Christa Craven, Ph.D.
When I originally set out to write an historical review of midwifery prosecutions, I envisioned presenting specific cases and names of midwives who had been put on trial as laws began to restrict their trade during the early 1900s. I imagined that thes e stories would serve as a reminder that--as Gertrude Fraser aptly summarized in African American Midwives in the South: Dialogues of Birth, Race and Memory --laws regulating and supervising midwifery during the early part of the 20th century, "inevitably mixed arguments about the need to reduce maternal and infant mortality and to improve health care with those confirming the importance of maintaining the racial and social order" (1998:72). While I knew that many of the oral stories of these midwives had been lost over time, I hoped legal records and historical documents would tell at least part of their story.
Sadly, this is not the case. In fact, as Mildred Roberson writes in My Bag Was Always Packed: The Life and Times of a Virginia Midwife:In the Virginia Department of Health central offices in Richmond, the repository for what few records remain of midwives and their history, there is simply a folder containing a smattering of names of midwives in practice in selected counties, in sp ecified years. Most records have been lost or destroyed. It is apparent that no one has maintained records in the central VDH office in Richmond on an on going basis. Staff now in the county health departments says that all required records were sent to R ichmond, and all local records were destroyed for lack of space. The story is the same elsewhere in the South. As Debra Anne Susie (1988: viii) commented in her book about Florida midwives: "The American midwife's misfortune was to lose not only her vocation but her history as well." [Roberson in Smith and Roberson 2003:115]
Many historical accounts have documented the way that state governments attempted to eliminate midwives during the early 1990s by enacting laws and regulations that restricted their practices and/or made the practice of midwifery illegal.(1) In fact, throughout the U.S., midwives found themselves at the center of a medical and legislative movement to "educate" and eventually eradicate all non-medical healthcare providers.(2) Public health officials, physicians, and local registrars had the authority to deny or revoke midwives' permits if they were deemed "unfit" to practice (i.e., refusing to fill out forms or utilizing traditional "unapproved" childbirth techniques). Ultimately, the federally sponsored public h ealth programs and the increasingly stringent policing of midwives conducted by public health nurses precipitated the steady decline of midwifery in many states during the mid-1900s.
During this time, state and legal prosecutions no doubt played a prominent role in the individual retirement of midwives throughout the United States, but sadly, few records exist to document their stories. These lost records, and more importantly, los t history, make a book like the one you are reading here--which serves not only as a legal advice book, but also chronicles the experiences of prosecuted midwives at the turn of the 21st century--so very important.
As you read the following pages (and perhaps anticipate future updated editions), I encourage you to think about your own stories... whether as a midwife on trial, a supporter of a midwife under investigation, or a medical or legal professional support ing midwives. Most importantly, WRITE YOUR STORIES DOWN. As midwives continue to serve pregnant women in the 21st century, we cannot afford to lose any more of our vibrant and sometimes difficult history. My hope is that when midwives look back to reconst ruct their history in the 22nd century that they have far more to turn to than we do today!
Collected by Valerie Vickerman Runes
I was born 1906, the 12th day of September. My momma who raised me (my momma died shortly after my birth) was a slave brought to this country and sold for three dollars at the age of thirteen. She was sold to the Charles' and had their last name. It was hard growing up back in those days. We had to raise our food and work in the fields. Corn, stripping greens and we raised our meat. We shelled those peas and tied them up at the top of the house. We would put chinaberry bulbs in those sacks of peas so no weevils would get in. I started goin' to the fields all my life. At first I was tied to my mother and then I had a row of my own. I wanted to get out of the fields as it was so hard and that is why I wanted to be a midwife. I was interested in goin' with Miss Ella Anderson, a midwife, and get out of those fields. Times were tough then, we knew nothing but the field.
At sixteen years I had my first of three sons. I borne my second son at home by myself and the other two sons at home with midwives. Willa Bill was my second midwife and I liked her because she was so sweet. She was working in the field when they we nt to get her to help me. I worked with Ella Anderson when I was learnin' how to be a midwife for two years, and helped her with a heap of babies. Sometimes I would be gone night and day. I wanted to learn everything I seen her do and kept a close eye on her so I would be a good midwife like her. Bless her soul in her grave today. We worked in the country area so it could be a long time to go and get the midwife. Sometimes she would be to another birth and I would there to help the woman birth. She taught me how to cut the cord and tie the cords properly. She was just as kind and sweet as you would want to meet a person. She was a good teacher. She taught several people to be a midwife.
Why do they want to cut out the midwives? It goes back to slavery days and before that they was nothin' but midwives. We worked with herbs, roots and teas. I am 98 years old and I have delivered over 3,500 babies. Midwives are just hangin' on a str ing because the doctors do not want the midwives to deliver babies. There was years on down that the midwives delivered all the babies. Then the hospitals came about and the doctors cut out the midwives. There was times when I would bring a woman to th e hospital for help and they would refuse to help her because she was poor. Then one day they asked us to bring all of our equipment in and we did not even have a pair of scissors to cut a cord with, drops for the eyes, dressing for the cord and you didn 't have nothin' to work with and sure enough had to quit. They told us that they would put us in jail if we delivered anymore babies.
What have we done that was so bad that they want to cut us all off? We do a good job, we take care of the babies, the mom and the whole family. We dress the baby; we had to learn some of them young babies how to suck as they were so small. I deliver ed a baby that was a pound and half, and she is as big as that door now. I had to teach those babies how to suck and first gave them the milk with a dropper. Some I had to give sugar titties. You put a little piece of thin cloth, tie a thin string on i t and they would go to suckin' and after that they would suck on their mom and helped them to nurse their babies. We did not use a lot of sugar and had them suck it a few times before we gave them to their moms. We done this down there through the years , before those doctors were here.
There are places in the U.S. that midwives still work and have no licenses and can work. That is best because if something goes wrong they goin' to come after you. Babies die in the hospital all the time and they do not stop the doctors from workin'. Why do they want to cut us off? When a baby dies at home they come after the midwives. Some babies are going to be dead when they are born. Some will not breathe after they are born and some may die afterwards. It is not our choice. We take what we can get. Why cut us off when we do a good job? It is God's choice who lives and dies. The midwives do a good job. They work hard. They get tired and hungry but they do not quit. They have ways of working with the mom, kind words beat it all in anyth ing we do. Midwives need to stick together. They need to respect each other. They do not have to be good friends but they need to help each other. When one midwife is fighting a battle she is fighting it for all midwives. We are all fighting the same battle because we are all midwives. So many midwives think that they are better than another but we all the same. Ain't no different from another. So when a midwife is fightin' a battle, send her $50-$100 to help her. When you are fighting a battle d o not be afraid. Tell the truth. Look to the hill where your blessing is comin' from, that's where all mine come from. I give it all to the Lord, because he knows all and gives all.
What are we going to do? We ain't going to give up. We goin' to keep a fightin'. We gonna win, we goin' to overcome one day. We goin' to fight as long as it takes. We fight with our mouths, with our words. We were trained with medicine. We were trained with herbs and make teas. We gonna fight with our words, our hearts, our love as long as it takes. We will fight to the end and we will win.
Margaret Charles Smith as told to Clarebeth Loprinzi
My name is Alice Skenadore. I am 55 years old, married to Roy, mother of 6 (5 boys, 1 girl). I began my midwifery through seeking better alternatives for my own pregnancy in 1978. We lived in Las Vegas, Nevada, and the medical establishment at th e time was very controlling of what the doctors would permit in the way of birth alternatives. Things like no I.V., no internal fetal monitoring, no drugs, no episiotomy, no separation of mother and baby, etc. were considered unimportant desires of women , and were often promised with no intention of following through. After spending many visits with three different obstetricians, I decided that I would just "do it myself" at home. I told my husband and he supported me in that decision.
We immediately began reading everything we could find about childbirth from the library and other places. We even went to the health department and talked to the people there and got some information, including a reel-to-reel projector and training fi lms that were intended for use in military obstetrical training (this was in the days before VCRs). In our quest for information and support, we found reference to H.O.M.E. (Home Oriented Maternity Experience) and sent away for the H.O.M.E. manual. When we got it, it had a letter giving us a list of other home birthers in our city. We called them and found there to be a group of families that met monthly to share information and support. We all agreed to help one another through our births, and we did . I was the only one of that group who ended up in the hospital.
After I ended up trying unsuccessfully to birth at home with my somewhat novice birth attendants helping me, we transferred to the hospital (we got scared because of the length of time it took), we had a really traumatic experience filled with all the things we had tried to avoid plus hostility and retaliation from medical staffers for trying to do it at home. It was obvious to me, after all that, that I wanted to try to give birth at home for my next baby. This experience served to further my resolv e to learn more about birth and to help myself and others to do this.
There were so many women in our area who were disillusioned with the medical interpretation of birthing, that we would get calls in the middle of the night from complete strangers who had heard that we were birthing at home and asking if we could help them to do the same. We agreed to do this and helped many people to have their babies at home.
During this time, all of us who were practicing midwifery thought we were probably doing so illegally, but we were willing to accept the consequences, because we believed we were doing the right thing. Every time we had to transport someone to the hos pital, we would hand off our nursing baby to the other midwife and we promised to nurse and care for each other's babies if we ended up getting arrested and going to jail.
A few years into this, a midwife who worked in the Carson City area was taken to court by a group of obstetricians, claiming that she was "practicing medicine without a license". The judge who presided over the case looked through her law books and fo und reference to midwives in the books (it stated that "the midwife shall wash her hands before delivering the baby" paraphrased), and ruled that the midwives are legal and told the doctors their suit was unfounded. Then we all sort of came out of the cl oset, placing ads in the newspapers, renting billboard space, putting bumper stickers on our cars (mine said "Our Babies are Born at Home, Naturally") and running articles about homebirths in the newspapers. Our meetings and classes grew and we developed a strong homebirth community.
After a few years, my family and I moved to Laughlin, Nevada, where I continued to help women to birth at home, learning by experience, supported by other women I could call for advice. I attended births throughout the southern part of Nevada and the northern part of Arizona. After about five years of practicing there, I received a cease and desist order from the State of Arizona, telling me that I was known to be "an habitual birth attender" and that I was ordered to stop. I told my clients about th is and they opted to come across the border to Nevada and have their babies in my home. I did continue to practice in Laughlin until 1992 when I moved back home to Wisconsin and resumed practicing here, where I still help others to have their babies at h ome to this day.
Philosophically, I believe that it is the natural birth right of women to be midwives for one another. I do not believe that midwifery is, nor should it be considered a profession or a medical process. That idea seems to me to be as wrong as calling motherhood a profession when, in fact, it is a natural way of being.
As a student midwife, I have some concern. I know that no matter what state you live in there is always the possibility of being prosecuted. I live in Michigan, which right now feels to be a "safe" state. Midwifery is alegal and no one has been p rosecuted in the recent past, to my knowledge. However, so many of the states in our region have midwives who are being actively prosecuted, and I do not think we are completely immune. I feel that midwives in Michigan should be actively trying to get l aws making midwifery legal before its too late. It only takes one court case to create a precedent.
I know that our profession is, quite simply, a calling and it is something I must do – help return our country to a place where birth is normal and good. I find the prosecution of midwives sad because the statistics are so blatantly clear: midwive s are good and provide good care for normal pregnancies and births. Regardless of the prosecution of midwives, I will not change my plans to continue on the path to be a midwife. I would definitely practice in states where midwifery is alegal, and would consider practicing in states where midwifery is illegal, based on the direction that I feel God wants me to follow.
I am an aspiring (student) midwife working toward CPM certification. I live in Virginia, which is as we know a very midwife UNfriendly state. Even if you are a CNM, the restrictions are so great, you end up just being another L&D nurse, except you have the master's degree and the others don't. Clients still need to know there is the option of homebirth, even if they have to do it themselves, which I have. So I will not be carrying insurance when I do homebirths, I will not advertise (but word sp reads quickly here!), and am finding out about tenancy by the entirety, to protect my husband's assets he has worked so hard for. This information was given me by a friendly doc in the western part of the state. He is a family practice physician and is a friend of ours, and knows my midwifery goals and training. Even as a doula I tell clients that I do not carry insurance, so in hiring me, they should be aware of that… (not that I would be liable, but the clients have to learn to take responsibility fo r their own health care, or don't hire me!). Anyway, that is what I am facing here. But I haven't yet finished all my training, and things may change before I am done with my formal training. If it doesn't we will probably move to Tennessee where thing s are more normal. In the meantime, I teach as many people as will listen…one at a time.
Cathi Wimmer Cogle
Another main concern I have about the threat of prosecution is my family. I have a husband and children, and I love them very much. I am fully dedicated to midwifery. I am PASSIONATE about midwifery. But my family is definitely my first passion an d dedication. The current problem with the prosecution of so many midwives is scary to me because it looks very similar to the start of major malpractice lawsuits with doctors. And that is a very out of hand situation. However, these worries only drive me MORE to become the fully informed and knowledgeable midwife I know I can be. I definitely will not let "the system" scare me away from becoming a midwife when MORE midwives are what is needed in the United States. I may consider practicing midwifery in a state where it is illegal. I most likely wouldn't move there purposely to do it, however my husband is in the military and we move a lot. We could get stationed somewhere where it is illegal, or at best alegal – and unassisted homebirth statistics are ju st not as pretty to look at as homebirth with a qualified attendant. It would be hard to say no to someone who wanted to bring their baby into this world in a safe way…wouldn't it? To me that seems unlawful.
My name is Holly Sippel and I am an aspiring/student midwife from Mesbury, MA. I have never been scared of the thought of being sued by a potential midwifery client (though the thought scares the dickens out of my family dad and my husband!), but th e thought of prosecution from a DA with an agenda is off-putting! I try to tell myself that I will probably continue to live in MA or at most, move to NH, VT or ME in which case I ought to be in good shape as these places are pretty midwife-friendly, but I do fear for my friends who are in states where their practice is either a misdemeanor or in some cases a felony. This is one of the reasons I have elected to wait until my children are older. I have visions of the MA DSS coming to take away my kids beca use mum is cuffed and stuffed as a result of coming to someone's home at their request in order to attend the mother in childbirth. I am not saying this is my only reason; there are many but this is one of them. I feel pretty sure that I will be in practi ce eventually and I am glad to wait as I do not want to miss certain things in my kids' lives while they are young. The question I have is this: If I feel this way, how many others do and have not said so out loud? How many other women are intimidated int o putting off careers for fear of persecution?
The question I want to address is would I be willing to risk legal action for the sake of midwifery and the answer is a resounding YES. I have very little patience with ridiculous rules and regulations. To me, dictating where and even when a woman s hould give birth is and should be the parents' decision. I have often thought of that scene in "Gone With the Wind" where the Dr. is tending all the wounded and tells Scarlett that having babies is a normal process and he doesn't have the time to take car e of Melanie with all that he has to do with the wounded. If there was such a scene going on here and now how over concerned would the doctors be with a normal condition such as a pregnancy and birth? They have created this monster of abnormality and wome n needing them to get through this experience, but if all the docs were sent elsewhere in the cause of war who would step in? The MIDWIVES and women could start realizing their own power all over again. I am a firm believer that there is room for all peo ple and all avenues of thought in this world of ours. And surely, there should be far more important things for legislatures to worry about than women having babies outside a hospital! Eventually, if there is a loud enough roar and enough midwives in jail perhaps there will be change or we can just wear everyone down and make it so unworthy of their time to fight about it anymore they will back off. As my children are grown I would willingly risk my freedom for this cause. I figure if I did have to go to jail I would spend the time educating the women there! I guess the future will let me know if I am called upon to stand behind my thoughts of today.
I'm only just starting out on my own as my mentor just moved a few weeks ago. I know my husband and I seriously considered these things before I started as there is a very hostile attitude toward homebirth and midwifery in this area. For my own safe ty and my family's sake I'm trying to keep a very low profile. My mentor told me to try to avoid using the "m" word and ask people to just call me a friend who attended their birth. I know some of the terms people use cannot be avoided. I feel like I'm st ill finding my way. I'm sure it would be so different practicing in a place that was legal or at least tolerant. But knowing God called me to this is such a comfort. My heart would be to someday practice on the mission field but God has me right here for now so I will trust Him to lead me through the uncertainties while I'm here.
We got involved in home birth through our own interest for our family. At that time my wife had no plans to be involved in midwifery although she had acquired some interest in it from her mother growing up in AZ. Believing that God is the designer of the family we did not view birth necessarily as a sickness or medical emergency that required hospital services and thousands of dollars, rather as a normal life experience that God intended a husband and wife to share together. We desired someone who had more experience than we did to help us: this we found in a midwife. One thing led to another and my wife began attending other births, especially in our church. Eventually our midwife left the area, and the calls began to come for my wife's involvemen t. Though the legal climate in our state is not at all favorable, we rest in the fact that the Lord has brought her into this work and if He wants to bring it to a stop, He can. It's not something we were seeking or trying to make happen, but it is someth ing there is a great need and desire for. We pray about every birth. We are somewhat careful which births we will accept responsibility for. We try to avoid the use of medicine without a license. With 3 of our own children, it can be a challenge to bal ance my wife's time. But God has given grace to this point. We try to schedule mothers to come here 1 or 2 days a month for prenatal care so my wife can be at home more. We have the support of our church group and several sisters attend births with my wif e as helpers. I've told my wife there is no way she can do all the work there is to do. She needs to train others.
Husband of previous "Name Withheld"
On September 17th, 2003, I pled guilty to the charge of practicing certified nurse midwifery without a license. This charge was brought against me in August 2002 by the complaint of an angry nurse. It came about that I transported a woman having wh at appeared to be a cord prolapse, four minutes after I walked into her house. I followed acceptable procedure according to anyone's guidelines. We eventually found out that although the cord did prolapse, it did so through a uterine rupture. This mom was not high risk for rupture and had no conditions prenatally that would sound warning bells. The attending doctor stated in front of several witnesses that had the mom been on the delivery table at the time of the rupture, they probably would have not save d the baby. He also stated that my reaction was correct and I probably saved the mother's life. By the way, this wonderful family has been very supportive and responsible for all their decisions. I am sure if they were not of this character, things could have been much worse for me.
Did the medical staff hail me as a hero? Were they thankful this mom had a midwife in attendance that reacted quickly and got the transport going and who was not too afraid to transport with her hand inside the mom, keeping a major hemorrhage from happ ening? Did I get a pat on the back for not being fearful for my own well being, but only had concern for the mom and baby? Well, we all know the answers to these and all the other questions being thrown at midwives allover this country. Their answer to me was to first try to get me for manslaughter. Next they tried to make the charge a felony (in AL it is a misdemeanor). Even when I pled guilty, the DA tried to make it impossible for me to practice anywhere, or even give advice until my probation is over.
My name is Karen Brock and for almost 20 years I worked in my state. I served families openly and always went to the hospital with them during transports. I kept an honest, open attitude with the medical community and tried to keep a good relationship. The Vital Statistic Dept. in Montgomery would call me when there was a change in birth certificate information and the Health Department would give out my number and even brought ladies to my door. I felt safe. I believed this was an alegal state. I beca me a CPM in 1997. After my arrest, I applied for and received my license from the state of Tennessee. I live under an hour drive from TN and travel up there for births. All of my clients so far have been from AL. As far as I am concerned there is no doubt which is better: to work in an illegal state with fear of arrest, or to work in a state that offers licensure and some amount of protection. I will choose the licensure over non-licensure any day.
The nurse that caused my arrest vowed to put an end to what she called the underground movement to birth out of hospital. She may have actually done me a favor. The next transport might have been the one that would lock me up for years away from my fam ily. By the way, my sentence is 30 days in jail (suspended) 18 months probation (unsupervised) court cost and fines. I can live with that.
Living through two investigations was a nightmare for me, but I learned a LOT from the experience and became much more politically astute because of it. First, the fact that we had very good documentation of our care was a huge factor in both invest igative cases being dropped. Never, ever underestimate the power of documenting your midwifery care! (Of course, if you don't provide good care, your documentation will attest to that, too, so be sure you practice very, very good midwifery!) Second, I had a really good reputation and had made some friends in the medical community. When push came to shove, they were there for me, and I will always be grateful for their advice and their support. We do not need to be adversarial with the docs; we can accompl ish a win/win between our professions in providing excellent maternal-child care, even if we don't always agree on how that is supposed to look. And third, I know that prayer helped tremendously. I was so frightened, and being able to turn things over to G-d when I could do nothing more was its own comfort. The process involved in investigations usually takes many months, so if it happens you just get to be patient with the process. So the point of all this rambling is that, from my experience, whether yo u are a CNM, a CPM, a DEM or even an MD, the struggle is bound to continue around provision of services for physiological, family-centered maternity care. It just takes different forms with different faces depending on the letters behind your name. Sadly, there is a well-documented tendency for the "powers that be" to let you alone if you are providing care for folks who are in lower socioeconomic groups or who are marginalized by a different language (Hispanic women and the deaf community come to mind as two notable examples). And if you want to provide services for women in recovery from substance abuse, go right ahead. But if you want to provide an alternative to hospital care for white, upper middle-class women, you may well find yourself in an unwelc ome spotlight at some point, especially if you get busy. That is particularly true if you are practicing in an alegal or illegal state. But all women deserve midwifery care, no matter what their demographics happen to be. Just be aware that the struggle i s inherent in donning the mantle of midwifery, and be smart about what you do. "Wise as serpents and harmless as doves" has no better application than to midwifery, I think!
Valerie Vickerman Runes
As a whole, midwives in the United States feel pretty secure. Even in states where we are not regulated, many of us believe that we will remain untouched by the law. After all, we are quiet about what we do. Some of us work in small religious or cul tural communities. We may not charge a fee for our services; we may not even call ourselves "midwives". If a hospital transport becomes necessary, we may opt out of going to the hospital, suggesting to the parents that they tell hospital staff that they were having an unassisted birth. If we do go to the hospital, we become a "sister" or a "friend" or a "doula". We are "stealth midwives". We fly beneath the radar. We go from birth to birth to birth, undetected by state authorities.
Or perhaps we are more public about what we do, because midwives are "alegal" in our states. They are neither licensed nor prohibited, so we practice openly, secure in the knowledge that the state cannot touch us because we aren't violating any laws. As long as we don't do anything that someone might interpret as the practice of medicine, we feel pretty safe. How can we be prosecuted for practicing midwifery when midwives are not prohibited?
If you are living in a state where midwives are not specifically regulated by law, you are not safe. Regardless of how quiet you are, how good you are, or how protective your clients are of you, you may still find yourself being prosecuted by the stat e in which you live. And the state really doesn't care how strong your calling is or how righteous your indignation. In this section, we are going to look at two of the most common myths about midwifery practice. We are going to explain why they are my ths, and what you can do to protect yourself.
"I am really underground. I tell my clients not to give my name to anybody and I don't go to the hospital with transports. Besides, I never call myself a ‘midwife'. I just ‘help out' my neighbors."
Even if we aren't this midwife, we probably know her. Her story goes like this:
"I don't actually call myself a midwife (although my clients might call me that). I am just a helpful friend, assisting in the normal process of childbirth. I do tell my clients not to ever give my name out to anyone, and if one of my ladies needs to go to the hospital, I tell her not to give my name to the hospital staff. Nobody even knows I am out here doing this."
The fact is, no matter how anonymous you think yourself to be, you are almost certainly one bad outcome away from prosecution. Regardless of how good a midwife you are, babies sometimes die, mothers sometimes bleed, and transports must sometimes be ma de. Will your client still protect you if she is told that her lack of cooperation may result in her own prosecution? If a hospital staff person is having a bad day and is annoyed by "yet another failed homebirth," and makes a quick phone call to the lo cal state's attorney/state regulatory agency, will you still be protected? Will the family withhold your name at the expense of their own security?
Let's look at another scenario. Let's assume that your clients are all happy, healthy, and delighted with your care. You have told them, of course, not to give out your name. But they are so thrilled with your services that when they are asked about their midwife, they reply, "Well, don't tell anyone else, but her name is _____". We all know how well most "secrets" are kept, and before long, half the county knows who you are and what you are doing. What if you are the kind of "Stealth Midwife" who simply doesn't refer to herself as a midwife? After all, you don't "practice midwifery" – you just happen to be present for a cup of tea when women go into labor. You don't charge for midwifery services (though you probably accept donations). You are just a helpful neighbor lady. Surely you can't be prosecuted if you don't call yourself a midwife, can you? There is an old cliché that "if it walks like a duck and quacks like a duck, it is a duck". Sub stitute the word "midwife" for "duck", and you pretty much have the State's interpretation of who is practicing midwifery. I may not call myself a midwife, but if I am doing the things a midwife does, I will be perceived by the State to be a midwife, or perhaps even something else besides a midwife. Consider the recent Illinois Supreme Court opinion in Illinois v. Cryns: "…[r]egistered professional nursing practice" includes "the assessment of healthcare needs, nursing diagnosis, planning, implementation , and nursing evaluation," the "promotion, maintenance, and restoration of health," and "counseling, patient education, health education, and patient advocacy." 225 ILCS 65/5-10(l) (West 2000). … the court observed that prior to Spencer's birth, defendant used various medical instruments to listen to his heartbeat and ascertain his health status. Further, defendant actively assisted in delivering the baby and in resuscitation efforts. In light of these facts, the appellate court concluded that defendan t was practicing nursing or midwifery, as she was assessing the healthcare needs of the mother and baby, making nursing evaluations, attempting to promote, maintain and restore the baby's health, and attempting corrective measures to improve the baby's he alth status…"
It is not necessarily what you call yourself that matters to the State. It is what you do.
Finally, let's presume that you never have a hospital transport. There are no bad outcomes. As best you know, everyone is happy. Yet one afternoon a former client calls to tell you that "some guy was here asking questions about you". You are being investigated. Why? How? Maybe the neighbor who doesn't like all the cars parked on the street? Maybe a bitter ex-husband? Maybe the sister of the best friend of the cousin of the lady whose last birth you attended? Maybe you will never know. But so mehow they found you and your "stealth midwife" status is gone for good.
In the late 90's, an undercover investigator for the Illinois Department of Professional Regulation began calling midwives, identifying herself as "Vicki Sloan" and asking for information about midwifery services. She was quite pleasant, very credible , and extremely successful. The result was that over the next couple years, nine cease and desist orders were issued to eight Illinois midwives. Those midwives still do not know why or how the initial investigation was instigated, but only one of the ei ght midwives is still practicing in Illinois.
The bottom line is that you might be working invisibly right now. You might even remain that way for a while – long enough to lull you into a sense of security. But you won't stay that way forever, and your first indication that you have been discove red might be a subpoena in the hands of a sheriff.
"Midwives are alegal in my state, so I am not worried about being prosecuted."
There is a myth about the legality of the practice of midwifery that continues to confound most midwives. That myth is that the practice of midwifery is legal, illegal, or alegal, depending on the state laws. To better understand the legal issues aff ecting midwives in every state, we need to have a clear understanding about what these terms mean or don't mean. The word "legal" is defined by Webster's as "authorized by law." "Illegal" means "forbidden by law". There is no definition of "alegal," tho ugh it has been used for many years to describe the practice of midwifery in states that do not have a law authorizing or forbidding the practice.
In nineteen states, direct entry midwives can receive a license to practice midwifery, in two other states they can be licensed if they have attended a nurse-midwife program, and in seven states direct-entry midwifery is prohibited by law. That leaves twenty-two states where the legal status is vague and where midwives have considered their profession to be unregulated but also alegal.
If there is no state law either authorizing or forbidding the practice of midwifery, then why should we not consider it "alegal" or at least defined in a similar context as not needing authorization? Why does any activity which is not expressly forbid den even need a defined legal status? The answer lies in the Medical Practice Act. Every state has a Medical Practice Act which says that it is illegal to participate in activities that the medical profession considers its own. Words vary slightly from state to state, but all contain references to treating, diagnosing, or prescribing for any disease, injury, pain, or condition. These activities are prohibited by anyone not authorized by the state through licensure or not exempted from the Medical Prac tice Act. Exemptions are often listed for persons acting as good Samaritans or in an emergency, or for parents treating their own children, or for religious reasons. Some allow exemptions if no fee or other consideration of value are exchanged. Many mi dwives feel that the Medical Practice Act does not apply to midwifery because the midwife is not treating a disease; she is nurturing or supporting a natural process. Some go so far as to not charge a fee but only accept donations, or to charge for child birth classes or labor support rather than midwifery services. While any of these defenses may seem to be reasonable to the midwife, they are rarely successful in the courtroom.
There is no clearly defined legal status for midwives except licensure or specific exemption from the Medical Practice Act. In the few cases where an exemption has been successful, it has either been revoked at a later date or it significantly restric ts the midwife to "catching" the baby, almost if by accident, without the extended exemption for providing prenatal care, which is considered by most midwives to be essential to midwifery. For all practical purposes, for midwifery to be legal it must be licensed by the state. In fact, all states do have some avenue for licensure as a midwife, but many of these routes apply only to the Certified Nurse Midwife who is licensed by the Board of Nursing and must practice according to the licensure requirement s for nurse-midwives. Direct-Entry Midwives (DEMs) are licensed in only 21states, and in two of those states (New York and Rhode Island as of January, 2004) the only direct-entry route is the Certified Midwife, a credential issued to non-nurse midwives w ho have completed their education in a nurse-midwifery program. DEMs who have received their training and education outside of the medical/institutional educational systems are licensed only in nineteen states. In all of the other states, the legal exem ption to the practice of medicine applies only to Certified Nurse Midwives. Unlicensed midwives can be charged with the practice of medicine OR the practice of nurse-midwifery.
Another myth regarding the practice of midwifery is that even without licensure, there are precedents in state law that protect the midwife. These precedents may help in the midwife's defense if she is charged, but they don't prevent charges from bein g filed. For example, there is a chart on the Citizens for Midwifery web site that lists seven states as "legal by statute, but licensure unavailable." That usually means that there has been some thing in an older law that referenced midwifery, or a previous system for licensure that is extinct, but there is no current process for licensing midwives. In one of those states (Alabama), a midwife who had been practicing for twenty years suddenly fou nd herself arrested. After being threatened with an expensive trial and potential charges of manslaughter in the death of a baby after transporting with a prolapsed cord, she pled guilty to practicing nurse-midwifery without a license and received a susp ended sentence and fines. There was no "legal by statute" protection for her. Another "legal by statute" state where midwives had considered their profession "alegal" for years is Georgia. The Medical Board has recently begun an investigation, stating they have a list of midwives. To date, only one midwife has been contacted though no charges have been filed. Another category on the CfM chart is "not legally defined but not prohibited." These are another seven states where midwives have considered t heir practice as alegal only to find the wolf at the door unexpectedly. These states are Connecticut, where four midwives were arrested in 2002 and charged with practicing medicine or nurse-midwifery without a license (and this happened even after the st ate was unsuccessful in prosecuting another midwife on these charges a few years earlier); Illinois, where two midwives have faced charges ranging from manslaughter to practicing without a license and several other midwives were issued cease and desist or ders; Nebraska, where one midwife was arrested for practicing nurse-midwifery without a license in July and two midwives were issued C&D orders in August of 2003; Ohio, where one midwife is under investigation currently; and South Dakota, where one midwi fe has been tried twice on charges of practicing medicine or nurse-midwifery. She was acquitted one time and sentenced to jail the second time. A third category of legal status is "legal by judicial interpretation or statutory inference." Eleven states are listed in that category. Of those states, Idaho has had a midwife arrested and charged with practicing medicine (charges were later dropped but legal fees were high), Pennsylvania has had periodic investigations and arrests in years past and there i s one active arrest and one recent Cease and Desist order, and Utah had an arrest in 2000. Many of these arrests lead to charges that are later dropped or are settled with a plea bargain before trial. But the expense and the emotional stress are very hi gh for the midwife and her family, and for the other midwives in the state.
Five years from now many of these cases will have been settled, and many more may have been filed. Some will have gained legal status through licensure. The point worth noting is that in all of the previously mentioned states, the midwives thought tha t the practice of midwifery was "alegal" in their states and many had practiced openly for years before being harassed. Some investigations were the result of a transport or a bad outcome, but many were just for attending births. Each year, midwives in t he alegal or illegal states face prosecution just for attending births, and almost surely manslaughter charges if a baby dies while in their care. Most of the currently active investigations and prosecutions are occurring in the alegal states; only a few are in illegal states, possibly because the midwives are less likely to practice in an open, publicly identifiable manner. Interestingly, there are no current prosecutions of unlicensed midwives in the states that license midwives. Their focus seems to be on regulating the licensed midwives rather than ferreting out the unlicensed ones. Certainly, in those states an unlicensed midwife could be charged with practicing midwifery without a license, but anecdotally there seems to be less tendency to do so . I know of one unlicensed midwife who has practiced in a licensed state for over twenty years. Recently, she transported a client to a local hospital where the OB casually asked her what she thought of the proposed midwifery regulation changes that had been written about in the state newspaper. She replied that she hadn't thought anything about them because she was not licensed. "Oh," he replied. He'd always assumed she was licensed, but at that point it didn't really matter that she wasn't.
Many midwives prefer the freedom to practice according to their own protocols rather than by government regulation. However, the annoyance of regulation is nothing compared to the stress of arrest and prosecution. Some midwives have fought diligently and persistently for licensure laws, and some have fought just as diligently and persistently against them. Regardless of our own personal feelings about regulation, licensure is the only way midwifery will survive into the next generation. Outlaw midw ives are a dying breed. Women coming in to the profession do not want to face jail time for serving the women in their communities. At the very least, they deserve to know the risks they face. Midwives in licensed states work to create acceptable regul ations. Midwives in illegal states accept the necessity of practicing underground until they eventually retire, leave the state, get arrested, or change the laws. Midwives in the other states are living with the most uncertainty because of the fallacy o f "alegal" status. They spend years in training, invest in setting up a practice, sometimes work for years establishing a reputation, and then one day when least expected comes "the knock on the door." Life changes at that moment. Her clients have to find someone else; all her time and money go toward her defense; her family tries to understand but nothing seems fair; and she questions her own sanity. "But wait," she cries, "I'm legal by judicial interpretation or statutory inference!" This is not a career path we can offer our daughters. This was not an issue faced by the midwives in the bus in the parking lot of Northwestern University in 1971, but even the Farm midwives are licensed now. Alegal is a concept of the past, and we are going to have to move forward. Licensure is not something that should be forced on recalcitrant midwives by a paternalistic government. It is something that should be created by midwives; it is the next step in self-actualization.
Midwives have created a certification process which upholds the integrity of the autonomous midwife for out-of-hospital birthing. This credential, the Certified Professional Midwife (CPM) is issued by the North American Registry of Midwives (NARM). N ARM is a prime example of how midwives can create a credential that reflects the Midwifery Model of Care. All of the states that license direct-entry midwives to attend births out of the hospital do use the NARM exam or the CPM certification as the basis for licensure. If we as midwives can take an active role in creating licensure programs in the same way that we created the credentialing program, there is great hope for the future of midwifery. If we turn away from regulation and leave our arrested s isters to fight the battle alone, then we will be picked off one by one until there is no one left. Our strength is not in our few numbers, but in our combined will, the intensity of our beliefs, and our unflagging determination. There is no alegal stat us; our legal status will be what we make it.
Collected by Valerie Vickerman Runes
A few quick things I wish I had known:
1) You don't need to let an investigator question you unless he has a warrant signed by the judge. NEVER give him any charts.
2) Get a lawyer before talking to anyone.
3) Question the lawyer before hiring him. It is usually best to get one with lots of experience, and he must have backbone because the medical establishment has lots of power! In my case, I think getting a local lawyer was a detriment.
4) NEVER sign a plea agreement they are trying to rush you into, and do not allow yourself to be put under a health department's protocols!
I wish I would have known not to trust ANYONE. We would like to think that we would have the integrity to defend our friends, our colleagues, and our beliefs, but what about our friends? Will they stand by us when the furnace gets hot and fear inf luences their thinking? Will they risk going to jail for US? I have realized that very few people have the courage to stand for what is right no matter what the consequences. They may swear to be true and promise not to divulge actions they knew at the time to be necessary, but illegal, BUT fear can cloud the mind and promises can be easily forgotten. Then they hid their faces from you and dissociate themselves from you and say, as Peter did, "I know him (her) not."
In the future my motto is, "No witnesses". If I ever have to cut an episiotomy to save a baby's life, I would ask everyone to turn their backs and turn off all video cameras. I would say to the mother, "I'm sorry, I had to TEAR you to deliver your ba by quickly" (ok, so you tore her with scissors). I do not carry Pitocin anymore. For those midwives who do carry Pitocin, I would advise them to never admit it to anyone who has the ability to testify (that is, anyone except your husband). If a midwife ever feels the need to inject Pitocin or administer any kind of drug, such as Methergine, she should refer to such substances as "minerals."
Be careful how you talk to your apprentices. You may think, "Not her, she would never betray me." In my experience, there were only a few out of hundreds of midwives in my state who stood by me and defended me.
Be careful how you talk to your clients. Always use terms such as "If I were you, I would…" instead of diagnosing and recommending. Always have them initial on their charts when they refuse to get lab work or choose not to see a doctor.
Be careful where you keep your medical supplies. A search warrant can be issued without warning to you at any time. Do not chart emergency medical procedures. Use a "made up" code that only YOU understand. Don't ever think it can't happen to you. I believe I was careful BEFORE I was prosecuted. I am even more careful now.
In reality, all of us are at risk all of the time. For a midwife to believe otherwise is very naïve. If a woman is not tough enough to handle prosecution, she probably would not want to go into midwifery. I, for one, have seen so much good come from my work that it far outweighs any opposition I have to endure. We should continue to pray every day for the Lord's protection upon our work. We should keep ourselves morally clean and obey the Lord's commandments that we might be worthy of his protecti on and inspiration. We should keep ourselves humble and know always that we are only instruments in the Lord's hands and not allow pride to cloud our minds. This is HIS work. He will not allow it to become corrupted. We will not be stopped unless HE w ants us stopped. During the process of my defense, I did not miss one birth. That was a miracle.
When I was served with the papers, I wanted to pass out, but I felt a calm come over me and I knew the Lord was with me and had a purpose to fulfill through me. I knew everything would be all right. Not only did everything turn out well, but with the publicity of my case, lawmakers and the public alike were brought to attention of our position in society. Lawmakers have listened to midwives since then and we hope that this will bring about protection for us in the future.
Make friends everywhere you can in your community. This is what saved me. I became an EMT so as to get along with them. I volunteered at my local hospital, so they would get to know and like and know I was not a "freak." I volunteered for the medic al team at the marathon each year, just taking blood pressures, but I was a big help to them. I find that in serving others you will gain respect and many friends. I received donations from doctors to help with my defense.
As long as we love the Lord and let him guide our lives, we might get a few bruises, but we will not be destroyed. I have no doubt this is true.
I was investigated for a period of 2 years by the New Jersey Board of Medical Examiners because of a doctor's complaint against me. No bad outcomes – just negativity toward homebirth. What I should have known was how my charts should have appeared before they were scrutinized. I had an excellent lawyer who learned all about midwifery because of my case.
Having dealt with a suit, which I am legally bound not to discuss specifically, the best advice I can give is to pay for your own attorney in addition to the one that may be provided by your malpractice carrier. The malpractice carrier's interests are not the same as the midwife's. But any settlement that is worked out (in court or not) will follow you forever, and if you do not feel that you were fairly represented, the pain of the whole thing is that much worse. I SO wish someone had told me th is – somehow I would have found the money, and wouldn't have to live with this "victim" feeling. The other thing to tell midwives is that the real purpose of malpractice insurance SHOULD be to provide long-term care for those who need it. If harm was do ne, this is the only (stupid) way we have to deal with it. One of the only ways I survived the whole thing was thinking about the baby.
I've had a few minor "run-ins" where I was questioned by the hospital doctors and/or the coroner. But once I was in enough "trouble" that I was required to be at a few police interviews and it was eventually taken to the Stark County Grand Jury. I delivered a set of twins. This mom had been my friend for 12 years and I delivered 5 of her other 6 children. She always goes 3 weeks over her due dates, and always gives birth to huge babies…10.5 to 11.5 pounds (never diabetic though).
In this case her twins were born 10 days early, but in my mind she could actually have babies that were almost 5 weeks early…regardless that they weighed 8-8.5 each. When one baby started having breathing problems two days after birth we got him to th e hospital. He was fine after transporting, but died the next day in the hospital under the doctors' care. The doctor and coroner both adamantly insisted I was a nutcase, this baby was only 10 days early and couldn't have had immature lungs. Yet the de ath report states just that.
They tried to charge the parents with child abuse and neglect (for – believe it or not! – obeying the midwife!). They tried to charge me with manslaughter. Although I was never formally charged, the prosecutor tried every angle to blame the death on me. The grand jury refused to charge me with anything and it was all finally dropped.
At the beginning I started bringing my own tape recorder with me to each interview. Partly because I thought if I would just cooperate they would see I had done nothing wrong and would not need an attorney, so I wanted my own record. That thoroughly pissed off the police. Since I hadn't been charged, they were told they had to allow it. That was the best thing I could have done and saved my butt several times when they tried to make up statements and comments later.
Second, I made copies of everything from the first afternoon the baby died. I copied all my records, copied all pictures taken at the birth, and made copies of the videotape the grandma made of the birth. I labeled the tape "Christmas Vacation 2000" and then handed three copies out to friends, instructing them to hide or give away the tapes and not tell me where they are. That videotape would be confiscated by the police and I wanted nothing edited or deleted.
I also started storing my birth bags at another house. It was a real pain to have to travel there to collect things before getting off to a birth, but I wasn't willing to lose a life's work worth of equipment just because the police would come in and do a sudden sweep of my house. The parents and I are still friends (they too were found innocent).
Anyway, that is my two cents. Copy everything, store your stuff elsewhere until all danger is passed, and take your own tape recorder to all interviews (especially if you don't have an attorney the first time you talk to someone!).
I have been in a few major battles as far as midwifery goes; these are my words of advice. Remember that this too shall pass. Do not sweat the small stuff and it is all small stuff. Keep oneself together—yoga, praying, support people, dancing, etc.
Midwives in the state need to work together and stop the witch hunting amongst ourselves. Get the support of the families—emotional and financial. Have the lists of names written up and a contact person for each list ready so that when they need to b e called for support the lists are ready.
Go for the best lawyer. Ask him to make an exception for the amount that he will charge you. Do not settle for the lawyer who tells you that you cannot win. You can get a lawyer who has worked for the "other side" -- the best out there. Tell him/he r who you are, what you need, and show them who we are. Even though they may have not danced in our world does not mean that they will not help us. Make them see how we work for so little money. The commitment from the families...ask the families to al l give a 100 dollars to your case. When you work with your lawyer, write the facts down on paper. Keep it simple. Show the lawyer that you can and will help with the legal work as there is a lot to do as long as you do not get in his way. Trust in the lawyer who you get, and if it is not the right one then get another. Listen to your intuition always.
Keep the faith up. Use the experience as a time for self growth. Keep your heart open, keep your mind open, and keep yourself full of love. Do not hate those that are doing this to you. Pray and learn to love them. This is the most important or yo u will not attract the right one to help you. Look at the "enemy" as small children who have been abused.
During depositions, questions are being asked by the other side. Take a breath every time before you answer the questions. Every time, count to six (or whatever number you like). Breathe in...same with the out breath. Then answer the question simply. Do not elaborate on the answer. Practice this in your life all day when kids, partners, etc. Ask questions -- the breathing part and the simple answer. Remember, although we work differently than the other side, our ways are good. For example, they m ay take vital signs constantly with blood pressure, pulse, temperature, etc. and we may hold her hand, massage her, breathe with her, sit at her side. We too can get the info that they got and even more. Trust in our ways and believe in them.
Remember to not get caught up in the rumors. They will happen. Do not partake in them and do get all emotional about them. This is why the witch hunts were so successful. Keep quiet, keep peaceful, gather info, do not talk amongst other midwives. O f course, have a trusting friend to talk but be careful who you talk with. Women and midwives talk way too much.
When I was first investigated for my midwifery practice, I was very legally naive. If I had known more then, I might not be going to jail now for being a direct-entry midwife. I falsely assumed that the court system understood the differences betwee n Certified Nurse Midwives and direct-entry midwives as well as I did. They did not!! I agreed to a temporary injunction to not practice as a CNM. I have never and would never do that. But my definitions were different from theirs. I should have challenged it instead, right from the start. Their interpretation was that if I gave food or fl uids to a pregnant woman or put a cold washcloth on her forehead, I was practicing as a CNM.
My first attorney, though a strong supporter of home birth and midwifery, did not have good advice about what might follow my actions. It took me years to help my next attorney understand my philosophy of practice. Thankfully he too was a strong suppor ter of home birth and midwifery.
Contrary to what most midwives think, it was not a transport or bad outcome that started me on my legal journey. The Board of Nursing simply found out that I had been at a birth. I have never advertised and do not sign birth certificates. But they foun d me anyway. I gave up my RN license because I would not promise never to attend another birth. But that did not stop them. They have continued to come after me until they have succeeded in sending me to jail. I have fought in the court system for 10 year s and won one victory, but had four losses. We have worked on legislation, but not yet succeeded in getting legal recognition. But the only real answer will be legislative action and recognition, whether licensure or registration or exemption.
I pray no other midwife has to go through what I have, but if someone does, I hope this book will help them be better prepared than I was.
Judy Kay Jones
I am a R.N., B.S.N. and I have been a Bradley teacher for over 25 years. I have also been a Homebirth Class teacher and studied lay midwifery. This is the advice I give to birthing families and to midwives who get into trouble. I know this may not w ork in more complicated circumstances. But this advice eliminates most petty problems before they become full blown.
To the family planning a home birth: Keep your mouth shut about your plans.
To the family who transports to the hospital in labor: Keep your mouth shut about the homebirth.
If the family feels intimidated by questions at the hospital: Keep your mouth shut. Pretend that you don't understand. Play dumb. It's not against the law to be dumb.
To the family involved in a third stage or neonatal hospital transport: Only report that the mother was in labor and all of a sudden the baby just came out! A spontaneous labor will not be investigated.
To the family whose midwife is being investigated: When the investigators arrive at your home, tell them "I don't want to talk about it".
Because of my beliefs and my outspokenness of them I have been persecuted. Every time that they went after me I recorded it and sent the accounts to the state board or kept them filed. I was licensed at one time in Oregon (though I am strongly again st licensure) and tried to fight from within the system. My license was sought after but I fought it and was the first person in Oregon to win a case against any board that took away a license. There had been one case where a chiropractor had won in Orego n and the state fired the hearing officer and hired another and retried the case and he lost. So when the lawyer I had told me that I would not win and I had no other options I thanked him and found another. A lawyer whose wife I had helped represented me . I took my case out of the state level and into the federal level in order to win. I listened to the gossip in the community and did not talk, I listened. I let the state board make many mistakes. For eight months I listened and took notes. In their gree d to get me they made sloppy mistakes. Patience is the key. It is just a long labor. I had a great outcome and let go of that license with no record.
In 1998 I had to defend myself as a midwife again. When you win a battle, know that they will want you even more. Always be prepared. Always watch your back. Remember these battles have been going on for hundreds of years. This time I got the best med ical lawyer in our area and one of the most reputable ones in Oregon. He fought for me, kept me on track mentally, and ended up becoming a good friend of our family. "This too shall pass" was his motto. Again the community rallied behind me, helping with costs and support. Another lawyer in the community also volunteered her legal expertise and joined our team. She was like an angel that came down to help. The right people will be there to help you. The lawyers know how to fight the battles. Let them do t heir work. Trust them as they trust us when we are helping them. I had eighteen hours of depositions to go through for that case. I was centered. I prepared for battle. My yoga became warrior yoga, my mind trained. My breathing perfected. Before I answere d any question I took a long breath and centered myself and asked for guidance. Truth is on our side. My prayers became strong. These battles have a lot of ups and downs. Do not get caught up with any of them. Just keep your center and let it ride out. Le arning to love those that were doing this to us is part of the battle. That is hard work. I prayed long and hard for that to happen. I prayed for their healing. When I saw them in the depositions I had love in my heart for them. I was blessed with a good outcome. I celebrated with a feast and giveaway to all that contributed.
So I have a lot of advice to give those that are fighting battles. First take care of yourself physically, mentally, emotionally and spiritually. I do yoga, dance and swimming. I went to my community of friends, many of whom I had helped birth, and the y helped me with open arms. They helped me with cards, letters and money to fight my battles. I centered myself. Whether it was praying in the middle of the night or calling my dear elder, Ms. Margaret Charles Smith, I always knew I would hear the right w ords. I knew I could win. "Positive thoughts and actions create positive outcomes and negative thoughts and actions create negative outcomes" (Dalai Lama) was written on my refrigerator. So I worked hard to keep that thought alive. I also took on a vow of poverty. I own nothing. I also suggest that you are careful about whom you trust. Sad enough there are some midwives who are invested in the medical model which is misogynistic and patriarchal. Because of this they are unable to support their sisters and often join the lynch mobs. So choose carefully as there are many more midwives and supporters who will be a strong team for you. There are those in the medical community who will support you. There was a medical doctor who reviewed my cases and knew that what I had done was correct. That doctor fought along side of me. There will be folks on both sides of the line there to help you. Keep your eyes open. As Ms. Margaret Charles Smith says, we are all hanging on a shoe string. We need to help each other wi th our battles as they all are our battles. We need to be strong. We need to fill ourselves with love. We need to be truthful. We will end up winning. I have no doubt. Let our Creator decide when that time is. Until then we keep working for this sacred ce remony. We shall overcome one day.
My case involved a stillborn baby in 1989. I tried to resuscitate, but nothing worked. Of course the EMT's didn't know beans about resuscitating a newborn, even if it was 9 lbs. The doctor in the ER made the complaint, and when the prosecuting atto rney didn't want to pursue it, he put a lot of political pressure on him and made him prosecute. To make a long story short, the felony charges of practicing medicine without a license were dropped, and we tried to sue the state of IL on constitutional g rounds: the right to practice midwifery, right for apprentices and students to study, and right of consumers to avail themselves of the services of a midwife. The Federal District Judge in 1989 said that consumers do not have the right to choose their med ical caregiver, and also that the state of IL is responsible to regulate midwifery, the same decision the IL Supreme Court made for Maggie Jihan in 1988. The state appealed it on the grounds that they could pick and choose what they wanted to regulate, an d we filed in Federal Appellate Court. Appellate said we had to go back to the district court and have a full hearing (trial), because we didn't have one yet. By this time: we had paid the attorney in excess of $50,000 and I couldn't justify spending more money from my husband's retirement fund. We fired the attorney. We had been having difficulty with him for some time. He didn't record any donations to the defense fund, and had misplaced several checks, one of which was for $500. He finally found it in the bottom of a box of papers. After firing him, he had the nerve to take me to court for non-payment. The judge made us pay an additional $20,000 because my husband wouldn't let me speak in my own defense. It's been a very bad situation all the wa y around. The knowledge that would have helped me before I was prosecuted in 1989 or what would have been useful to me was knowing that my husband really was not in favor of my being a midwife, and only said he was because "it made you happy". When push c ame to shove, he couldn't take the pressure, and made me quit without phasing out my clientele. Another thing I wish that I had known was that you don't need attorneys who are knowledgeable regarding midwifery... that is easily handled when you talk with your attorney. He/she will ask the questions needed to know to defend you best. I also wish that I had remembered that the attorney I ended up with had not served a midwife friend well, and was more interested in what he would get out of it than the cause .
(1)See, for example, Judy Barrett Litoff's (1978) American Midwives: 1860 to the Present, Debra Susie's (1988) In the Way of Our Grandmothers: A Cultural View of Twentieth-Century Midwives in Florida, Gertrude Fraser's (1998) African A merican Midwifery in the South: Dialogues of Birth. Race. and Memory, and Hans Baer's (2001) Biomedicine and Alternative Healthcare Svstems in America: Issues of Class, Race, Ethnicity and Gender.
(2)The Flexner Report in 1910 was instrumental to this process. In 1906, the Carnegie Foundation initiated the report--the first corporate-funded survey of the quality of North American medical education--at the American Medical Association's recommendat ion. Abraham Flexner, a businessman, delivered the report in 1910, based on his visits to regular, eclectic, homeopathic, and osteopathic schools in the U.S. and Canada. The effects of this report were far-reaching; it initiated a significant decline in t he number of biomedical schools (from 162 in 1906 to only 79 in 1924); it impelled surviving irregular schools to orient their curricula towards those of medical schools; and it prompted a shift in financial support by corporate-sponsored philanthropies t o fund only regular medical schools that were defined as "superior" by the report (Baer 2001 :36-37). Additionally, the report resulted in the closure of smaller, poorer, and "irregular" schools throughout the country. Notably, the schools that were most affected by the resultant policy changes and selective philanthropic funding were those that admitted women and African-Americans and those that offered low-cost training to working-class and lower-middle-class students (Ehrenreich and English 1978:88; M ullings 1989:156). Indirectly, midwives were affected by the increasing political, corporate, and public support of the growing medical profession, and consequently, the medicalization of childbirth practices in the United States.
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