I've always wanted to live in New York. For a long time, I imagined that living in New York meant having access to anything you want, whenever you want it -- great pizza! real bagels! somebody who knows somebody who's touched Donald Trump's hair! -- all against the backdrop of bright lights and big city and possibly Sarah Jessica Parker loping in tutus in front of buses. Which, from what I understand from friends who live in New York, is mostly all true, except for the Sarah Jessica part. Also, this: It turns out that while living in New York might involve being able to get great pizza any time of the day or night, it doesn't involve being able to give birth whenever or wherever you want.
This seems surprising, coming from the city that gave us The Doula Project,* but it's true. A story in Bitch Magazine makes the issue plain: It's getting more and more difficult to have a midwife-attended home birth if you live in New York City. They note that although it seems "ironic" given the seeming mainstreaming of home births and midwifery in recent years, "it's now, at least in New York City, headed back to the margins:"
St. Vincent's, the NYC hospital that had backup agreements with more than half of the city's home-birth midwives, closed on April 30 due to bankruptcy. New York State law requires that all practicing midwives have WPAs with hospitals, but due to a variety of factors -— malpractice fears/costs, skepticism over home-birth safety, and more -— doctors at those hospitals have so far declined to negotiate new agreements with midwives. The result is that home birth in New York City could effectively become illegal almost overnight. The clients of these midwives are now forced to choose between two deeply insufficient options: Show up at their local hospital when they go into labor and be attended to by whatever provider happens to be on call, or have their babies at home, as planned, with a midwife who stands to lose her license if the birth ends with a trip to the hospital due to complications.
I did not have, nor did I ever want, a home birth. But I know plenty of women who did or who do and it seems to me a backward step in reproductive and maternal empowerment for women to not be able to make these choices according to their own lights. That, and the very culture of maternal and reproductive rights advocacy suffers, I think, when the arena of those rights and the practices related to those rights becomes circumscribed. I might not have wanted a home birth, but I felt much more empowered as a pregnant woman for having a wide range of choices to consider: The very fact that there was choice underscored for me the very important idea that this was my birth and that I was the primary agent in that experience and that it was right and good that I be able to define that experience to the extent that I could. If those choices become restricted, women become disempowered to a corresponding degree, not because any of those choices are necessarily more choiceworthy, but because the very fact that there is a choice in how we approach labor and childbirth is important to our sense of agency as mothers and as women.
Andi Zeisler, who wrote the article in Bitch Magazine, makes much the same point: "Choosing how one wants to give birth is an essential piece of the larger picture of reproductive rights, and for many women giving birth at home is both personally meaningful and a mindful effort to avoid the snowball effect of medical interventions that often result from minimum-risk hospital deliveries like the one I had." Mindful effort: that's key, I think. Having choice is both reminder and encouragement for mothers to pursue -- and a necessary condition of them pursuing -- mindful effort in giving birth, whether that mindful effort is directed toward minimizing pain or creating a peaceful environment or avoiding excessive medical intervention or whatever: It keeps us, as I suggested above, in our proper place as agents in the delivery of our own children from our own bodies.
More's the pity for us if we take a step backward in the struggle to not only preserve, but also advance our maternal agency. New York, we're watching you.
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