Attorney General Letitia James mailed off a letter to New York-Presbyterian (NYP) Allen Hospital this week, expressing her concern about the hospital’s proposed plans to close its midwifery services.
With an ongoing, critical maternal healthcare crisis among Black and brown New Yorkers, the rationale for suddenly terminating this crucial obstetrics service at NYP Allen is perplexing, the attorney general wrote.
NYP Allen services the Inwood, Washington Heights, and Bronx communities. It’s in upper Manhattan, in a neighborhood where local residents are predominantly Black and/or Latino and the average income is around $41,000 a year.
Two weeks before this past Christmas, NYP Allen sent out letters to its midwife staff, stating it had plans to close midwifery services at the hospital. Seven national and state licensed certified nurse midwives were scheduled to be terminated.
The letter the midwives received was straight and to the point: “This letter is to inform you that the Hospital will be eliminating your position, as a nurse midwife, at the Allen Hospital,” it read.
“This elimination is scheduled to become effective on or around February 1, 2024.
“Should you choose to remain at NYP, we will work with you to secure another position at the Hospital. A meeting will be set up with you and your representatives to discuss these changes and potential impact to you. We will contact you shortly with those details.”
The midwife eliminations were later rescheduled to take place March 3, 2024.
The New York State Nurses Association (NYSNA) came out to rally against the proposed midwifery services closure on January 11. “NYP’s decision to terminate these vital services at NYP Allen Hospital will contribute to health inequities that Black and brown birthing people already disproportionately face,” the nurses’ union said in a statement. “Most of the NYP Allen midwives live in the community where they work, and some have decades of experience serving this community.
“Eliminating experienced, community-based midwives will likely have a negative impact on quality care and health equity. New York State Nurses Association is calling on the hospital to maintain these services.”
Perinatal care positions
“New York Presbyterian … claims to prioritize addressing historic inequities in the communities it serves,” AG James said in the letter sent to the hospital. “Eliminating this long-standing program with deep ties to the community undoes a critical historical exception and a legitimate point of pride for NYP and the City of New York.
“I believe that the elimination of Allen’s midwifery program is a step in the wrong direction and would strongly urge you to reconsider this decision and look instead at expanding the program.”
In a statement to the Amsterdam News, New York Presbyterian claimed midwife services are not actually ending at NYP-Allen: “To clarify, full-service midwifery care will be available on-site at NYP Allen Hospital. Going forward, the program will be managed by Columbia, increasing coverage and access to the highest standard of care, including the best and most experienced clinicians, for the benefit of our patients.”
NYP Allen’s seven current midwives have been invited to take on “other perinatal care positions within our system,” the hospital said.
But NYSNA contends that Columbia’s planned services at NYP Allen are still not concrete or, if they are, have not been shared. In the meantime, the hospital’s current midwives have not chosen to work with Columbia, where they have only been offered non-union positions. “Most have agreed to different positions at CHONY (NewYork-Presbyterian Morgan Stanley Children’s Hospital),” a NYSNA spokesperson said.
New York City Public Advocate Jumaane Williams wrote in a white paper that pregnancies that utilize midwife services tend to lead to less maternal deaths and fewer stillbirths and preterm births. The availability of midwife services can be crucial for low-income families who, instead of paying out of pocket, can use Medicaid.
Obstetric care under midwives can lead “to lower use of potentially harmful interventions like C-sections for low-risk deliveries, epidurals, and instrument-assisted births,” the public advocate’s office reported. “Midwifery care has also been reported to improve patient satisfaction and maternal psychosocial well-being outcomes, including those for postpartum depression. If a pregnant person has a low-risk pregnancy, they can choose to have a midwife care for them during pregnancy.”