Busytown by Jolisa Gracewood

Liable to collapse

Another New York birth centre, the Brooklyn Birthing Center, has fallen victim to the same catastrophic rise in insurance costs that scuttled the Elizabeth Seton Childbearing Center: read about it here. As that article notes, only one birth centre remains in the wider New York metropolitan area: the Morris Heights Childbearing Center, which is federally funded and insured and thus insulated from the upheavals in liability insurance (and vulnerable only to the whims of government funding and policy).

Nothing is ever certain, particularly when it comes to the well-understood but individually mysterious process of birth. You can hope and plan all you want, and get something completely different. Both you and the baby are at the mercy of forces literally beyond the control of either of you, although your first task as a mother is to prepare yourself as best you can to navigate the uncharted rapids ahead. At the same time, in a very important sense, birth is the baby's journey. It is the baby who is making its way into the world, and acquiescing to the process is a preliminary lesson in accepting the invigorating chaos - and the utter otherness - that a child brings into your well-ordered life. Among my friends, I've heard of (and in a couple of cases witnessed) labours that were serene, chaotic, sudden, long-awaited, traumatic, ecstatic; labours that were over as quickly as they began, that lasted longer than seemed bearable at the time, that ended in emergency C-sections, that consisted entirely of planned, absolutely necessary C-sections. I know people who've had difficult birth-centre births, and perfectly fine hospital births. Nothing is ever certain.

Nonetheless, it was sobering the other night to visit Elizabeth Seton for what will be the last time and sit in a room full of women due to have their babies any day now, as they absorbed the news that their carefully chosen birth context -- the one thing of which they could be certain, until labour began -- had been extinguished by the stroke of a pen at some insurance company HQ. Some of these women will choose home-birth, which is the closest one can get to a birth center birth. Others will move with some of the Elizabeth Seton midwives to the temporary rooms at St Vincent's, or seek out other hospitals, where they will be subject to the hospital protocols that limit the number of supporters in the room, define visiting hours, accelerate the speed with which artificial methods of induction are applied when labour slows down, and mandate the frequency of internal exams (see a list here of the major differences in St Vincent's birth protocols).

For those interested in learning more about the dubious rationales and cascading effects of these apparently minor differences, Henci Goer's must-read The Thinking Woman's Guide to a Better Birth is a partial (pro-natural birth) but impeccably researched and annotated guide to studies of the impact of various medical interventions.

More reading: an older article in the New York Post that lists the Soho Midwives Center as another casualty of the insurance rise. And although my focus here has been on midwifery in New York, it's not just New York, and it's not just natural-birthing facilities that are feeling the pain -- the crisis is a much, much wider one and it's been coming for a while.

Obstetricians all over the country are finding it too expensive to renew their insurance policies, leaving some areas - especially rural areas - without any pregnancy-related services at all. The profession as a whole is suffering. (These last two links were found at Overlawyered, which fair froths at the mouth detailing particularly outrageous liability suits in every field -- their medical section is here). So which medical or diagnostic practice will disappear next? Mammograms?

Tort reform -- limiting the circumstances and dollar amounts of liability suits -- seems to be the only answer, although funnily enough the trial lawyers don't necessarily agree... At MedPundit, an anonymous doctor replies, and links to this fascinating story of one woman's experience with ambulance-chasing lawyers. None of this is news, of course. But none of it is good news either. And don't even get me started on the latest news about the alarming concentration of harmful substances in the breast milk of North Americans... it'll just make me want to sue someone, dammit.