Midwives: From L.A. to Santa Fe
The legal state of midwifery (Chronicle reprint from 1993)
On January 4, 1991, with guns drawn, a cadre of police swept into the Gentle Birth Center in Glendale, California, and began confiscating computers, books, records and the personal belongings of the women operating the clinic. Backed up by members of the California Board of Registered Nurses and the California Medical Board, the police handcuffed, fingerprinted, and detained the women at the clinic for 14 hours. Today, the Los Angeles County Attorney is pressing charges against three midwives and two co-workers from the clinic who are awaiting trial on felony counts of practicing medicine without a license and conspiracy to set up a birthing group. If convicted they could serve up two years in jail. In the meantime, the authorities have refused to return their possessions.
Tonya Brooks, a midwife for 21 years and a founder of the clinic, is one of the women facing jail time. Still awaiting the return of old love letters from her husband that were confiscated by the police, she calls the raid "harassment" and says that the issue is "nothing but an absolutely filthy battle for the bucks."
As a midwife and head of the Association for Childbirth at Home International, Brooks operates her birthing center in a legal gray area. California doesn't have laws against midwifery, nor does it have laws that make it legal. Able to deliver babies for a fraction of the cost of doctors and hospitals in the Los Angeles area, Brooks has delivered 3,600 babies in her career. Her clients at the Gentle Birth Center range from indigent women to millionaires. And although she works with several doctors at the birthing center, she believes the California medical community is trying to stop her because she offers a low-cost alternative to hospital birth. The battle, she believes, is "high touch versus high tech."
Meanwhile, in New Mexico, midwifery is flourishing. In Taos, non-nurse midwives provide care to indigent women and are reimbursed for their services by Medicaid. The only state in the union that will pay for complete care of pregnant women by non-nurse midwives, New Mexico pays for midwife attended births at home or in a birthing center. Legal since the 1800s, midwives fought to gain clout throughout the Seventies and Eighties and now non-nurse midwives in the state can deliver even certain high risk babies in the hospital under the supervision of a doctor. CNMs also practice in the state, but midwives do not have to be nurses to get licensed. (Texas midwives want similar status.)
Rebecca Watson manages maternal health programs for the New Mexico Department of Health. When asked if the increased status of non-nurse midwives has been good for the state she responded, "Yes. Absolutely." Watson points out that non-nurse midwives have an infant mortality rate less than half that of the state at large, and she believes other states should allow non-nurse midwives more latitude "if they have very good educational standards and requirements for non-nurse midwives."
Elizabeth Gilmore, founder of the Northern New Mexico Midwifery Center in Taos, has been a midwife for 23 years and is a longtime activist for midwives in New Mexico. Three-fourths of her clients are on Medicaid. She says that midwives were able to show through a pilot project that licensed midwifery would continue to be an important part of providing prenatal care to the rural women of New Mexico. Then she says, the state health department "recognized that midwives should be trained by the department of health so that rural women would have access to prenatal care."
Gilmore says she has worked with doctors who were very cooperative and helpful. But she says that care for pregnant women "takes a back seat to the money. The most important issue is money and turf: who takes care of these women and who gets the money for it. The medical community is very committed to see that non-nurse midwifery fails."