TAKE ACTION
New York City is facing a maternal health crisis.
Fantastic news!
A year after the NY Covid Maternity Task force gave their recommendations, the birth center bill unanimously passed the NY Assembly and Senate! After the Governor signs this legislation, Midwives will be able to use national accreditation instead of NY’s onerous, burdensome & expensive Certificate of Need process to open! A big thank you to AM Gottfried and State Senator Rivera for their sponsorship. We’re looking forward to Gov Cuomo’s final signature to eliminate barriers to opening birth centers!
You can take the following action steps to thank AM Gottfried, State Senator Rivera and Governor Cuomo and ensure that this bill becomes law!
Step 1: Call Governor Cuomo at 518-474-8390
Step 2: Use one of the following scripts:
Hi, I’m a New York State resident from _____ and I’m calling to say that I am looking forward to the Governor signing A259A/S141A into law so that midwives in NY can use national accreditation instead of the burdensome Certificate of Need regulations to open birth centers in NYS.
Hi, I’m a New York State resident from _____ and I’m calling to say that I am looking forward to having expanded access to birth centers after the Governor signs A259A/S141A into law so that midwives in NY can use national accreditation instead of the burdensome Certificate of Need regulations to open birth centers in NYS.
Step 3: Tweet at Governor Cuomo @nygovcuomo or direct message his account using the email script above.
Sample tweets:
I’m looking forward to Midwives being able to open birth centers without onerous CON regulations after @GovCuomo signs A259A/S141A
Birth Center bill passes unanimously in both houses! This bill will substitute the burdensome CON regulations for national accreditation after @GovCuomo signs
Bill to Release birth centers from the prohibitive CON regulations passes assembly & senate unanimously! Looking forward to the Gov’s final signature and more birth centers in NY!
Step 4: Send a fax to Cuomo, using the script above as the body text in the fax. Here’s a free fax service. Cuomo’s fax #: 1-518-474-1513
Step 5: Email the governors’ women’s affairs person, Emily Kadar at Emily.Kadar@exec.ny.gov, and use the script above.
Step 6: Call Melissa DeRosa: 518-474-4246 or 212-681-4580, and use the script above.
Even before COVID-19 and the BLM movement, New York’s Birthing people have struggled to access affordable and respectful care.
New York State has the 12th highest C-section rate and New York City’s is even higher at 34%.
New York City in particular has one of the highest disparities in maternal mortality with Black people up to 12 times more likely to die in childbirth than their white counterparts attributed solely to racism.
Birthing people struggle to find respectful care in NYC because:
New York City lacks Birth Centers
The chart above shows the stark differences in outcomes for pregnant people who give birth in birth centers or at home, as compared to at hospitals. Birth center and home births have much lower c-section rates, much lower infant mortality, and much lower maternal mortality.
A birth center is a regulated and credentialed facility dedicated to perinatal care for low risk people and typically runs on an integrated model with midwives and physicians. Birth Centers should be integrated into the perinatal health care system.
85% of people giving birth are considered low risk; their births are considered healthy events and they are able to safely deliver outside of a hospital either in a birth center or at home – yet these options are drastically limited (home birth providers being out-of-network and birth centers simply limited)
Coming back to the C-section rate though, that means that – even for healthy, low-risk people – more than 1 out of every 4 people who give birth in hospitals end up having C-sections. On the other hand, more than 9 out of 10 people who give birth in birth centers have vaginal births.
In fact, 94% of people in the US who enter labor planning a birth center birth achieve a vaginal birth. In other words, the C-section rate for low-risk women who chose to give birth at a birth center was only 6%—compared to the U.S. C-section rate of 27% for low-risk women. That’s a big difference!
So to summarize, more than 1 out of 4 low-risk births at the hospital results in a C-section, whereas, roughly only 1 out of every 20 low-risk births at a birth center results in a C-section. Still, birth centers do have plans in place for hospital transfers in case of emergencies or prolonged labor, but less than 1% of people giving birth at birth centers actually transfer because of an emergency.
Only about 1% of people in the US deliver outside of the hospital, but the demand for out of hospital birth had already been steadily increasing since 2004, and with the COVID-19 pandemic, that demand has now skyrocketed with a 200% increase in the last 10 years.
The cost of a vaginal birth at a Birth Center is about $3200 compared with a cost of $6500 at a Hospital. If more pregnant beneficiaries accesses Birth Centers for maternity care they would experience better outcomes and medicaid would save money!
In many countries around the world, birth at a birth center – or even at home with midwives – is understood to be the safest birth option for a low-risk pregnant person, but, for a complex set of historical, political, and economic reasons, in the US we have embraced a highly medicalized version of birth, where most people believe that it is only really safe to give birth at the hospital.
Out of 345 birth centers across the country, New York State only has 3, with 2 in Brooklyn. Note that both these facilities are led by physicians.
In the last 20 years NYC has lost the following birth centers: Elizabeth Seton, St Vincents, Soho Womens, Bellevue Birth Center, Mt Sinai West and many more.
NY has zero Midwifery-Led Birth Centers. A law was passed in 2016 that should have finally made it possible for midwives to open birth centers in New York, but it took the Dept of Health four years to pass regulations. It wasn’t until the NY Maternity Task Force after the peak of the pandemic pressured the DOH to release a process for licensure. Unfortunately the DOH has included MLBCs Certificate of Need (CON) process for Article 28 facilities classifying MLBCs under a new Section NYCRR Part 795. What this means is that MLBCs have to go through the same lengthy and expensive process as an Intensive Care Unit Hospital, Many states in the US utilize the rigorous standards for accreditation as the only requirement of licensure for birth centers, developed by the Commission for the Accreditation of Birth Centers (CABC) and rooted in evidence-based practice that have proven to promote safety along with the numerous positive outcomes for birthing people, that freestanding birth centers are known to achieve. This process for licensure is appropriately labor intensive to ensure that the quality assurance protocols and procedures necessary to maintain high standards of care at each center are in place. In contrast, the CON process does very little to ensure a center is regularly meeting a high level of quality assurance and clinical safety. As a result, we are seeing many more delays and hurdles to MLBCs opening in New York City.
New York State struggles to have adequate access to Midwifery care and is actively criminalizing Community Midwives (CPMs)
34 out of the 50 states have recognized the valuable role that community midwives play in supporting reproductive health and reducing racial inequalities in outcomes, however in NY State CPMs are criminalized for providing care.
CPM’s are midwives that are trained in out of hospital and community birth settings require twice as much experience to be certified as those with nursing or graduate degrees. Therefore CPM’s tend to represent and serve BIPOC communities where the need is most dire.
During the COVID-19 pandemic, Governor Cuomo briefly lifted these restrictions when the need for community health workers was dire. The pandemic has not ended and New Yorkers continue to demand respectful healthcare that midwives can offer. New Yorkers need and deserve more qualified midwives.
In fact, the first Black-owned Midwifery School in the United States was just accredited to offer education for direct entry midwives and under the current New York law, graduates of the school would not be able to practice in New York, despite their experience. In a time where we need more Black and Brown Midwives, it is outrageous that these health care providers continue not just to be restricted but criminalized.
In Downtown NYC alone, the loss of midwifery and birth services has been staggering: SoHo Midwives closed in 2002; Elizabeth Seton Childbearing Center closed in 2003; St. Vincent’s closed in 2010; Mt. Sinai closed their in-hospital birth center in 2018; Beth Israel closed its midwifery unit in 2017; Bellevue closed it’s birth center in 2007 and slashed it’s 24-hour midwifery program in 2017; and NYP Downtown’s birth center was a short-lived and failed experiment.
New York City has a strong public health tradition of investing and supporting midwifery and birthing people that we can build on, but we need resources and radical imagination to do so.
In the 1920s, Dr. Josephine Baker founded the Bellevue Midwifery School and the NYC Baby Health program.
The City built publicly funded 68 Baby Care clinics where people could go to get free antenatal and new-born care, (imagine if the public library system also provided basic antenatal care) and midwives were sent to people’s homes to offer care, resulting in a dramatic decrease in maternal mortality.
These facilities were cut as part of the 1970s fiscal crisis, and if we still had those facilities today, New Yorkers would have better access to safe perinatal care.
With care, and attention, we can be smart about investing in public community health programs to benefit all New Yorkers.