Karen Brock
After a midwife goes through a criminal prosecution, what then? After the sleepless nights, the endless interviews with your lawyer, the docket calls, court dates, probation or jail time, what next? After you pay the lawyer fees, court costs and fines, do you continue in the very act that landed you amidst this storm in the first place? Is there life after prosecution for midwives? If you deny the midwifery calling where do you direct your energies and frustrations? Do you lose your identity if you quit? There are about as many answers to these and all the other questions as there are midwives and situations in which midwives find themselves. Each midwife must decide for herself where to go from here. One thing is certain. Every aspect of your life will be different. When you look back at who you were before and who you are now, you will see a changed person. Hopefully it will be for the better, yet sadly it may be for the worse. But midwives by their very nature tend to rise to the occasion and show amazing fortitude. Following are stories and thoughts from midwives, consumers of midwifery care and others who have been through it and are dealing with the changes they face.
A criminal conviction often alters your community's perception of you. Folks who were once in awe of what you do may look at you differently. Doctors and other professionals may be forced to decline services they once offered. Families you helped through several births may turn elsewhere. As you join the ranks of non-law abiding citizens you lose a certain amount of respect. The severity of change will be related to the severity of the situation. Expect more reaction if the charges are a felony instead of a misdemeanor, and even greater if you are found guilty. A midwife of eighteen years said she found herself trying to read the look on peoples' faces around town when they recognized her as "Oh yeah, you are that midwife." After her conviction the positive looks changed to those of sympathy or even smirks.
During the early days following an arrest supporters and friends rally around. Motivation is strong to encourage you. Often fund raisers will be held in your honor. Cards and calls will pour in. Prayers will be sent up on your behalf. All this helps tremendously, however, time moves on. Expect the support to dwindle down even from the very ones who benefited from your services. One midwife expressed the emotional pain she experienced after she agreed to a plea bargain that ended her legal battles. Some of her supporters thought she should do the jail time to make a statement. They said she let the women and babies of her state down by taking the plea. This left her with feelings of despair and confusion.
Judy Kay Jones, CPM, describes her life after her battle with the state. "In the past, the Board of Nursing would threaten midwives with prosecution and they would fold - either move away or stop practicing. Instead I continued to practice and fought a running battle with the state for ten years. I won a few rounds, but in the end they won. I spent 30 days in jail for practicing unlicensed midwifery (practicing certified nurse-midwifery without a license according to them). So what do I do now? I can no longer practice as a DEM or CPM in my state unless I want to go back to jail for two full years. The first thing is to continue to fight for legislative changes. My incarceration has spurred supporters to work hard this year and actually raise enough money to pay for a lobbyist. We continue that fight."
If you live in an illegal state, a prosecution often motivates the consumers to begin the legislative process in an attempt to legalize midwifery. This is the positive side of a criminal prosecution. Yet even this can have a down side. My state became divided between the supporters of licensure and the non-supporters. This is very common in midwifery circles, but if there are other midwives to take your place, expect this movement to lose momentum. Occasionally, there will be a few movers and shakers to keep things going forward, but only the most determined will stay the for long haul.
Lisa Clark, a recipient of midwifery care, had this to say: "The end results of the prosecution of our local midwife are still very much a reality. One of the things that bothered me most about this was the toll it took on women and their families. When we realized she (the midwife) would be charged I saw the tears, the fear, and the anger at having choices taken away, some even while they were carrying a child. For all of us, the contentment and peace that is part of a homebirth was taken away. Eighteen months later we have adjusted to the new reality but the personal price is still rising. Every mother who has to struggle with the choice between an unassisted birth, hospital birth or driving out of state to use a licensed midwife adds to this price. I wonder how much it will cost us before we say 'It is enough!'"
Another consumer wrote, "I think the awful thing in all this is that there are mothers who will stay home to give birth, even if no midwife is available because they have been forced out of practice." This woman is from a state that has prosecuted two midwives in the past five years, and has had as many as eight good midwives leave the state to look for greener pastures.
Derek Chris expresses the frustration felt by those who have had the privilege of birthing in a state where midwifery care is legal and then moving into a place where midwives are under harassment: "My wife and I recently discovered that we would be welcoming our third child into the world. Though we are happy to have a third addition to our family, we also know that it will bring with it many stresses. The stress isn’t necessarily caused by the baby itself, the changes that come with incorporating another child into the family mix, or even the financial strain of having a child. Rather, the stress that we feel most is that of our birth options. Our first two children were born in California. In fact, they both were born in the little two-bedroom condo that we were renting. In California, it was very easy to find a midwife for our planned homebirth. In fact, all you have to do is open up the phone book and look in the yellow pages and they have their own heading and full picture ads! We met with several of them, settled on one, and both of our children’s births were attended by the same caring and loving midwife. She was a very compassionate, wise, and warm-hearted woman. Without a doubt, she was the perfect choice to help us usher our little ‘gifts’ into being. As our children grew, many different factors made us decide that we should move back home to North Alabama. We had been back here for about a year when we found out the good news about having another child. Soon thereafter, we started to look for a list of midwives in our area to interview and to our dismay, we found North Alabama to be a very foreboding place to have a homebirth. The search has been very complicated and what was once good news now brings us a lot of stress as we struggle to come up with the best way to birth our child. What we have found is that inconsistent laws and a general lack of understanding of midwifery, has created a very harsh environment for competent caring midwives to work in. Because of the way that midwives are prosecuted here (more like persecuted), our options are very limited. We have not been able to find any midwives that are willing to come to our home for the birth, though we have learned that there are many qualified midwives here. The options that we have discovered thus far are not very pleasing. We could drive to a few different places in Tennessee that would range from about one hour to the closest place to over 3 hours for the farthest. A hospital birth is not even on the radar for us so the only other option would be to have the child ourselves, unassisted. We are debating doing this, but our previous experience with a midwife has been very positive and we both feel much more comfortable having a midwife there. For us, having a midwife available helps put our minds at ease and lets us focus on other things instead of worrying about how we might handle any complications that might arise. A competent and trained midwife would know how to correct many of the different little things that can make or break a positive birth experience. The inconsistency of the state has been very frustrating. We know that just a couple of hours south of us, midwives there are pretty much free to practice without much imposition from the state. However, they cannot practice at all here in North Alabama because they face harsh punitive measures if they do. As it stands now, it seems that the state of Alabama would rather leave families to fend for themselves and risk having an unassisted birth instead of allowing a trained and licensed midwife to be there if they want one. The fact that these blocking measures are being initiated by the state leaves many families without a comprehensive array of safe birth options."
A very real challenge that must be faced is financial considerations. Hiring a good lawyer may mean the difference between jail time and freedom but also might result in sinking deep into debt. Depending on your situation, you stand to lose an income your family depends on. Often clients will seek out another care provider just because of the stigma or the worry over legal issues they perceive as connected with you. If you were blessed with a great lawyer who donated his time, you still may be faced with court costs, fines and loss of income. Even long after the legal battle, the financial battle can be a formidable enemy.
A midwife prosecuted in the late 80's had this to share about the financial woes: "We spent $70,000 in attorney fees, mostly from our retirement fund. It has been a very bad experience all the way around."
The financial crunch was felt by Judy Kay Jones when she was forced to stop serving women in her state of S.D. She said, "Since my income has been cut by two-thirds, it means changes in lifestyle. Not that our lifestyle was extravagant before, but now with an income less than $10,000/year we really need to pinch pennies." The stresses from prosecution are perhaps greatest on our families. They must deal with the day to day realities of the situation. Great burdens often fall on the husband who has possibly been the main support person. A midwife expressed it this way: "My family was very embarrassed that I was prosecuted to the point of being disgraced...My teen son had the hardest time of it with kids harassing him about his jail bait mom."
Another midwife felt the strain in her marriage because her husband had never been very supportive of her midwifery calling and after the prosecution, she says, he had the "I told you so" attitude.
From Marla Webster Hicks: "My former husband, Bruce, and I have always remained good friends. In a recent conversation, he remarked to me that one of the single most frightening events in his life occurred some twenty-two years ago, just after we received notification that I was being investigated by the California Board of Medical Quality Assurance. We had just finished dinner one evening in late autumn when we heard a knock at the door. Bruce answered to find a uniformed policeman there who asked, 'Is Marla Webster here?' Bruce said that in that moment his greatest impulse was to yell, 'RUN!’ As it turned out, the policeman was investigating a neighborhood disturbance that had occurred a few days previously...nothing at all to do with midwifery. But I wondered during this conversation nearly a quarter of a century after the event if the 'dust' ever fully settles for any of us following a midwifery investigation."
The media often enjoys portraying the midwife as an uneducated villain. Our children and family members may suffer the backlash from less than desirable newscasts. In my own experience a most unattractive picture was broadcast with unfavorable captions. Family and friends called, very concerned. We had reporters sneaking through our woods late in the evening trying to get us on film. This can be upsetting to young children who view their mom as a good person but now see her portrayed as a criminal. Long after the dust settles these visuals can remain and cause unsettling feelings.
Marla Hicks felt the stress of two investigations:
"Each case took two to three years to resolve and each had great personal impact for me and my family. In the first instance, my term baby turned from vertex to breech...Three years later, when we learned I was being investigated a second time, our family decided to move out of state... Happily, in both instances my partners and I were completely exonerated. Nevertheless, the experience of being investigated had a lasting impact and would permanently affect my approach to midwifery practice and politics. I've thought a lot about it, and I don't believe the dust of midwifery investigation ever really settles. Maybe that's a good thing, because there's a lot at stake here. As long as I can take a breath, I intend to use my experiences to ensure that the midwives' model of care endures for mothers and babies and their families, for my daughters and their daughters. For me the dust will settle when my own dust settles, and not before."
The whole future of aspiring midwives is often altered when they see senior midwives going through hardships. Concerns voiced from one future midwife: "As a student midwife, prosecution does concern me. The last place I want to be is sitting in some jail cell."
Lisa McDonald feels this way: "As an aspiring/student midwife, the persecution of midwives does bother me, however it has not changed my plans to become a midwife. I feel called by God. However it may make me feel a bit more cautious about how I practice. I used to be very vocal with my opinions. Now I show a bit more restraint."
These words come from someplace in Georgia, a state long considered to be "alegal": "I was investigated but not prosecuted. The investigator said if I quit practicing, he wouldn't prosecute. My heart remains torn in two even two years later. My occupational calling in life is midwifery and I can't work it. When 'my' ladies go into labor I can't be there and yet I find myself staying awake all night while they labor, pacing the floor, and praying for them. Because of the legal situation in my state, there are almost no midwives in my area who attend homebirths. Many of 'my' ladies are going to the hospital and having births that are filled with interventions they didn't want. I continue to pray and work for change in my state as do the women I've helped in the past."
There is an odd reaction many midwives are slapped with at a time when they least expect it or need it. When one midwife gets arrested often other midwives in the same state want to believe it was her fault. Not the fault of the state legal system or the medical establishments but that she, the midwife, must have done something to deserve this. Recently a midwife said this was one of the hardest things she had to face. She could not tell her side of the story until all the legalities were over and yet the atmosphere of guilt pointed at her. She "practiced" instead of "served" the families. Her faith "must be weak" and so on. She says, "Now that my case is over and behind me, I deal with the feeling of being an outcast in a state I 'served' for almost 20 years."
When at last you are through with the legalities and you can breathe easy once again, reality sets in. How will going through all this change the way you practice if you continue to practice? Reality is that it can happen to me! Reality is that even if I am the most non-invasive midwife and let nature take its course, I can still have a bad outcome. Reality is that even if I am agreeable with doctors and nurses and can talk on their level, a complaint may still be filed against me.
"When I was first investigated for my midwifery practice, I was very legally naive. If I had known more then, I might not have gone to jail now for being a direct-entry midwife. I falsely assumed that the court system understood the differences between Certified Nurse Midwives and direct-entry midwives as well as I did. They did not!" says Judy Jones. "Am I still a midwife? Yes, I am. I still attend births in other states since I live close to the state line, but I can no longer do prenatal care or attend births in my home state. Anyone who does risks going to jail for any birth they find out about - even if there is no transport. Transports automatically signal an investigation. And sometimes it’s truly necessary to transport. So if a family wants me to help them we must meet out of state."
Expect these realities and more to affect the way you think as a midwife. It might not be as easy to say "Sure, breech babies come out fine" or "Babies will come when they are ready". You might see a potential transport in each slightly unusual situation. Anxiety will be your companion. From the Midwest come these thoughts: "Because of all the suffering, I have faded out of the midwifery world completely. Will I ever catch another baby? In my best dreams, I will. In reality? Probably not. Fifteen years later I am finally getting to a place where I can exist without catching babies… It has taken a long time to return to 'normal'. I had to suddenly stop practicing, leaving 35 ladies without a midwife...I went into a deep depression. It has taken me nine years to heal to the point where I can talk to a pregnant woman without wanting to cry."
Anonymously from elsewhere in the Midwest come these sad words: "I think the worst part is the phone calls. ‘Hi! I just found out I am pregnant again, and want to make an appointment with you!' Each time I have to go through the same story. 'Well, I am not actually practicing anymore, but I can give you a referral...' That is probably the hardest part. Knowing that a family that I have been so close to in the past will be moving on to other births and other babies without me. It's been a little over two years since I attended a birth, and sometimes I wonder--would I still know what to do? Would I still know what to say? Would my hands remember the feel of a small wet head as it pushes its way into the world? Would I still be able to hear a few beats of an unborn baby’s heart and be able to say with certainty that 'well, that is in the 130's?’ How much have I lost? I think most midwives know that midwifery is not so much something we do as it is something we are. When the state took that away, they also took a part of my soul and I have grieved for a long time. So what is there to do? I have been asked ‘What do you do with the anger?’ I guess mostly I try not to be angry--at least not in the sense of sitting in my house and silently fuming at the courts. I try to be angry at a system in desperate need of change, and I try to use my situation to facilitate those changes. I pursue my various court cases and will continue to pursue them as far as I can. If I lose, I will try again and again. In the courts and in the legislature and in the media until there is finally nowhere left to go. I may be no longer able to midwife mothers and babies, but if I can midwife political change, perhaps not all is lost."
Helen Keller said "When one door of happiness closes another opens, but we often look so long at the closed door that we do not see the one that has been opened for us." I, Karen Brock, was charged with practicing Certified Nurse Midwifery without a license in August of 2002. After trying for a year to find a loophole or some angle that had not been presented in the past, I pled guilty to the charge. Sometimes we are forced to choose between two evils so we pick the one that will hurt us less. I have often looked at the arrest as a blessing in disguise. The next situation I found myself in may have been the one that sent me to jail, away from my home and family.
At the time of the arrest there were 27 women who considered me their midwife. I started looking for that door of opportunity and found it in a neighboring state. The state of Tennessee encourages and welcomes midwives and if you are a CPM you may become licensed and practice openly. By October of 2002 I was a licensed midwife in TN with a small house just over the Tennessee/Alabama state line. Within 14 months we had 36 babies born, all from Alabama families, in a secure out-of-hospital environment. Best of all, we do not have to worry that each birth is a potential arrest. I have lost several of my former clients because they do not want to leave their homes, but at the same time I have had many who I have previously midwifed at several births pack their bags and meet me in Tennessee. They said it is the out-of-hospital experience they seek and not so much the homebirth. Also, they value my safety and refuse to put another mother, wife, woman in jeopardy for their own experience. I have not given up the fight in Alabama. To return to my home state and serve families will be my midwifery goal and this can only be achieved by creating a law to protect the one giving the service and not only the one being served.
From the wise lips of Margaret Charles Smith, a 98 year old midwife, we hear once again: "What are we going to do? We ain't going to give up. We goin' to keep a fighten'. 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."
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