August 18, 2003

More birth centres under threat

I have received notification that another midwifery service, this time the Elizabeth Seaton Childbirth Centre, the only free standing birth centre in New York City, is to close by September 1, another casualty of the insurance crisis.

There is not much that I can do about this, as I live in Sydney, Australia, but I can give it some publicity, at least amongst the readers of this Diary. If you want to know more, they have full details of the centre and the issues surrounding the closure - please email them at:

elanit@att.net

This is not th first time that free standing birth centres in the US have been forced to close - the last time, which was some years ago now, an insurance company who would underwrite the malpractice insurance was found at the last minute. It is to be hoped that another company will come forward so that this Centre and many others, will not be forced to close.

It seems that independence (in many respects) is now a condition under severe threat. In the end, the only way for birth centres to exist may be as part of the regular services offered by hospitals (this is the way they operate in the UK and Australia). This can be viewed as both positive and negative. On the plus side, parents get easy access to a birth centre environment, at no cost, making it an option that is truly available to the whole community. The midwives who staff these centres are covered by the hospital insurance and have their working conditions covered by employment laws.

On the minus side, there is the possibility that hospital administrators will curtail or place limitations on the kind of clients that can use the Centre and the services that can be offered (no vaginal breech birth, twins or perhaps VBACs, for example) thus effectively curtailing the Centre’s availability to the whole community. This would also mean that limitations were placed on the midwives’ scope of practice, a situation that would not apply to the doctors who use the hospital.

Is the demise of independent birth centres such a bad thing? I believe that these centres offer models of care that “keep the bastards honest” (to use a well-known Aussie political phrase) and that without them we, as a community, run the risk of being completely dominated by hospital based medical practices. Choice is an important measure of a democracy and in a small way, the maintaining of independent practitioners and birth centres is a measure of our tolerance and sense of fair play.

The fact that insurance companies are not willing to accept the safe outcomes provided by these birth centres and independent midwives is an indictment of the power they are exerting over us in these litigious times. In Australia, we are getting much closer to convincing the Government that they can support independent practice by underwriting the necessary insurance themselves and that this measure will ultimately save them money in a number of ways, whilst producing safer outcomes for mothers and babies

I doubt that this route for gaining support will be available in the US, where a universal public health care system does not exist. I can offer no suggestions or strategies for keeping them open at the present time. I suspect that only a complete turnaround by the politicians who run the US and a complete shake up in the health sector will ensure freedom of choice for all US citizens and true choices for birth. And changes of this magnitude are a very long way off.

Posted by andrea at August 18, 2003 06:03 PM

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