Birth of a movement
Last month, a seven-judge appellate panel in Pennsylvania ruled that delivering babies is not the practice of medicine. It's always comforting when the law catches up to history; midwifery is, after all, the second-oldest profession.
A Pennsylvania midwife named Diane Goslin, who had delivered thousands of healthy babies for the Amish community, was convicted of violating the state's restrictions as to who can assist a woman in childbirth. The court found that in fact Goslin had not engaged in the practice of medicine, and reversed the state Board of Medicine's cease-and-desist order against her.
Goslin's plight is reminiscent of the courageous Vermont midwife, Carol Gibson-Warnock, who risked imprisonment to defend the maternity rights of women in this state. In 1980 a woman gave birth at home in Whiting with only her husband in attendance. Both mother and baby did well; however, the mother had trouble delivering the placenta. Her husband called Ms. Gibson-Warnock, who administered prescription medication to alleviate bleeding, called for an ambulance and accompanied the mother to Porter Hospital. Upon arrival, the admitting ob-gyn deftly separated mother and midwife, escorting the mother into an examining room and instructing the midwife to wait in the lobby. The mother returned home later that evening with a healthy baby. The doctor was later to testify that he "was seeing a number of home birth people" at the time and that he "disapproved of all of them."
Ms. Gibson-Warnock admitted all of the factual allegations against her in her criminal trial for practicing medicine without a license. The jury acquitted on all counts.
What's happening? Why are midwives prosecuted even with successful outcomes while maternal and perinatal mortality/mobidity rates go largely unreported and unremarked? According to leading scholar Robbie Davis-Floyd in her book "Mainstreaming Midwives," "A further barrier to midwifery care has to do with the negative publicity that occurs almost every time there is a bad outcome at a home birth. Deaths in the hospital of baby or mother are rarely publicized because the hospital constitutes the cultural standard for safety, and physicians tend to protect their own from public view. Thus a death at home rings loud cultural bells, sounding the culturally ingrained message that home birth is an irresponsible choice for mothers, and that home birth midwives must be far less competent than hospital-based practitioners."
Vermont's double standard in assessing midwifery care vs. physician-provided care has come to the attention of Citizens for Midwifery, a national nonprofit membership organization of consumers interested in broadening the spectrum of professional and safe maternity care and birthing options available to women in this country, including access to midwifery care in out-of-hospital settings. CFM has commented on the "nationwide effort to roll back recent advances of midwifery in favor of restrictive, more costly and, frequently, less safe physician-dominated in-hospital birthing. Of particular importance is that this agenda appears to be carried out through discriminatory and selective law enforcement against midwives as opposed to physicians."
The Goslin court also faulted the Board of Medicine for its unconstitutional attack on the midwife in Pennsylvania, noting that Ms. Goslin had not been permitted to "know against what charges she must defend herself."
I know how she feels. The Vermont Office of Professional regulation revoked my midwifery license in 2004. A major justification for this action was my supposed "inclination to avoid the physician community" — an accusation for which I was never charged. Only in the order of revocation did I learn the sin for which I was to be punished. The ironic twist to this finding is that I moved to Vermont with the specific intention to introduce a midwifery bill that would not only make midwives more accountable, but also one that might foster collaborative relationships with the physician community. That endeavor was successful, and in 2001 Vermont licensed midwives whose primary place of practice was in the home setting.
The backlash from passage of the bill was brutal. Much to my dismay and before any "unfavorable" outcome, my clients were being told by at least one Rutland obstetrician, "If you are going to that midwife, you may not return to my office, even for a gynecological emergency."
While the particulars of this case are still to be determined by the Second Circuit Court of Appeals, other interesting aspects have emerged. First, the person appointed to hear the case was a hearing officer who was totally unfamiliar with the profession of midwifery. The Vermont Supreme Court affirmed that this person should not be accorded deference because of his lack of expertise and then ironically, although lacking the same expertise as the hearing officer, thought that they themselves should be accorded deference in deciding my case. Nowhere in this process was there any one individual who possessed the expertise to listen to the state's experts or mine. This is virtually unprecedented in that cases involving professionals normally are reviewed by boards made up of people practicing that same profession.
Second, the secretary of state boldly announced that I was responsible for the death of one baby and the "brain death" of another. In the end, the state backed away from those allegations (the baby who the state contended was "brain dead" has no health problems — oops) and instead applied the same punishment for far less serious violations. Although the death of the baby occurred in the hospital, no investigation into the physician community ensued.
Finally, the Rutland Herald has never fully described the nature of the lawsuit I have brought against either Secretary of State Deborah Markowitz or Dr. Patrick Keenan. The underlying premise of the lawsuit against them alleges that their joint actions violated my fundamental rights. The suit alleges that Keenan, a Rutland area obstetrician, essentially used the state in furtherance of the interests of the physician community by intentionally instigating the filing of a materially false and deceptive report. His motive: to eliminate his competition — competition which he was vehemently opposed to during the legislative process when midwives were trying to gain licensure.
While this struggle has been injurious to me both in New York and now in Vermont, the issues associated with women's fundamental rights are at once emerging and manifest. As prompted by my case, my attorney (and friend) Lisa Chalidze was so incensed by the issues that she attended Skidmore College and completed a master's degree which culminated in a thesis entitled, "Misinformed Consent: Non-Medical Basis for American Recommendations as a Human Rights Issue." In essence what has played out in Vermont are not the actions of an incompetent midwife, but in part how a movement emerges. What has also played out in midwifery cases mentioned is not unlike what has happened in many other professions attempting to legitimize themselves.
After enough personal injustices, a movement builds and ideas are born. In the case of chiropractors, for example, a successful restraint of trade suit finally stopped the American Medical Association from initiating the arrests and harassment of chiropractors and ultimately paved the way for the profession's existence. In the case of midwifery, I have seen the evolution of the acts of those midwives who practiced "underground" finally supported by multitudes of editorials by well-respected journalists. In Vermont, a bright, articulate and passionate lawyer writes a brilliant thesis, offers it for publication and develops it into curriculum which she is currently teaching at a local college, and I continue to stand for the truth of what I know happened to my practice through the Second Circuit Court of Appeals. I am just one of the casualties along the way — a small price to pay for the right to inform birthing women of what is really happening in maternity care; to inform them that Caesarean section rates are three times higher than the World Health Organization has told obstetricians they should be and that these unnecessary Caesarean sections account for nearly all of the increase in prematurity (there has been a 92 percent increase in premature births or one in eight); that the infant mortality rates in the United states remain higher than that of many developed nations; and that all well-done research shows that low-risk women have better outcomes in out-of-hospital settings.
Roberta Devers-Scott is a midwife and psychologist living in Castleton.