1 in 3 counties in the United States do not have a birthing facility or an obstetric clinic. That's according to a report by March of Dimes, a nonprofit that focuses on raising awareness about maternal health risks. WAMC's Sajina Shrestha spoke with Tisha Graham, the cofounder of BirthNet New York, about what these numbers mean for expecting parents in the Capital Region and New York State at large. BirthNet New York is a birth justice organization in the Capital Region working in maternal care such as doula training and postpartum care.
INTERVIEW TRANSCRIPT
Editor’s note: This conversation has been lightly edited for clarity.
Shrestha: Tell me more about the state of maternal care in New York. What are the needs? What are some gaps that people are not seeing?
Graham: Just to give you a little bit of a picture in terms of the United States, and then we'll narrow it down to New York, and then we'll come further into the Capital Region. The maternal mortality rate in the United States averages at about 18 deaths per 100,000 live births. That's about the average. It might go up and down a digit or two, but 18 per 100,000 deaths overall. When we look at Black birthing people, that number is 50 deaths per 100,000 live births. So, in this country, we have a huge problem with regard to maternal and infant mortality and morbidity with regard to race. In New York, we have a three times greater risk of Black and brown women dying during birth than their white counterparts, and four to six greater risks of infants dying compared to their white counterparts. So, we have a big problem in New York in the Capital Region. Those numbers are about consistent with the statewide numbers. The other is that we have a very, very large number of people who live in a number of communities across the state in which there is no maternity care available to them at all — zero, zilch, none. So, of the 60-plus counties in New York, 20 to 21 of those counties have zero maternity care options. There are no hospitals that have a labor and delivery department. Labor and delivery units are closing down all over the state. In fact, we locally here in the Capital Region were very successful in the last couple of years of keeping one such labor and delivery unit opened over at the Samaritan Hospital [in Troy], the Burdett Birth Center. That was an example of one of many, many labor and delivery units that are closing down, and so we have a maternity care desert issue. And thirdly, we have an issue with regard to access to what we call community midwifery. Not here in the Capital Region. We have a number of practices, midwifery practices, that provide services not only in the hospital setting, but what we call the community setting, out-of-hospital setting. So that's birthing centers, of which we don't really have any in the Capital Region, at least not those kinds of centers that are defined as independent, freestanding birthing centers. We have a lack of access to birthing centers, but we don't have a lack of access here in the Capital Region to community midwifery, meaning people who choose to birth at home. We have a lot of home birth practices, which is great, but across the state, the state doesn't enjoy that great access to out-of-hospital services.
Shrestha: What does this mean? Let’s say I'm a expecting parent, and I can't plan my birth because the birthing center down a couple of miles away closes?
Graham: It means that you have to travel. In many cases, in some parts of the state, people have to travel through two to three contiguous counties in order to get maternity care. One such example is that the labor and delivery unit at Columbia Memorial Hospital down in Columbia County, that labor and delivery unit closed, and so those people who live down there and points south of Columbia County have to travel up to Albany Medical Center or to St. Peter's Hospital. That's the closest maternity care available to them. It means traveling, in some cases, great distances, especially out in the western part of the state, in the Finger Lakes region. Wayne County Hospital just closed its labor and delivery unit. People have to travel many, many miles, and in some cases through two to three counties in order to access maternity care.
Shrestha: Why are so many centers closing down?
Graham: I mean, my general understanding is that they're not making enough money, and to associate how much money a hospital makes for its labor and delivery unit, and whether or not that unit gets put on the cutting block, it's unconscionable to say that. To say, "Well, this unit isn't making enough money," or "we're not really making enough money,’ and again, the cost of healthcare, the cost of maternity care, obviously, it's, you know, it's all very high.
Shrestha: Do you think maybe there should be a different way of considering the "profits" of operating as a birthing center? I mean, can you put a price tag on a birth?
Graham: No, exactly. I mean, you know, you ask a very compelling question, and that has to do with the sort of the universal conversation that's happening here in the United States, whether or not we should have universal healthcare, is true for other countries. In those other countries, their birth outcome statistics are much better than they are here in the United States. So, we are not, you know, at the top five countries in the world that has a good, good statistics and good outcomes for birth. And I'm not talking specifically Black and brown people now. I'm talking about just birth in general. A lot of people think, "Oh, we spend more money on maternity care than any other developed country." Yet our outcomes are way down on the list, beyond 25. We think, "Oh, we must be in the top three, or maybe we're in the top five countries with regard to really great outcomes." But even though we spend more money than any of the other developed countries that we typically compare ourselves to, with regard to demographics and income and such, we fare very, very poorly in the world with regard to our maternity care outcomes.
Shrestha: You've been in the birthing field for over 40 years. What are some recommendations that you have that you think would help with addressing the crises that we have in the state of New York?
Graham: I've been doing birth work for a long time, and what I think are some of the solutions to the maternity healthcare crises, particularly in the state of New York, is greater access to community midwifery, greater access to midwives who specifically provide services in the home or in birthing centers across the state. That's one such answer to the maternity care crisis in New York. Also, having more midwives in the hospital setting — we have a number of hospitals here in the Capital Region, many of which do have midwifery practices and midwifery services, but not all of them. And we are, I think, and I'm very hopeful to state that we are moving in the direction where some of the other hospitals that haven't had midwifery programs are in the process of developing them, or are in the process of hiring midwives. And I say I talk about midwives because midwifery, as a model of care in the maternity care field, is one in which boasts a, you know, just greater outcomes with regard to reducing surgical birth, increasing patient satisfaction, increasing breastfeeding.
Shrestha: Do you think having home births could maybe also help with the problem that maybe many people have of having to travel different counties?
Graham: There's no question about that. There are midwives at the ready, and midwives willing and ready to serve their community, but for certain challenges here in the state with regard to how midwives are licensed and which midwives have access to that licensure. Midwives that are specifically trained in community birth, in out-of-hospital birth, are trained and certified, credentialed in a very specific way, which is different than how nurse midwives or certified midwives who might work in the hospital are trained. So, we have an issue, and I'm part of legislation with an organization that serves to try to find a licensing mechanism for midwives who are specifically trained for community birth. But yes, that is one of our biggest arguments: that we would fill the gap of some of those maternity care deserts in which there are no services currently available with regard to maternity care. And the other thing that we could address as community midwives, if we were decriminalized and given a mechanism, a process for licensure, would be to serve Black and brown birthing women who, understandably, have fear going into the hospital. If you know that the statistics for you as a Black or brown birthing person is that you have a four times greater risk of dying in that hospital compared to your white caucasian counterpart, you might question whether or not going into the hospital is a safe place for you, so having community midwives certainly would address both of those issues.
