010. .
Gawande, Atul. "How Childbirth Went Industrial." The New Yorker. 9 Oct. 2006. Web. 24 Mar. 2010. .
Grady, Denise. "Lessons at Indian Hospital About Births." The New York Times. 6 Mar. 2010. Web. 25 Mar. 2010. .
Grady, Denise. "Maternal Deaths Decline Sharply Across the Globe." The New York Times. 13 Apr. 2010. Web. 13 Apr. 2010. .
Sulzberger, A.G., and Nick Pinto. "Bellevue Natural-Birth Center, Haven for Poor Women, Closes." The New York Times. 7 Nov. 2009. Web. 13 Apr. 2010. .