A Changing Brooklyn: Babies of the “Brownstone Belt”

The resurgence of hospital closures in Brooklyn’s “brownstone belt” is pushing many of the borough’s expectant mothers across the bridge to Manhattan to deliver their babies. But for Brooklyn mothers unwilling to take a chance with the commute across the river, alternative childbirth options, particularly those associated with midwifery, seem to be a popular solution.

Carroll Gardens, Cobble Hill, and many of their bordering neighborhoods in Brooklyn have become magnets for young couples looking to escape Manhattan life for a place where they can build a family. Pregnant women wobbling down the street and mothers pushing strollers filled with children crowd Court Street’s sidewalks. Brooklyn is changing, and in the brownstone belt, the latest group looking for residency is babies. But not every Brooklyn baby is actually born in Brooklyn.

According to a New York Times analysis of statistical data of birth trends in New York City from 1998 to 2008, women in Brooklyn’s brownstone belt typically choose among four Manhattan hospitals to give birth: New York University Langone Medical Center, the Roosevelt branch of St. Luke’s-Roosevelt Hospital Center, New York-Presbyterian Hospital/Weill Cornell Medical Center, and Mount Sinai Medical Center.

Sarah Moriarty, 38, a managing editor of A Child Grows, a Brooklyn-based online guide for parents, has lived in the borough for 11 years. Although she currently resides in South Slope, she opted to have her baby at St. Luke’s-Roosevelt Hospital Center in Manhattan. “There is no one hospital that women are flocking to. Methodist is certainly a popular choice for lots of Park Slope moms-to-be because of its proximity,” Moriarty said.

While Moriarty chose to give birth in Manhattan, it was not about the location or the hospital’s reputation. It was about the services she wanted. “I had my daughter at St. Luke’s-Roosevelt because of their birth center,” Moriarty said. “St. Luke’s is a popular choice, as [was] LICH.”

Meanwhile, while many of today’s expectant mothers opt for a traditional hospital birth, some women are leaving hospital rooms and epidurals behind. Birthing centers, home births, and midwife-assisted births are proving to gain traction nationwide.

Between 1990 and 2009, the number of births in the U.S. attended by a certified nurse-midwife (CNM) doubled, from 3.3 percent of all U.S. births to 7.6 percent, according to the Centers for Disease Control and Prevention’s (CDC) report on birth data from the National Center for Health Statistics. While the percentage of increase may seem small, it represents a total of 313,516 U.S.-born children whose mothers gave birth under the care of a midwife. While data exists to verify the present rise in expectant mothers consulting midwives, few studies have yet been conducted on the geographic trends in regards to the distribution of midwife-attended births in the U.S.

Brooklyn’s Hospital Problem

Since 2000, 19 New York City hospitals have closed, including the University Hospital of Brooklyn at Long Island College Hospital (LICH). LICH’s recent closure exposed the subsequent lack of adequate, accessible healthcare options for the borough’s northwestern residents. And LICH is not the first shuttered hospital to alarm Brooklyn’s residents living close to Manhattan. St. Vincent’s Hospital Manhattan, the third oldest hospital in New York City, closed in 2010 and most of its facilities were converted into luxury condominiums. Its closure was a surprise to many residents and medical professionals throughout the city.

Christiane McCloskey, a certified midwife and the owner of City Midwifery, a small, private midwifery practice, attended many labors and deliveries with her clients at St. Vincent’s. “I work with a group of midwifes, and we were really shocked and amazed that they actually closed that hospital,” McCloskey said.

New York state legally recognizes two types of midwives who are certified by the same exam, certified midwives (CMs), which enter the practice with a science-based background, and certified nurse-midwives (CNMs), which enter the practice through nursing. Most CNMs and CMs work in hospitals, or in private practices and partner with hospitals or birthing centers to deliver their clients’ babies. Those with private practices tend to develop closer relationships with their clients through meeting more frequently, McCloskey said.

By law, midwives must work in collaboration with a physician and have a written agreement, protecting expectant mothers and their children in case of complications during pregnancy or childbirth. When St. Vincent’s closed, McCloskey scrambled to find a new collaborating physician for her practice, and as LICH prepared to close, she was again without a hospital.

McCloskey said she looked at a few hospitals in Brooklyn, and even considered collaborating with a few in Manhattan. She eventually decided on Maimonides Medical Center in Borough Park, where staff members helped her find a collaborating physician.

Midwife Solutions

Approximately 13 private midwifery practices currently operate in Brooklyn. There are a number of hospitals in Brooklyn that partner with midwives based in the borough, like Maimonides and the Coney Island Hospital, or those with internal midwifery branches, like New York Methodist (which has been providing midwifery services for 15 years). The only freestanding outpatient birthing center in the borough and the city is the Brooklyn Birthing Center in Midwood.

McCloskey said many of her patients prefer having a midwife in Brooklyn, even if they work in Manhattan, because it’s more convenient. The prospect of personalized, medical-based attention during a pregnancy is attracting more Brooklyn mothers to Brooklyn-based midwives and away from hospitals. “Part of the understanding when you are working as a private healthcare professional is that you would never abandon your clients.,” McCloskey said. “A lot of my private clients don’t want to spend a lot of time in hospitals.”

While convenience and personalized care play large roles in more women deciding to consult midwives during their pregnancies, one of the biggest attractions for expectant mothers is that babies are not separated from their mothers after a midwife-attended birth (except in cases of medical complications), McCloskey said.

Samantha Huggins, 37, a trained doula (birth assistant) who co-founded Carriage House Births, a Brooklyn-based doula collective, and a pregnancy support center in Williamsburg, had her two children, Juniper and Jasper, at home with the help of a midwife. “I appreciate the model of care that comes with midwifery,” Huggins said. “It’s more personal.”

Few midwives attend home births, as they are still rare, with less than one percent of women giving birth outside of hospitals in the U.S. However, the number of home births increased by 29 percent nationwide between 2004 and 2009, according to the CDC’s analysis.

Huggins said she always knew she wanted to give birth at home, but when initially found out she pregnant after taking six at-home pregnancy tests, she sought medical attention from her gynecologist. However, she was turned off from the idea of a traditional birth after waiting two and a half hours in a crowded waiting room during her appointment with her physician. When she finally saw her gynecologist, she was pressured to have an ultrasound done (even though all six of the pregnancy tests she had taken tested positive). When Huggins told her gynecologist that she was interested in a home birth with a midwife, her appointment came to a screeching halt and she was sent home.

The CDC reported that the proportion of vaginal births attended by CNMs reached an all-time high of 11.4% in 2009. One-third of all U.S. pregnancies end in a Caesarean section (C-section), according to a recent report by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. Huggins said midwifes practice under a “less is more” philosophy, and ultimately that approach helped her decide to forgo a traditional hospital birth, where she would have risked medical intervention and possibly been advised to give birth by a C-section. “I wanted to be able to deliver my babies with someone who believed that I could deliver vaginally,” Huggins said.

Brooklyn has 14 hospitals where mothers can give birth, including Maimonides (a popular choice among local midwifes). None of those worked for Huggins. In fact, she wanted to be as far away from a hospital and any medical intervention as possible. “There are plenty of hospitals around me, but if I could stay away from a hospital, I would,” Huggins said. “Hospitals are for sick people and emergencies. I wasn’t sick and I didn’t have any complications during my pregnancy, so I didn’t see the point in going to a hospital.”

For many of the borough’s residents living in the brownstone belt, a trip to the nearest hospital has increased in distance. (The two nearest hospitals to Cobble Hill, the Brooklyn Hospital Center and the New York Methodist Hospital, are respectively 1.5 and 2.6 miles away from the neighborhood. In good traffic, that distance amounts to 12 minutes and 15 minutes respectively.) For a woman in labor, a few blocks or a couple of minutes can make a great amount of difference (a risk that some can’t take). Midwives are prepared to bridge the gap, offering care that focuses on women and extends beyond the delivery room.

“There’s no reason you can’t get great care in Brooklyn with a midwife,” McCloskey said.