Homebirth midwives are not professional

Homebirth midwives are constantly carping that they not treated like medical professionals. If they expect to be viewed as professionals, they need to start acting like professionals and they could start in the state of New York.

New York State, like most states, requires written practice agreements between midwives and the obstetricians who have agreed to cover their patients in cases that go beyond the scope of midwives’ practice. Yet, as an article in The New York Times explains, the midwives view this as an unnecessary burden.

Laura Sheperis, president of the New York Association of Licensed Midwives, said that New York State had 800 to 900 practicing midwives, more than any other state, and that about 10 percent of them were having trouble getting written practice agreements, which must be renewed every year.

Therefore, they promoting a bill in the State Assembly that would abolish the requirement.

Not surprisingly, obstetricians are opposing the bill:

The obstetricians’ group has argued that written agreements are needed to keep women safe. Suppose a woman is giving birth in a hospital, attended by a midwife without a practice agreement, and the woman starts to hemorrhage, Donna Montalto, executive director of the New York division of the congress of obstetricians, said Thursday.

“What obstetrician who has never seen the patient, doesn’t know the midwife, and happens to be at home at their son’s baseball game is going to say, ‘Sure, I’ll come in and take care of your patient,’ ” Ms. Montalto said.

The midwives are indignant that they are not going to be allowed to dump their patients in local emergency rooms when complications develop. It hasn’t occurred to them that professionals do not dump mistakes and complications on other professionals without prior agreement.

Imagine Dr. Jones saying to the patient in his office: “Wow, it looks like you’re having trouble breathing, but I’m not a lung specialist. So why don’t you drive to the pulmonologist across town. He’s the expert. I bet he’ll be able to help you.”

Or how about internist examining a patient who has been injured and remarking: “Whoa, look at all that blood. What? You accidentally chopped your finger off. I don’t do stitches, you know, so you’re on your own. I’m sure they’ll be able to help you at the ER.”

It’s not just medical professionals who make arrangements for the care of their patients. Can you imagine a dentist who stops in the middle of a root canal and says: “This one looks too hard for me. I heard that there’s a dental surgeon who works at the local hospital. Just head over there and have him finish it.”

It’s not just care providers who need to make agreements with other professionals in order to count on their cooperation. A caterer plan an elaborate menu for a client and then at the last moment find herself overwhelmed. She’s not entitled to tell the client to call Martha Stewart to take over the preparations just because Martha Stewart is a better caterer. If she expects Martha Stewart to come to her rescue, she must get Martha Stewart’s agreement in advance.

Homebirth midwives whine that they should be free to dump patients in emergency rooms because doctors are supposed to take care of emergencies. But doctors don’t dump on other doctors. They call ahead to tell the emergency room what is going on. They have formal and informal support arrangements with specialists. And when doctors cover for each other, they provide detailed information on complicated patients, so if those patients require care the covering doctor will be prepared to provide that care without wasting time gathering background information.

If homebirth midwives want to provide safe care, they MUST have formal practice arrangements with obstetricians or they should not practice. If they want to be treated like professionals, they must behave like professionals. And that means meeting the standards that an individual obstetrician demands in exchange for coverage. No doctor would cover for another doctor he did not trust. Midwives should not expect that a doctor should cover for a midwife he does not trust.

Homebirth midwives, like all midwives, cannot practice safely without doctors. That is a limitation of their restricted education and restricted clinical experience. No doctor is obligated to fix their mistakes and take care of their complications simply because they don’t know how. Just like a caterer cannot demand that another caterer bail her out, or a dentist cannot demand that another dentist bail him out, midwives cannot ethically demand that an obstetricians bail them out.

Professionals can’t demand back up from other professionals. They have to earn the trust required by such an agreement and they have to fulfill the obligations that any agreement would include. If midwives want to be treated like professionals they need to behave like professionals. Step one would be to recognize their professional obligations to patients and to other providers.