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April 3, 2006
Midwives -- Natural Assistants Or Unlicensed Menaces?

The New York Times reports today on a prosecution against a midwife for delivering babies in defiance of legislation requiring attendants to be licensed nurses or doctors. Adam Liptak writes that the triggering event in this prosecution was the death of a child during birth, but that the charges have been limited to practicing without a proper license:

Angela Hendrix-Petry gave birth to her daughter Chloe by candlelight in her bedroom here in the early morning of March 12, with a thunderstorm raging outside and her family and midwife huddled around her.

"It was the most cozy, lovely, lush experience," Ms. Hendrix-Petry said.

According to Indiana law, though, the midwife who assisted Ms. Hendrix-Petry, Mary Helen Ayres, committed a felony punishable by up to eight years in prison. Ms. Ayres was, according to the state, practicing medicine and midwifery without a license.

Doctors, legislators and prosecutors in Indiana and in the nine other states with laws prohibiting midwifery by people other than doctors and nurses say home births supervised by midwives present grave and unacceptable medical risks. Nurse-midwives in Indiana are permitted to deliver babies at home, but most work in hospitals.

Midwives see it differently. They say the ability of women to choose to give birth at home is under assault from a medical establishment dominated by men who, for reasons of money and status, resent a centuries-old tradition that long ago anticipated the concerns of modern feminism.

The midwife in question, Jennifer Williams, assisted a family whose delivery had serious complications. Williams conducted her own pre-natal exams on Kristi Jo Meredith, performed an episiotomy during the birth when the baby's heart rate showed signs of distress, tried reviving the child through CPR, and after the baby died closed the suture she had made. Both the prosecution and the defense agree that the family has not pursued the prosecution, at least not with any enthusiasm, although Liptak could not get them to comment on the story.

Normally, my approach to questions like this is to ensure that all sides understand the limits and ramifications of their choices and act responsibly; if a family wants a midwife delivery, then let them have one -- but the midwife can't take it upon herself to act outside her own expertise. The prosecution has a strong case that Williams wasn't acting as a midwife but practicing medicine without a license -- and the fact that they have focused on that point shows the proper prosecutorial temperament.

And the first question that should be answered is this -- why didn't anyone call 911 when it started to go wrong?

I'll share a little story with you that will illustrate my frustration with this. Many years ago (well, not that long ago), friends of mine asked me to help out when their baby was due by babysitting their older daughter. They also asked to borrow my camera for pictures of the birth, so I brought along my Canon AE-1 SLR rig for the father to use. I assumed that they would be going to the hospital while I stayed at their place, but it turned out that they had arranged for a home delivery by a midwife. Labor turned out to be about twenty hours or so, during which time I got regaled with the entire political history of the oppressive male-dominated medical establishment and their extermination of midwives as witches, and so on.

Oh, and by the way, it turned out that the photographer was going to be ... me. Surprise!

I didn't really mind all of this, although it would have been nice had they just told me the entire story when they asked me to volunteer. I considered it a bit odd -- well, more than a bit -- but relatively harmless, and giving me the opportunity to be present at the birth was really rather sweet. However, that all changed once the labor got serious. The midwife could not get the water to break properly, causing some significant distress to the mother, and then the head got caught in the cervix. It turned out that the baby was a lot bigger than anyone had anticipated. At that point, I suggested we call an ambulance, but the midwife assured me that they had a backup plan for a hospital in case of complications.

It turns out that the hospital was twenty miles away. And this was in Orange County, CA, where we probably passed a half-dozen hospitals as everyone drove from Yorba Linda to the midwife's preferred birthing center in La Palma. I would have cheerfully strangled the midwife myself by that point, but she disappeared when they took the mother in for an emergency Caesarian. Fortunately, everyone survived the experience, but it turns out that only the father got to see the birth. I loaned him the camera, but I don't recall if he took any pictures.

I can understand why people might choose a midwife, I truly do. Most probably aren't as nutty as the one with which I spent almost two days. However, the truth is that births often bring complications, and midwives aren't qualified to deal with most of them. It seems to me that allowing unlicensed midwives to operate independently in home births asks for trouble, especially when they attempt surgeries and conduct prenatal examinations that supplant those conducted by medical professionals. Hundreds of years of medical research, understanding, and training do not turn people into oppressors; it turns them into professional doctors and nurses who can rely on that knowledge and experience to rescue people when things go wrong.

Addendum: Thanks, Mom, for going to the hospital 43 years ago today.

Sphere It Digg! View blog reactions
Posted by Ed Morrissey at April 3, 2006 6:04 AM

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