Best Practices: Jacques Moritz
The NYC Medical Director of Tia on advocating for patient choice, the importance of in-hospital birthing centers, and redefining whole-person women’s healthcare.
For the past five years, Dr. Jacques Moritz has been listed as one of New York Magazine’s “Top Doctors” — and it’s easy to see why. From his work in patient advocacy to his contribution in creating New York’s only two in-hospital birthing centers, Dr. Moritz has long been on the forefront of innovation in women’s health.
Read on to learn how he got started in obstetrics, why he helped build in-hospital birthing centers in Manhattan, and how he’s redefining the experience of women’s healthcare with Tia.
How did you get started in medicine and what inspired you to choose your specialty?
My mother was a midwife, which played a big part in my decision to go into OB-GYN. In addition to inspiring my career path, the stories I heard from her also helped to inform me about the doctor that I didn’t want to become.
Though the field of obstetrics has changed in recent years, midwives have long been considered “second-tier” by many doctors, and that’s always been something that bothered me.
I personally think that midwives should be the first choice for every woman having a baby, while also having a doctor that supports the midwife on standby.
But in this country, it seems to be just the opposite, in that midwives are still often considered a fringe group that pose a threat to doctors.
You’re a renowned advocate for patient choice in childbirth. How did you get involved in this work?
I’ve always been a proponent of patient choice and women’s choice within my local community, but my position reached a wider audience when I was introduced to Ricki Lake and a producer who turned out to be my patient when they were working on the film, The Business of Being Born — which is now a requisite must-watch for every single pregnant woman in America and across the world.
The film was not meant to be critical of the medical establishment of having a baby, but when viewed by physicians and people in the healthcare industry, they did not like having the mirror turned upon themselves.
Since I’m featured in the film, I soon became publicly involved in the movement of patient choice and women’s choice — and this caused a big stir. I received a lot of hate mail and a lot of calls asking me “to come off my high horse” by multiple fellow OBs.
Now, even though the film is over ten years old, it’s not as dated as it should be. What I mean is, there are aspects of that film that should elicit responses like: “We’d never do things like that anymore,” but unfortunately, we do. We still have a long way to go in this country.
Have there been advancements in the space that you’re excited about?
First, we saw negative change, in that women were scared into thinking that any choice other than the traditional medical way of having a baby was significantly more dangerous. Many articles were published on that front, and The American College of Obstetricians and Gynecologists came out forcefully against home birth and patient choice. At that point, the number of home births was very low, something like 0.1% of all the births in the country, and they still came out hard against it. And though I’m not a proponent of home births, I do believe that women should have a choice in the matter.
My advocacy was about building spaces in hospitals that are safer than delivering at home, but as comforting as someone’s house. And that’s what we tried to attain with the in-hospital birthing centers.
I think more women are demanding that now, and that there has been more push back against the medicalization of birth.
Before this film, no one really spoke about the one thing that we all have in common: birthing and dying. Though I’m not on the dying end, I am on the birthing end, and I’ve witnessed how the industry has long stuck to the status quo — but the film has inspired big changes in that regard, and I’m proud to have been a part of it.
Can you tell us more about your work creating the only two operating in-hospital birth centers in Manhattan?
It’s like they say: I was just at the right time at the right place.
I felt that if midwives had a place that they could call their own, where they could deliver the way they wanted to in a hospital setting, and where it was safe, it was something that I wanted to be involved in.
I also believed — and still do — that it’s the best choice for women who want to have a natural childbirth within the safety of a hospital.
98% of the time, birth is a natural, uncomplicated thing. But 2% of the time, it can go very south, very quickly.
And, especially in Manhattan, the time it would take to get from somebody’s house to the hospital could literally mean the time from hemorrhaging to death or not hemorrhaging to death. So we built these spaces to combine the comforts of home with the resources of the hospital, where all the medical equipment is hidden away, and where we really strived to make the environment even nicer than somebody’s house.
As NYC Medical Director of Tia, what do you most enjoy about working with this team?
Tia is a completely different take on what a woman’s experience of healthcare should be. From the minute they walk in the door to the minute they leave, we strive to give them a patient-centric and woman-centric experience of whole-person care.
The medical record is comprehensive and primarily patient-driven. When first speaking with a new patient, we ask many questions about their sleep, what they eat, how much they exercise, how they were born, and even about whether or not they were breastfed — which can help determine the likelihood of developing certain allergies. Sleep is also one of the major factors of stress hormones and period control, so we look closely at your quality and quantity of sleep, too.
The physical setting is also very different from a traditional clinical space. To start, the interiors are designed to put you at ease, and when you walk in you’re given a luxurious spa robe to put on, rather than the unfriendly and uncomfortable paper gown.
In the gynecological rooms, the speculums are warmed and the more invasive equipment is hidden away from view until they are needed. In that way, the approach is similar to the birthing centers I mentioned. The shared philosophy is that all of the equipment and resources are still available — but they don’t have to be front and center. In that way, we leverage the resources of a traditional clinical setting, without having it feel clinical.
We also offer acupuncture and behavioral health to our members, too. When I first joined Tia, I was treating a very different group of patients than what I was used to, because they were young and mostly not pregnant. And I was just surprised by the level of anxiety and depression in this young population. And then Covid hit, and of course, anxieties were exacerbated. But thankfully, our behavioral health resources were set up virtually and it has been wildly successful.
What do you wish more people know about gynecological care?
One of the biggest advances in women’s care has been the HPV vaccine. It’s the first vaccine that actually prevents cancer. And if all women are immunized with it, the days of cervical cancer will be gone. And possibly the days of Pap smears will be gone. In fact, I believe that Pap smears will become increasingly less important in years to come because of this advancement.
So the next question is: If you’re not going to do a Pap smear, what’s the point of a gynecological exam?
In this way, I believe Tia is ahead of the game with their focus on whole-person, preventive care. Because things like mental health, diet, and sleep hygiene can also impact a person’s gynecological health.
At Tia, we have a philosophy of looking at what’s called the allostatic load, which is basically the accumulation of stressors that the body encounters. Now, some allostatic loads are good. For example, when you go to the gym. But there are also bad allostatic loads, like chronic stress, or work or relationship trauma. And while we can’t remove the stressors from your environment, we can mitigate the impact it has on your health. A lot of times, these allostatic loads are related to behavioral health issues that can be resolved through talk therapy.
If we look at it through this lens, the future of gynecological health isn’t relegated solely to Pap smears and pelvic exams, but an integral part of whole-person health.
Vital Signs
What are you reading or listening to right now? I’m reading Bellevue by David Oshinsky. It tells the long history of Bellevue Hospital and how the other hospitals in New York behaved during that same period. Sadly, I see a lot of parallels between how these hospitals behaved back then and how many are behaving now.
Favorite restaurant in NYC? M. Wells, a one Michelin star restaurant in Long Island City. The chef is incredible, as is the food, and my wife designed the interiors.
Why do some people get so hungry while on their period? It has to do with the change in hormones, and people usually like comfort food during those times. Progesterone makes everything slow down, and it also makes you crave carbs like crazy. In the first trimester of pregnancy, I don’t even try to get patients to decrease carb intake because it’s the only thing most of them want.
What’s one healthful habit you’d love to see patients adopt? Hopefully, we’re past the age of smoking, but if any of my patients do smoke the first advice I give is to stop. Beyond that, I’d love it if patients could put their phones and computers away one hour before bedtime. I’ve seen how Instagram in particular can really get the brain activated and wreak havoc on sleep. Over the next few years, I believe sleep is going to be the new hot topic in healthcare, overturning exercise and physical fitness. Sleep is so crucial to our wellbeing, and even though it might be difficult to put the phone away, it can make a huge difference when it comes to sleep quality.
You can learn more about Dr. Jacques Moritz here.
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