Caring for the disenfranchised
NYC midwives hesitant to celebrate gov’s passage of birth center bill
COURIER LIFE, JANUARY 21-27, 2022 37
BY KIRSTYN BRENDLEN
At the last possible moment
on New Year’s Eve, Gov. Kathy
Hochul signed a bill restructuring
the way midwife-led
birth centers will be licensed
and operated in New York
State, but midwives are hesitant
to celebrate the new law.
For weeks leading up to the
eleventh-hour approval, midwives
and activists pushed
her to sign the bill before it expired
on her desk as the new
year started. The legislation
— an amendment to state public
health law sponsored by Assemblymember
Richard Gottfried
and state Sen. Gustavo
Rivera — was meant to completely
overhaul the licensing
procedures and regulations for
midwife-led freestanding birth
centers.
As they stand, advocates
say those regulations, written
by the state’s Department of
Health, are too restrictive and
too expensive. No midwife-led
birth centers have opened in
New York since they were effectively
legalized in 2016. Under
the originally-proposed bill,
the state would have adopted
the accreditation standards of
the Commission for the Accreditation
of Birth Centers, which
were developed by and for midwives,
and have been proven,
activists say, to be safe and effective.
The legislation passed easily
through both the state senate
and the Assembly, but hit a
snag when it reached the executive’s
offi ce.
A few weeks before the new
year, Hochul’s offi ce sent out
the bill with their fi rst set of
proposed amendments, and the
changes horrifi ed Myla Flores,
a Bronx-based midwife who has
been working to pass the bill
since its inception.
“Like, several paragraphs
they entered into the bill was
stuff that essentially canceled
out the purpose of the bill,” she
said. “That was why we rallied
up to say, ‘Sign it as it is, sign
it as it is.’ It wasn’t signed as it
was, but the changes are somewhere
in the middle of what
they were proposing and what
exists now.”
Negotiations started at
about 3:30 pm on Dec. 30, she
said, and continued until 11
pm. Flores and the coalition of
midwives and birth workers
lobbying for the bill met with
each other, with Rivera’s staff,
and with other stakeholders
in turn throughout the day as
they worked through their concerns.
The result was a set of
fi ve modifi ed amendments, not
as restrictive as what Hochul’s
offi ce had originally proposed
but not granting as much freedom
as Flores and her colleagues
had hoped.
Changes to the bill
The fi rst amendment states
that, rather than adopting the
CABC’s tenants outright, an
applicant must prove that they
meet their requirements, and
show their ability and intent
to obtain that accreditation.
In addition, though, they must
fi le an application with, and be
approved by, the state’s Public
Health and Health Planning
Commission.
“They are appointed by
the governor, so we don’t even
have a vote in who they are,
and they have a high interest,
often, in the profi ts of their organizations,”
Flores said, of
the people who make up that
commission.”There’s a history
here, where we know that midwifery
gets pushed to the sidelines
all the time. So what is
the exception now that is going
to become something that they
prioritize?”
The council’s current members
include representatives
from Northwell Health, NYU
Langone, and Mount Sinai.
While state law dictates that
a number of members of the
council be representatives of
hospitals, nursing homes, labor
organizations, and more, none
are required to be midwives or
birth workers.
Hochul’s second added
amendment says that applicants
have to provide evidence
of their capability to fund acquisition,
renovation, and construction
costs — at the time of
submission, and that the buildings
planned to be used as birth
centers must meet certain state
safety standards — an ongoing
issue for birth centers now, because
most of those standards
were developed for much larger,
wealthier hospitals.
“The interpretation of this
overall amendment is that the
PHHPC application is basically
still a barrier to lowerresourced
birth centers, and if
a building is already spotted,
there might be some technicalities
or restrictions against using
that building for its full purpose,”
Flores said. “People who
don’t already own property or
have the resources to complete
this expensive, lengthy application
process will have a harder
time than those that do.”
Among those without those
resources is Trinisha Williams,
owner of Haven Midwifery. Just
before the negotiations began,
Williams told Brooklyn Paper
about the struggles she’s faced
trying to open a birth center in
Brooklyn, which are largely fi -
nancial. An address is needed
to apply for accreditation with
the state, but renting a commercial
space large enough for
a birth center for months while
working through the application
process, all while leaving
the space empty and out of operation,
is untenable.
“Until I see action, I can’t say
anything is different from them
signing or not signing off,” she
said. “Until I see actionable
items based on what little bit we
did get, I can’t say that it’s been
benefi cial, I just can’t.”
The third and fourth amendments
are a little more hopeful,
Flores said. The third requires
PHHPC take up completed
birth center applications at
their next scheduled meeting,
rather than letting them languish
for months as has often
happened in the past, she said,
and the fourth states that where
New York and the CABC’s regulations
differ, government offi -
cials must work with midwives
to “harmonize” them.
NYC birth centers still
face challenges
It’s impossible to pass judgement
on the amendments without
seeing those regulations,
Williams said, but from where
she stands, nothing has changed
for her. She is still planning on
fi nding and somehow purchasing
a suitable building for a
birth center in Brooklyn after
years of being forced to give
up leases while trying to navigate
the application process,
but she’s not feeling optimistic
about her prospects.
“I do have a colleague,
Maura, who’s up in Buffalo,
who has an application in,” she
said. “It’s not like I think it’s
going to be different for me because
we applied. I’m hopeful
that for Maura, she’s going to
be able to move her facility forward.”
Flores, who is planning to
purchase land for a birth center
in the northwest Bronx when
the time is right, said she does
think her counterparts upstate,
with more options for cheaper
sites, will have better luck than
midwives in the city.
While more options for maternal
care and childbirth are
needed statewide — New York
is ranked 30th in the nation for
maternal mortality and Black
women are about three times
as likely to suffer and die from
from childbirth-related complications
as white women. A 2019
report by the state’s task force
on racial disparity in maternal
mortality said it is important
to “recognize the role of racism
in maternal physical and mental
health,” and that structural
and individual racism can compromise
the healthcare Black
people receive over time, contributing
to higher rates of complications
and death.
More work to come to
make birth safer
Of course, there is more
to do outside of the newly-approved
bill. Flores had hoped,
during negotiations, to win approval
for temporary licenses,
so birth centers could serve
families using Medicaid benefi
ts while the state continues
to hash out their new rules.
New York State also continues
to prohibit Certifi ed Professional
Midwives from practicing,
a loss for facilities and
their patients, Flores said, as
many are people of color who
speak multiple languages and
are prohibited from working
in their own communities.
“We’re just stepping back,
breathing, because we know
there’s nothing for us to do
right now,” Williams said. “We
don’t know what DOH is going
to do on their side to meet
what we asked for in terms of
our bargaining.”
The state has 180 days, about
fi ve months, to work on and
publicize their regulations.
Until then, Williams, Flores,
and her colleagues will wait to
see what their next fi ght is.
“We chose to give care to
people who are disenfranchised,
so the fi ght is always
going to be there,” Williams
said. “So, the fi ght is always
going to be there. For me, I
don’t see when it is ever going
to stop.”
Midwives and activists rallied outside Gov. Hochul’s New York City offi ce, encouraging her to sign legislation
changing the regulations on midwife-led birth centers in New York. Photo by Thomas O’Keefe