State questions legality of midwifery

Stacey Decker, a mother of two, stayed home for her children's births. A midwife delivered her kids, Keegan, 5, and Cora, 10 months, at her Bloomington home.\n"I felt comfortable and safe at home in my own space," Decker said. "(Our midwife) was able to do everything she needed to do."\nBut the midwife who assisted Decker, Mary Helen Ayres, committed a felony punishable by law. Ayres was practicing medicine and midwifery without a license. In Indiana, only doctors and nurses can deliver babies.\nPhysicians, legislators and prosecutors in Indiana and nine other states prohibiting the practice of midwifery say that women who choose to have home births attended by midwives are placing themselves in grave and unacceptable medical danger.\nMidwives disagree. Birth is a natural process and the body is programmed to deliver a child without medical intervention, midwives say. Midwifery, they say, is an age-old tradition that is under attack by a male-dominated medical establishment.\nThese debates about the legitimacy of midwifery were prompted by the death of Oliver Meredith, a baby delivered by midwife Jennifer Williams in June. Prosecution against her is pending in Shelbyville, Ind. The charges held against Williams are practicing midwifery and medicine without a license.\nSitting in a small, wooden office lined with pictures of newborns and her family, Georg'ann Cattelona, executive director of Bloomington Area Birth Services, explained, "Midwives run the risk of being arrested at every birth attended."\nIndiana law does not prohibit home births. But the law is ambiguous, Cattelona said, because it leaves no provision for non-nurse midwives. Certified nurse midwives are the only level of midwifery recognized by the state. But most nurse midwives only practice in hospitals or birthing centers. It is hard for nurse midwives to practice outside of a medical setting, Cattelona explained, because they are required by Indiana law to have a physician attendant at all times.\nCattelona, a birth dula who has worked closely with midwives, said she feels that midwives do not have to become nurses to be competent. \n"We focus on birthing," she said. "Learning geriatrics is just not beneficial or needed to perform a birth." \nMidwives are very focused on all birthing needs. At Bloomington Area Birth Services, mothers-to-be are offered childbirth education classes, breast feeding support, and prenatal yoga. The average prenatal consultation lasts anywhere from 30 minutes to two hours, as opposed to the standard five minutes at a doctor's office.\nAnd midwives are more personal, Cattelona said. \n"We are able to provide all the necessary care, like screening the mother-to-be for symptoms, checking the fetus and other prenatal testing during each visit, but we get to see our patients at home, in their space," she said.\nHospitals, Cattelona said, are trusted because the state put them in place. The state says hospitals are safe for births, so people trust those in the hospital to know what they are doing. Midwives, she said, deserve that same sort of trust.\n"We are very professional," she said. "We carry oxygen, know how to take care of bleeding and monitor heart rate. We know what we are doing. We want to be treated like professionals."\nLiz McDaniel said she was impressed with the level of professionalism shown by the midwife who attended the birth of her child. When deciding where to have her daughter Katherine, McDaniel interviewed both doctors and midwives. McDaniel chose a midwife birth because she said she liked that midwives treated birth as a normal, healthy process.\n"Doctors treated birth almost like it was a disease," McDaniel said. "But midwives gave a different message. They saw birth as something that was supposed to happen. They made you trust your body to do what it is supposed to do."\nMcDaniel's birthing experience touched her so much that she changed careers. After 16 years as a medical engineer, McDaniel returned to school to become a midwife. She has been practicing for four and a half years.\nDavid Pace, a history professor at IU, was also touched by the birth of his son Griffin. Like McDaniel's daughter, a midwife delivered Griffin.\nSitting in his eighth floor office filled with books and boxes stashed with papers and pamphlets, Pace admitted that he was somewhat skeptical about his wife having a midwife birth. His daughter Kate, from his first marriage, was born in a hospital. But once he looked into midwifery, he said he was impressed by the people he met. They were very professional and knew what they were doing, he said.\nThe switch from hospital to home came with a lot of changes. Home births, he said, have more social and cultural meanings. It was, for him, very special to have Griffin at home, as opposed to a place associated with death. The doctor, he said, was good, but it was not the same experience.\n"Midwives treated the birth as a life event, and that really does make a difference," Pace said.\nAnother difference is the price. A home birth costs about $1,500. A hospital birth averages about $20,000.\n"When you walk in the door of a hospital, there is so much overhead," Pace said. "It costs a lot more to pay for that."\nBut opponents of the legalization of midwifery would argue those costs are important.\nState Rep. Patricia Miller, R-Indianapolis, who is one of the more vocal opponents of midwifery legalization, thinks that hospital costs are necessary. \n"The emergency equipment is just different at the home and at the hospital," she said.\nBut midwives argue that the emergency equipment in hospitals is often unnecessary. Most births are low-risk. The equipment Miller referred to is used in hospitals for high-risk births where complications are likely to occur. And in those cases, midwives urge women to have a hospital birth, Cattelona said.\nBut emergency equipment alone is not the only reason Miller and others are against legalizing midwifery. \n"I think the education level and training are different," Miller said.\nAround the nation, there are about 3,000 midwives without formal medical training, according to the Midwives Alliance of North America. But about 1,100 of these midwives have been certified by the North American Registry of Midwives, an international certification agency whose mission is to establish and administer certification for the professional midwife. To achieve this certification, midwives must pass specialized, competency-based education programs, risk assessment training and pass a written exam and hands-on skills evaluation.\nIndiana midwives without this formal medical training might soon have to seek out certification from the North American Registry of Midwives. Rep. Peggy Welch, D-Bloomington, has sponsored House Bill 1237, legislation that would recognize and regulate midwives through a set of qualifications set by Indiana. For the estimated 1,000 Indiana women who have their children at home each year, these qualifications would legalize only certified professional midwives to assist home births.\nThirty-four other states have passed bills similar to this one. Indiana might be next.\nCattelona is optimistic the bill will succeed in the Senate. \n"I think there is a good chance it will pass sometime next year," Cattelona said. "It is going into summer study committee to investigate the issue more thoroughly. This is a good sign"