Update: Since this article was published, New York State has initiated plans to establish off-site birthing centers, away from hospitals.
In the midst of a pandemic, healthy, low-risk pregnant people are being asked to give birth in hospitals whose emergency rooms and intensive care units are being overwhelmed by patients ill with COVID-19. Healthy pregnant people — who are asked to bring their own personal protective equipment (PPE) — are being admitted into the same systems where hospital staff themselves often lack adequate PPE and where every spare inch is being converted to care for COVID-19 patients.
On average, there are about 10,000 births per month in New York City. Of those, 85 percent are low-risk and can be safely done outside a hospital. Yet we are asking pregnant people to go into hospitals, the epicenters of our struggle against coronavirus, while everyone else is asked to stay at home. This does not make sense.
Worse, pregnant people are being induced early (which creates a significant respiratory risk to newborns), expected to give birth without their family members and doulas, owing to new pandemic-driven policies at hospitals allowing the presence of only one birth companion, and —at significant risk — sent home early with nonexistent postpartum care.
Recent reporting by the New York Times from Brooklyn Hospital, and a letter to the New England Journal of Medicine from doctors at Columbia University’s Irving Medical Center suggest that more than 80 percent of people who have given birth since the onset of the pandemic in the city have tested negative for the virus, but among birthing people who tested positive, almost 90 percent of them were asymptomatic upon presentation. Clearly, to protect birthing people and their care providers, universal testing is necessary and safe alternative sites for giving birth must be created.
Pregnant people in New York City recognize their lack of options and the challenging position into which they have been thrust. They are scared and anxious. Many of those who can afford to have left the city. (However, it’s only a matter of time before much of the rest of the country faces similar challenges to those currently being faced in NYC.) Pregnant New Yorkers have also chosen in large numbers to opt-out of the hospital system and give birth at home, creating an unprecedented burden on the 20 independent homebirth midwifery practices in the city .
We need to create auxiliary maternity units so we can get through this crisis without causing unnecessary trauma and harm to birthing people and their babies.
It wasn’t always this way. In 2001, New York City had four free-standing birth centers and multiple within-hospital birth centers or midwifery-led care floors. Now, New York State has just three out of the 345 birth centers in the United States, with just two in New York City, both located in Brooklyn. New York City has among the most staggering disparities in maternal mortality in the country, with black people 12 times more likely than their white counterparts to die giving birth. The state’s C-section rate was 33.9 percent in 2018, the 12th highest in the country.
As a whole, the United States is the only wealthy nation whose maternal mortality rate has steadily increased in recent years.
Now, in the midst of this pandemic, we are left with the Brooklyn Birth Center and the Birthing Center of New York, both in Brooklyn, as well as those 20 independent home-birth midwifery practices to handle the immense number of requests for out-of-hospital births that have poured in from pregnant people afraid to enter hospitals for fear of contracting the virus.
We know that birth outside the hospital is safe — in fact, for the 85 percent of pregnant people who are low-risk, it is safer than birth at the hospital. Given that our hospital system has been overwhelmed by COVID-19 cases, we need a strong state and citywide response to create auxiliary maternity units (AMUs) so we can get through this crisis without causing unnecessary trauma and harm to birthing people and their babies.
I launched this effort in mid-March. Unfortunately, extensive interactions with people at multiple levels of government have made clear to me that AMUs are not currently a priority for Gov. Andrew Cuomo or Mayor Bill de Blasio.
In an unprecedented pandemic, we need our hospitals to work at full capacity. We should keep more healthy people out of the hospital — including pregnant people, partners and midwives. In the process, we will save our resources —limited PPE, hospital beds and staff — for those who need them most.
We also need New York State to complete the licensure process (legalized in 2016 and regulated in November of 2019, but still stalled in Albany) for midwife-led birth centers, so as to expand free-standing birth centers for low-risk birth. While lawmakers are at it, they should implement expanded community-based perinatal care.
There is a longstanding crisis of care around pregnancy, birth, and postpartum. Health workers and doulas should be empowered (and paid) to provide education and support during pregnancy, labor, delivery and postpartum, including care for newborns. If we’re smart, we’ll seize the opportunities inherent in confronting this crisis and finally take long-overdue steps to protect, support and nurture pregnant and birthing people, new parents and their infants.
Neelu Shruti is the Founder of Love Child, a support space for expecting and new parents located in Manhattan’s West Village and is slated to start midwifery school in the fall. Her email address is firstname.lastname@example.org. To support her petition calling for the creation of AMUs in New York, click here.