Midwifery in Indiana

[Sojourner]

OK, so I recently wrote about a case involving a midwife in Indiana who was arrested following the death of a child.

As a bit of background, midwives in Indiana are subject to a licensing process. The way the law reads, if a person is a nurse and wishes to be a midwife, she must be licensed. There is a distinction in the statute between a nurse-midwife and a direct-entry midwife (a midwife who does not have a nursing background). The law is unclear about the licensing requirements for direct-entry midwives. So, a group of direct-entry midwives have been practicing in Indiana for a number of years.

Jennifer Williams is one such midwife. Williams has been practicing for a number of years, and all told has delivered something like 1,800 babies in Indiana. Her clients are primarily from three groups of people: 1) Amish/Mennonite or other conservative religious groups who don't use hospitals; 2) People who are too poor to afford to have babies in hospitals; 3) People who philosophically support home/natural birth. Up until last year, Williams had never lost a child in childbirth. Williams is not certified through the state, but she is a certified professional midwife; her certification comes through the North American Registry of Midwives. Certification requires extensive training and experience in out-of-hospital settings.

However, last June a baby did die. The couple in the case had tried unsuccessfully to have children and finally decided to go the natural route. Things went well up until the birth, then the baby started having problems. Emergency medical personnel were called and the child was taken to the hospital, where he or she (can't remember the gender) was declared dead. An investigation ensued, and the prosecutor in the county in which the birth happened filed charges against Williams for practicing medicine without a license, interpreting the law as reading that anyone who works as a midwife must be licensed under the state. Williams accepted a plea agreement in the case, and will not practice as a midwife for at least a year, but she's pursuing an legal action against the attorney general seeking clarification of the existing law. She's also planning to lobby heavily in the next legislative session, also for clarification.

Now, I was discussing this case with a friend, and he made the following comment: "If I were a non-nurse midwife practicing in IN, I'd have the parents sign a document that states that I am not a midwife or any other sort of medical professional, that I am just an guest in their house, and that they are giving me money as a gift."

Now, I don't know whether such a document would actually protect someone from criminal or civil liability in the event something went wrong ... but let's assume for argument's sake that it does. Would it be ethically OK for someone to sign such a document?

[homeschoolmom]

Hmmm... Frankly, think don't think people should have to sign such papers.

If there's an emergency birth and an innocent bystander helps with the delivery is s/he "practicing medicine" without a license? What if that person were a firefighter or police officer?

And yes, a midwife makes a living delivering babies but is delivering a baby really "medicine" in most cases?

(and for the record, my babies were all delivered in a hospital by a doctor )

[Sojourner]

[quote name='homeschoolmom' post='1006345' date='Jun 15 2006, 02:19 PM']
Hmmm... Frankly, think don't think people should have to sign such papers.

If there's an emergency birth and an innocent bystander helps with the delivery is s/he "practicing medicine" without a license? What if that person were a firefighter or police officer?

And yes, a midwife makes a living delivering babies but is delivering a baby really "medicine" in most cases?

(and for the record, my babies were all delivered in a hospital by a doctor )
[/quote]
I agree on the not being "medicine" in most cases.

And in the interest of full disclosure I wouldn't go to a midwife, at least not for a first child. Loooong history of problem births in my family. But I'm philosophically supportive of the idea, and have dear friends who HAVE used the services of a midwife.

[Laudate_Dominum]

I know a family with 11 children, all of which were delivered by the father. I suppose he's been "practicing medicine" illegally. *rolls eyes*

And if child birth is a medical procedure that requires licensure then I suppose the real person giving birth, namely the mother, ought to be a licensed specialist.

A woman has a right to deliver her baby any way that she sees fit. It's her body. Isn't that what this country is supposed to be about? Stay out of our bedrooms and keep your laws off our bodies? *rolls eyes again*

[homeschoolmom]

Good point.

[Sojourner]

Most women would be fine (albeit less comfortable) giving birth at home, and some research shows that home births (or at least birthing naturally sans medical intervention) is better in many cases for mom and baby (this according to my friend who's done it).

The ones advocating for licensure are doctors, who (and let's all admit this up front) may not be totally altruistic in their desire for people to give birth in hospitals for safety purposes -- that is, after all, how obgyns generate paychecks. But I personally am grateful for the doctors and hospitals who saved my mother from dying in childbirth with me, and my grandmother from dying in childbirth with my aunt.

[Birgitta Noel]

[quote name='Laudate_Dominum' post='1006373' date='Jun 15 2006, 01:52 PM']
A woman has a right to deliver her baby any way that she sees fit. It's her body. Isn't that what this country is supposed to be about? Stay out of our bedrooms and keep your laws off our bodies? *rolls eyes again*
[/quote]


You'd think. But in many (and I mean MANY) hopitals if a woman has had a C-Section she is not allowed, yes you read that right NOT ALLOWED , to give birth vaginally in subsequent pregnancies. Hospitals cite liability and risk. The medical literature is unsupportive at best and inconclusive at worst.

I've done the research, am speaking on it in Oct in fact, and there are a number of reasons why this is unethical, etc.

The point is this, childbirth has become highly medicalized. Women often loose a lot of control in the process. Much of hospital birth is geared towards the convenience of the physician, or to minimize lawsuits, not toward the woman giving birth.

[Lil Red]

[quote name='Birgitta Noel' post='1006403' date='Jun 15 2006, 02:36 PM']The point is this, childbirth has become highly medicalized. Women often loose a lot of control in the process. Much of hospital birth is geared towards the convenience of the physician, or to minimize lawsuits, not toward the woman giving birth. [/quote]and that's why i probably will not be having my babies in a hospital. my aunt had her babies by midwife, and i will probably do the same.

[IcePrincessKRS]

There was a similar sort of case in OH a couple years ago. The midwife in question was an older Amish woman (like this woman she'd delivered well over 1,000 babies). She was arrested after administering Pitocin to a hemmoraging woman, when the bleeding didn't subside they took her to the hospital. Granted it actually WAS illegal for the midwife to give that medication, but if she hadn't the woman surely would have died.

My 2 girls were delivered by midwives in a birthing center--the comforts of home with some of the ameneties of a hospital without all the garbage that can be involved with a hospital birth (they even made us breakfast afterwards!). For that reason alone I am a bit sorry for leaving the Pittsburgh area, I think that the facilities like I had with my girls are few and far between. I wish they were more popular, I had the best possible birth experiences I could have hoped for. I think midwives/homebirths get an unfair bad rap because its not the norm. Frankly the idea of a homebirth still scares the snot out of me, but thats a personal preference, not an "ew, weird" factor. I'm just a wuss.

[Sojourner]

The woman's attorney told me that between 5,000 and 10,000 home births occur in Indiana each year. I was a bit surprised by the number. I only know a couple poeple who've done it ... oddly, both live within a block of me.

[Socrates]

This is just yet another example of our disgustingly litiginous society.

[Sojourner]

What the heck are you talking about?

I mean, I understand "disgustingly litiginous society," but I don't at all see how this is an example of that.

[Socrates]

[quote name='Sojourner' post='1006537' date='Jun 15 2006, 06:31 PM']
What the heck are you talking about?

I mean, I understand "disgustingly litiginous society," but I don't at all see how this is an example of that.
[/quote]
The original lawsuit against the midwife . . . ok I see that is not really the point of this thread - my bad. Ignore my last post.

[missionseeker]

In Alabama it's fine to practice as D.E.M. (direct entry midwife) if you have a lisence from the state and an accredited midwifery school. But the state won't issue licences.
So if a D.E.M. is at your birth and something goes wrong, they go to jail no matter what.

My mother had my littlest bro at home and was fine. Most home births are. My mother knows more about where to find stats and stuff than i do. (She was once studying to become a D.E.M. and most OB's are her pet peeve)

I want to know what the state has to loose by issuing lisences. If anything it would generate income because they could sharge money for it. And for renewal. They loose money from it if they have to prosecute someone for not having a lisence.

[MichaelF]

A primary reason for the confinement of most births to hospital/clinical environments is that, if something goes wrong during Delivery (as opposed to Labor), you have a surgical team on site.

A pregnancy can be A-OK for 9 months, then bolo up in 5 minutes during the delivery process. At that point, surgical intervention is the only shot for the mother and child.

If the delivery is nominal, pretty much anyone can assist in delivery, and a Midwife is more than enough. If any of twelve or so scenarios go wrong, all a Midwife can do is watch both patients die. There is no way to tell if a standard pregnancy will end in a standard delivery.

It's not what some wish to hear, but hospital ("team-based") medicine with surgical backup is what is responsible for the dramatic drop in death-by-childbirth in the early part of the 20th Century.