http://www.nytimes.com/2006/04/03/us/03midwife.html?pagewanted=1&ei=5070...

Prosecution of Midwife Casts Light on Home Births
By ADAM LIPTAK
Published: April 3, 2006

BLOOMINGTON, Ind., March 29 — 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.
Chloe Hendrix-Petry's birth has not given rise to criminal charges, but a prosecution against another midwife, Jennifer Williams, is pending in Shelbyville, Ind. It was prompted by the death of a baby named Oliver Meredith that Ms. Williams delivered in June. But she is not charged with causing or contributing to Oliver's death.
Instead, to hear the county prosecutor tell it, the case against Ms. Williams is not unlike one against a trucker caught driving without a license.
"He may be doing an awfully fine job of driving his truck," the prosecutor, R. Kent Apsley, a trim, intense and direct man, said in his office in the basement of the Shelby County courthouse. "But the state requires him to go through training, have his license and be subject to review."
Legal experts said prosecutions of midwives were rare but not unheard of, and Mr. Apsley suggested that he might have looked the other way but for Oliver's death. "There isn't anyone I'm aware of going out and doing surveillance of midwives," he said.
Stacey A. Tovino, who teaches at the Health Law and Policy Institute at the University of Houston Law Center and has written on midwifery and the law, said prosecutions of midwives almost always started with a tragedy.
"No one complains until a baby dies or a mom dies," Professor Tovino said. But once the issue arises, she said, legislatures often become involved as well, with doctors and midwives engaging in a bitter struggle over the proper regulation of midwives, one driven by a mix of motives that are difficult to disentangle.
"There has always been a tension between true quality-of-care concerns and anticompetitive concerns," Professor Tovino said.
Around the nation, there are some 3,000 midwives without formal medical training, according to the Midwives Alliance of North America. About 1,100 of them, including Ms. Williams, have been certified by the North American Registry of Midwives, a private agency whose evaluations are recognized in some 20 states. In Indiana, though, only doctors and nurses may deliver babies.
That is a misguided approach, said Ms. Ayres, who helped deliver Chloe Hendrix-Petry and who is the president of the Indiana Midwives Association.
"Midwifery is an autonomous profession," Ms. Ayres said. "It's an art and a science that predates the medical model of care. Midwifery sees birth as normal and basically safe.
"It's made safer by reliance on the woman's power," she continued. "The medical model assumes the woman is passive and her body needs to be acted upon. Every birth is presented as a potential disaster from which every woman needs to be protected and potentially rescued."
Mr. Apsley said his decision to prosecute Ms. Williams was driven solely by the law as it currently stood. "We can all have different opinions about the speed limit or the age of consent or whether drugs should be legalized," he said. "Those decisions are for the legislature."
He added that the evidence against Ms. Williams was strong.
According to an affidavit filed by Rick Isgrigg, an investigator with the Shelby County Sheriff's Department, Ms. Williams conducted a dozen prenatal examinations on Oliver's mother, Kristi Jo Meredith; monitored the fetal heart rate during labor; made a surgical incision known as an episiotomy when she detected fetal distress; performed frantic CPR on the baby when he emerged; and sutured the incision afterward. Ms. Williams charged the Merediths $1,550.
Sipping bottled water at a cafe in Bloomington, Ms. Williams, 54, was as soft-spoken and halting as Mr. Apsley was forceful and precise. She would not talk about the details of her case, citing her lawyer's advice. Her trial is scheduled for July.
She did say that she missed her practice terribly.
"You get to be there when her baby is born," Ms. Williams said. "It never loses its magic or miraculous quality."
Oliver Meredith's parents have showed little enthusiasm for the prosecution, people on both sides of the case said. "It's not like they're knocking down our doors to pursue the matter," Mr. Apsley acknowledged. "They just want to get on with their lives." Efforts to reach the Merediths by telephone and e-mail were unsuccessful.
Some 99 percent of all births take place in hospitals, and nurse-midwives participate in about 8 percent of them, according to the National Center for Health Statistics. Two-thirds of the remaining births are in homes, and the last third in freestanding birthing centers. Reliable data for how many births outside of hospitals were attended by midwives with and without formal medical training were not available.
Women choosing to give birth at home are taking a big risk, said Dr. Kevin R. Burke, president of the Indiana State Medical Association.
"Because routine things sometimes become very un-routine, the best environment for labor and delivery is in a hospital or in a facility that adjoins the hospital," Dr. Burke said. If some women say that medical settings can be sterile and demeaning, he added, "well, then, let's make the hospital a more friendly, user-comfortable environment."
Ms. Williams scoffed at that.
"They hide the IV pole behind a fern," she said. "There are women who don't want a nice hospital. They want to have their baby at home."
Peggy Welch, a Democratic state representative in Bloomington, has introduced legislation in Indiana to recognize and regulate lay midwives. She said the issue boiled down to choice and safety.
"It is not illegal to have a home birth," Ms. Welch said, noting that about 1,000 Indiana families had their children at home each year. "But doctors and nurses are choosing not to do home births."
The current law, Ms. Welch said, drives midwives underground. "I don't want to have a midwife hesitate to take a woman to the hospital because she is afraid she will be arrested," she said.
Ms. Hendrix-Petry gave birth to three children before Chloe. Her oldest son was born in a hospital, where she said she received "adequate care." But, she added, "I felt like I wasn't getting the answers I needed from my high-tech doctors."
Her experience with Ms. Ayres was different, Ms. Hendrix-Petry said. "The care I have received from her felt so genuine," Ms. Hendrix-Petry said. "It was healing and miraculous."
Professor Tovino, who has studied the question for years, said she remained on the fence.
"Midwives have a terrific service to provide, and our hospitals can be overmedicalized," Professor Tovino said. "But I hope people are making informed decisions."