NJ Midwives Statement on Out of Hospital Birth Access and Equity During COVID-19 Pandemic

As midwives providing out of hospital services, we share the New Jersey Black Women’s Physician Association’s (NJBWPA) concerns about the wellness of families of color in New Jersey, and particularly African American families. The current pandemic has only further demonstrated the vulnerability of marginalized populations birthing within our medical system. For Black birthing people and families, concerns about COVID-19 infection, birthing alone, or weeks-long separation from their newborns only compound the very real preexisting fears that their voices, symptoms, and needs will be ignored, with tragic results. Twenty-six year old Amber Isaac’s final tweet before her death last month expressed her frustrations with the care that she was receiving at a hospital in New York, where her attempts to draw providers’ attention to concerning symptoms were ignored until it was too late. Her story is not unusual, or unique. Black women die at a rate four times greater than white women, regardless of their socioeconomic status or level of education, and New Jersey ranks at an abysmal 47th in the United States for maternal mortality.

We also agree that the challenges facing African American families in the United States healthcare system are deep and multifaceted, and we recognize that the solution must also be multifaceted. As licensed midwives providing community-based midwifery services in homes and birth centers in New Jersey, we have a role to play in improving outcomes for marginalized populations, including African American, indigenous, and other families of color.

The authors of the op-ed do not seem to realize the full scope of our care. We carefully assess potential clients to ensure that they are appropriate for community-based care and carrying healthy pregnancies. If and when a medical condition arises, such as the hypertensive disorder that Isaac herself identified symptoms of, we swiftly arrange for those clients to be seen by a doctor. Our services include discussion of the risks and benefits of all choices, as well as integration with other kinds of medical services, including complete lab work and ultrasound, pediatric care, and consultation with Maternal Fetal Medicine specialists as needed. We are also connected with doula support services, including community-based, paid and volunteer services that center African-American families. We are trained to manage medical emergencies, and clients enter into our care fully aware that on rare occasions, these emergencies do arise and will sometimes require transfer for medical care.

As Certified Professional Midwives and Certified Nurse Midwives offering home-based care, we see families throughout pregnancy, typically spending an hour per visit with clients. This extended contact facilitates the formation of close relationships and mutual trust, enabling clear communication. We also see our clients for numerous postpartum appointments, tracking their wellness and their baby’s health, providing lactation support, nutritional counseling, monitoring for postpartum mood disorders, and coordinating support services as the need arises. Our frequent contact with clients, ease of communication and accessibility, and awareness of their medical history and course of pregnancy, birth and postpartum all facilitate the quick identification of medical problems that may arise. This is our standard of care.

It is not our experience that the American healthcare system is unable to support and coordinate care for planned home birth. Rather, where there are challenges, it is because of the lack of willingness on the part of hospital-based providers to work together with out of hospital midwives. Furthermore, though the American College of Obstetrics has itself stated that pregnant people may freely choose to birth out of the hospital, this does not always translate into respectful care for our clients during transfers. We recognize where and how the system needs to be improved, and we warmly welcome collaborative, mutually respectful relationships with all obstetric care providers that center the needs of birthing families. We are happy to share the tools and research that have already been generated to facilitate smooth transfer of care and the already-existing models of community-based midwifery care that demonstrate exceptional outcomes for families of color.

The NJBWPA states that mandating coverage for out of hospital birth is “not optimal” for solving the problems faced by families of color. We strongly disagree. On May 5th, the same day that the NJBWPA published their statement, The Institute for Medicaid Innovation released a report that supported a case for the midwifery-led model of care in Medicaid. Founding director Dr. Jennifer Moore writes that:

“COVID-19 is laying bare existing health inequities, the consequences of lack of health insurance coverage, as well as the limited capacity of existing birth centers, regulatory barriers and restrictive requirements for midwives. This moment presents an opportunity to address these inequities and barriers and fully incorporate the midwifery-led model of care into the Medicaid program.”

In our commitment to increase equitable access to midwifery services, many of us already provide care to Medicaid-eligible families by offering discounted fees without compromising on services, providing the same comprehensive, personalized, and professional care that we give to full-paying clients. Though insurance reimbursement is only one piece of the puzzle in addressing issues of access, it is an important one. Insurance reimbursement is an equity issue, because reimbursement ensures that families have equitable access to the broadest possible care options, enabling them to select the provider with whom they feel most seen and most safe. All families deserve that option.

New Jersey Midwives Alliance

Dina Aurichio, CPM, LM
Dahlyt Berezin-Bahr, CPM, LM
Alaina Broach, CPM Candidate
Krystina Friedlander, CPM, LM
Jennifer Goldsmith, CPM, LM
Vicki Hedley, MA, CPM, CM
Samantha Magpi, CPM Candidate
Asasiya Muhammad, CPM, LM
Ray Rachlin, CPM, LM
Christy Santoro, CPM, LM