Reproductive Justice

Seeking Reproductive Justice: Written Practice Agreements and [the lack of] Home Birth Choice
-Leandra Carrasco

Introduction

Sabrina was seven months pregnant with her first child when St. Vincent’s Hospital in New York City closed its doors at the end of April, 2010. Little did she know, even though she was planning a home birth with a licensed midwife, the hospital closure meant she would be forced to change her birthing plans. In New York, up until the end of July, 2010, as in most states in the United States, a licensed midwife was required to have a written practice agreement with an obstetrician or a hospital if she was going to practice outside of a hospital setting. St. Vincent’s was the only hospital that “backed” home birth midwives in New York. As such, Sabrina’s midwife, along with six of the other thirteen home birth midwives in New York, was no longer legally able to practice. With two months to her due date, decisions needed to be made: should Sabrina continue with her birth plans, risking that her midwife might get “caught” practicing without the necessary written practice agreement? Should she acquiesce and have a hospital birth despite her desire to give birth at home? Or, should she risk birthing at home without a midwife? None of these options are particularly desirable.  And, they all result in reproductive oppression.[1]

The purpose of this paper is to explore the reproductive justice impact of the regulatory requirement that certified nurse-midwives (CNMs) have written practice agreements (WPAs) with obstetricians or hospitals in order to practice home birth. I begin this paper with some background – an overview of the state legislation relating to WPAs, a brief look at home birth in America, and a general introduction to Reproductive Justice Theory. In the model of Reproductive Justice, I will then look at the interests of the parties who are key to this issue: the state, midwives, parents, physicians and hospitals, and the pharmaceutical industry. Following this, I will review the case law that relates to a parent’s right to choose where and how to birth. I will then turn to how the legislation creates reproductive oppression. Finally, this paper will examine two options for working toward reproductive justice in this area: attacking legislation on legal grounds and working for legislative change.

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[1] This story is a hypothetical one based loosely on the facts about St. Vincent’s closing expressed in: Anemona Hartocollis, St. Vincent’s Closing Puts Midwives in Jeopardy, N.Y. Times, May 5, 2010, available at http://www.nytimes.com/2010/05/06/nyregion/06midwives.html?_r=1.