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Birth Day Presence Blog

  • Another birth center plans to close in NYC and expectant parents might lose one of the last few options for low-intervention care during childbirth.

    By Jada Shapiro, founder boober and Birth Day Presence.

    Drawing adapted from photograph by jada shapiro at the Mt. Sinai West Birthing Center.

    This past weekend, my social media blew up with a notice from a midwife that NYC’s Mt. Sinai West Birthing Center is slated to close at the end of the year. This is devastating to the NYC community because people in labor deserve safe and healthy birthing options. It is a step backwards in a city which is already crippled with a lack of childbirth choices across all communities. NYC should be a leader in offering birth options to all people and instead we are sliding backwards, losing one of the last in-hospital birth centers in New York.

    As a longtime birth doula and founder of boober, the on-demand lactation-consulting platform and Birth Day Presence, the childbirth education center and doula-matching platform, I have been attending births at the Birthing Center at Mt. Sinai West (formerly St. Luke’s Roosevelt) and recommending this place of birth to low-risk, expectant parents who are seeking low-intervention birth for 16 years.  As a birth doula, I always relish the opportunity to work with a client in a birth center, because I know my clients will be treated with respect, and will receive compassionate, evidence-based care, while being included in the decision-making process, in a home-like environment. As Rebecca Dekker, Ph.D., RN, APRN of Evidence Based Birth writes for the American Association of Birth Centers, “Birth centers are universally committed to family-centered care. In birth centers, the childbearing woman’s right to be the decision-maker about the circumstances of her birth is fully respected.”

    Although it has long been recognized that many parents who planned to birth at the Mt. Sinai West Birth Center were not able to deliver there due to medically “risking out,” lack of staff, or overbooked rooms, the benefit of birthing in the hospital’s regular birth floor still stood out. The staff was regularly exposed to people’s desire to freely move, use the shower, and have their baby on their chest immediately after birth. I am by no means saying this hospital is perfect. One of the big issues with the birthing center is that it is generally not available to people on public insurance. With NYC African-American mothers twelve times more likely to die than their white counterparts, access to birth center care for all people is vital. In fact, since the closure of the Bellevue Hospital Birth Center (where I started the Bellevue Hospital Volunteer Doula Program which served many parents who could not afford private doula care) many years ago, NYC has not had an in-hospital birth center which consistently offers care to lower income people with public insurance for years.

    In trying to quantify what the loss of this birth center would be to New Yorkers, I spoke with top doula and birth expert, Debra Pascali-Bonaro, President of Pain to Power Childbirth LLC, Chair of the International MotherBaby Childbirth Organization, Lamaze Childbirth Educator, and DONA International Doula Trainer. “In a leading international city such as NYC, the closing of Mt. Sinai’s birth center is limiting pregnant people’s rights and access to choose evidence based, low tech birth options that are the safest for both MotherBaby health and well-being. NYC, which prides itself on its wealth of knowledge, culture, technology, theater and so many more options, offers the least amount of choices for safe, evidence-based birth, making a strong statement on how little Mothers and Babies are valued.”

    The Value of Low-Intervention Care

    Birth centers provide a low-intervention type of care that increases the likelihood of vaginal births and decreases the use of pharmacological methods of pain management and episiotomies.  People who give birth at a birthing center are less likely to have a cesarean and more likely to breastfeed. Birth centers promote and utilize midwives, whose model of care is known to significantly reduce unnecessary medical intervention, while increasing patient engagement in their care and their satisfaction. (It should be noted that a few OBGYNs also choose to assist births in the birth centers and that OB’s can practice this model of care, as well).

    Studies consistently show that people who birth at birth centers have greater positive outcomes and lower rates of medical intervention. Check out this study that looked at over 15,000 low-risk parents in birth centers. Says certified nurse midwife, Amanda Segilia, CNM, who attended hundreds of births at this birth center and gave birth herself there three times, “We are very lucky to live in a time and a place where women can have safe and satisfying birth experience in a number of environments. For low risk labors, the environment of a Birthing Center allows people to feel safe as their physiologic labor and birth progresses. The setting of a quiet and low intervention space as well as the use of intermittent fetal monitoring and hydrotherapy are important options for women who want to give birth without the use of pharmacologic interventions.”

    Not surprisingly, people who give birth at a birth center report greater satisfaction with the birth experience overall.  In a birth center, they’re “allowed” the freedom to move at will, eat and drink as they see fit, and use things like a jacuzzi tub, a well-known comfort measure. And for many people, birth centers have the benefit of reducing anxiety. As certified nurse midwife, Melissa Bair, CNM who has been affiliated with many NYC birth centers says, “For people in labor, the environment matters. Birth centers are not for everybody. But for people who are low-risk and don’t need the extra levels of intervention and monitoring, birth centers give people in labor and their families an environment similar to home, something familiar.”

    Examples of the difference between a regular hospital birthing floor and a birth center are numerous, as explained on Mt. Sinai’s own page about their Birthing Center.  The double bed allows the birth partner to get into bed, too, to help with birthing positions during labor, and later to lie down and relax as a whole family after the baby is born. Laboring parents are allowed to eat and drink, keep the lights low, and invite whomever they want to be there.  In a birth center, low-risk people are often monitored with a hand-held monitor (auscultation). This allows the laboring parent to be wherever they want to be – the shower, the toilet, the bath, leaning over, wherever they feel right and find the best relief from labor pain –  while the midwife, doctor, or nurse can still listen to the baby’s heart tones. In contrast, in a typical hospital setting, even low-risk laboring parents are monitored with an EFM (electronic fetal monitor), which requires sensors on the belly and wires that are hooked up to a monitor. Although you can move around (staying within the length of the monitor wires), most hospital staff will encourage parents to lie down so that the sensors stay in place. Birthing centers support a general commitment to patient-driven comfort measures and positions and non-medical approaches wherever possible.

    As a doula, why do I love when one of my clients is going to give birth at the birth center? I know my client won’t feel pressured into unnecessary medical interventions, but will have them if they need them. I know I won’t have to expend a ton of energy advocating for skin-to-skin contact between parent and new baby, because in the birth center, it is just assumed, provided baby is well. And I know I will be welcomed and respected, as the staff views me as an asset to the birth team and not an adversary. 

    Why parents chose the birth center in their own words.

    My friend, call her Shanna, gave birth there 2 years ago. It was so important to her to give birth in a birth center inside a hospital that she “flew across the country to arrange prenatal care that would lead to a delivery there ahead of my move from the west coast to NYC. I was then willing to make the long trip from Brooklyn to the upper west side for my care and delivery because this setting was the only one that would support my desire to have a relaxed, natural birth with the confidence that top-rate medical care was right there if I needed it. My experience at the birth center was wonderful and tranquil. The nursing care I received surpassed my expectations – it was loving and supportive and reassuring while I felt vulnerable.  It meant so much to have a comfortable room where I could relax with my husband and our new daughter in the days after delivery – those were magical days.”

     

    Jessica Vanderberg, mom of 3 and founder of MomtownNYC chose to give birth twice at the birth center, because she “wanted the handholding of midwifery care and the space that would let me labor with support that was present for the duration of my labor while encouraging me to trust my body. I wanted to labor in the same space where I’d recover. I understood the birth center model to be very different than labor and delivery in other hospitals and was comforted knowing should anything go wrong I was already in the hospital. I didn’t anticipate wanting to be in water (in fact, I was very clear I didn’t want that), but the moment I stepped into the room, I took off all my clothes and got right in before it was even filled. Having access to water during birth changed my whole experience. More women need access to low-intervention care with a practitioner who is by their side for the experience in a space that offers them freedom and choice”

     

    Ayelet Kaznelson, IBCLC writes, “I gave birth at SLR BC when I had my second child. It was such an amazing and meaningful experience and so vastly different than my experience giving birth in a hospital setting, that I know my life would have never been the same if I didn’t get a chance to have this birth. Everything about it was fantastic for me. The cozy room, the jacuzzi, the lack of medical equipment (that is so well hidden but ready if needed), the ability to move as I pleased, to wear what I wanted…to not have the constant monitoring and to have the continued presence of my midwife, who was so calming and reassuring, sitting on the floor by my side whispering encouraging words I’m my ear was just beyond what I could have asked for. When it was time for me to push my baby out the midwife urged me to reach down and pull the baby out and then my husband announced the sex of the baby. I felt like a powerful strong woman joining generations of other strong women who birthed their babies this way. It was a true gift. I love both my children fiercely but can’t compare the miserable way I felt after my daughter was born in a hospital setting to how powerful, strong and invincible I felt when my son was born at the birth center and how it impacted my recovery, Breastfeeding, and immediate postpartum period and ability to cope on the most positive way.”

    There are thousands more stories like these.

    Why is the birth center closing?

    Reportedly, the hospital is closing the birth center to make way for private-pay postpartum rooms. Granted, we need more private rooms. Most NYC hospitals do not allow fathers or non-birth parents to stay overnight because everyone (besides those who can drop $400-$1000 on a private room) shares a room for their postpartum days. So yes, make private rooms! But not at the expense of the birth center.

    I, and many others, suspect the real reason is not a new consciousness about the value of privacy but the fact that birth centers aren’t as profitable as other parts of the hospital. “We’ve had evidence of the safety and value of birth center care for over 30 years, but for every new birth center that opens, another one closes. This is because the economics of low-intervention birth don’t function in a system that rewards procedure-based care over person-centered care,” says certified professional midwife Brynne Potter, CEO and Founder of Maternity Neighborhood, a digital health platform that supports over half of US birth centers. Pascali-Bonaro echoes this sentiment. “Both science and recent national and international initiatives recommend the use of front line natural comfort measure in a positive birth environment, like those found in both hospitals and birth centers, which support physiologic birth to achieve the safest births outcomes, while also reducing costs.  Limited access to birth centers and the care that supports physiologic birth is putting people at risk and putting profit ahead of people and newborns.”

    Where do we go from here?

    NYC expectant parents who want to birth in the least interventive environment possible, with the greatest chance of a vaginal birth, need birth centers to support that intention.

    I have attended many hundreds of births in NYC, and though I have certainly experienced some non-interventive births in hospitals, those experiences are few and far between.

    As with any kind of health care, we need choice and options. NYC is one of the least progressive places to give birth in the US.  We have few birth centers, few midwives, few places with tubs for water labor or birth, we barely do “gentle cesareans” (a newer approach to cesarean birth which, while still being a major surgery, tries to mimic certain aspects of vaginal birth, like immediate skin-to-skin contact and breastfeeding), we don’t have wireless fetal monitoring (although it has been available for years!), and doulas, though slightly more accepted than they were when I began working, are still treated with resentment in many of our hospitals.

    Mt. Sinai West has the opportunity to become an even greater asset to the NYC community by expanding its birth center to include all parents including those on public insurance who receive clinic care, and to be a leader in providing access to the safest type of birth care to all people.

    What can you do?

    • Sign this Petition to keep the birth center open
    • Call the Patient Representatives at Mt. Sinai at 212-523-7225 and tell them why you think the birth center should remain open. If you birthed there, tell them why it was important to you personally. If you believe that the birth center should be more accessible to clinic patients on public insurance, tell them that too!
    • Follow @birthdaypresence and @getboober on Instagram to stay tuned for more opportunities for action, as organizers plan a rally. You can for updates as we begin to organize.

     

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