The arrest, prosecution and conviction of Roberta Scott Devers for the practice of midwifery is a crime against mothers and midwives perpetrated in the name of the citizens of New York. Roberta is no more guilty of criminal activity than was Rosa Parks when she sat in a "Whites Only" seat on the bus that infamous day in Montgomery Alabama in 1964. As a mother and a midwife, Roberta had no more chance of being treated fairly by the medical establishment than black Americans living in the South prior to 1960s.
Roberta’s practice of midwifery was a brave act of civil disobedience, characterized by personal honor and courage. The legal reasons behind this act of civil disobedience are legion. As early as the 1600s, an all-male medical fraternity on the European continent began to suppress independent midwifery. Roberta’s situation is just the most recent in a long line of injustices. Her case brings to light the upsetting story of a campaign by medical politicians in the United States to eliminate what medical politicians refered to as "the Midwife Problem" by eliminating the independent practice of midwives.
The strategy to abolish the profession of midwifery (as practiced by midwives but not as practiced by physicians) was a multi-faceted, intergenerational campaign. It included a three-pronged legal, legislative and public education approach, described as “elevating the public conscience”. This propaganda campaign misrepresented the dangers of childbirth and inflated the abilities of medical care to eliminate them, while denigrating midwives and denying the economic agenda of organized medicine.
Gender-Sensitive Civil Death
Unknown to her, Roberta lost her gender-related civil liberties long before she was born. Without her permission or participation, she was sentenced to a gender-sensitive form of civil death merely for being a childbearing women, for once she has chosen not to terminate a pregnancy, she looses the right to choose the persons, place and circumstances of her childbearing. As a midwife she has also lost the right to be professionally educated in direct-entry midwifery and to provide normal maternity care as an independent practitioner. All childbearing women and unborn children in the US suffer directly and indirectly from the loss of these most elemental of human rights.
The purposeful destruction of the midwifery model of care by medical politicians over the last 100 years has cost women and families an "excess mortality" which exceeds the fatalities in all the wars ever fought by the US. In 1932, a well-known physician-statistician fixed the "unnecessary mortality" rate at 70,000 unnecessary deaths of mothers and babies PER YEAR, attributable solely to the absence of a midwifery-based maternity care system in the US. [1937-A] While maternal-infant mortality is no longer at this staggering rates -- thanks mainly to improved standard of living combined with public health and sanitation measures -- the US continues to hold its historic position of having the worst infant mortality (third from the bottom) out of the 25 "First World" countries.
Families in the United States continue to suffer higher surgical and medical intervention rates, maternal and infant mortality and morbidity, unnecessary medical expenses and lower breastfeeding rates than those countries which utilize a midwifery model of care for healthy mothers, and who reserve obstetrician care for complications and mothers who need or want anesthesia.
Ironically, US courts cite the Roe vs. Wade Supreme Court abortion decision as supporting this breach of safety and privacy rights. According to the Bowland Decision (California, 1976), much quoted by courts all over the US, once a pregnancy reaches the stage of viability, the state assumes the role of in loco parentis. This theory defines the state’s “interest” in the viable fetus as superseding that of the mother's. The Bowland Decision uses the idea of “protecting the fetus”, as cited by the Roe v. Wade abortion decision, to extend the state's "authority" to prohibit all pregnancy and birth-related care except as provided by state-licensed physicians or their designates and therefore to criminalize non-nurse midwifery. Without any factual basis, the Bowland Court assumed by that physicians are more knowledgeable, skilled and protective of the unborn baby's welfare than it's mother or her chosen midwife and that hospital-based care is "obviously" safer than home-based care.
Not only do these conclusions lack any scientific foundation but the reverse is true statistically -- low and moderate-risk women consistently do better when cared by midwives in domiciliary and/or low-tech settings. This is not because midwives are "better" than doctors but because midwives do different "things" in the course of normal "management" -- a word that itself means "handling". Midwives typically "handle" labor with a low-tech/high sociology or "hands-on" approach and lots of one-on-one time. Luckily for the mothers they serve, that management style is what most laboring mothers need to help them handle their own labor so that it progress spontaneously without the need for drugs or surgery. Unluckily for physicians, the "standard" protocols of high-tech obstetrical management miss the mark for many mothers and in some instances, actually impedes their progress, leading to a "cascade" of interventions which have associated complications.
Medicine is Defined by Law,
Midwifery is
Defined by Biology
The foundamental legal issue is that medicine is defined by law and law is defined by men and their institutions. The discipline of Medicine has only existed as an "applied science" since the 17th century. In contrast, midwifery is not primarily a legal entity but rather is an organic function defined by biological imperatives and the social customs required to meet the needs of women giving birth. In the early decades of this century, the medical fraternity usurped the power of law to unethically define the independent practice of midwifery as an illegal or unauthorized practice of medicine.
In the big picture, the recurring theme is political power, voting rights and women's historical lack of both. The unconstitutional War on Women had already been lost by the time women had won the constitutional right to vote. Legally and legislatively speaking, the infrastructure of "modern" medicine was laid down in the late 19th and early 20th century and has remained untouched and untouchable ever since. These 19th century attitudes and policies have created a sovereign classification for physicians and a subordinate, substandard classification for midwives. This tactic has already been dragged along intact throughout the entire 20th century. If we don’t respond effectively, subordination and criminalization will remain the foundation for the 21st century midwifery. Midwives have always faced legislation and regulation without representation. Unrepresentational legislation merely replaces the crime of unlicensed midwifery with even more sophisticated and insurmountable barriers to practice under licensure!
The Hundred Years War Against Midwives
The Hundred Years War Against Midwives started in earnest in the late 1800s. By 1910, a well-financed, organized and aggressive campaign -- fueled by the criticism of medical education contained in the Flexner Report -- was well under way. The battle plan was devised by medical schools administrators and professors of obstetrics who hoped to completely vanquish their prime competitors, the independent midwife.
This war was waged in the legislature at a time when women did not have the right to vote. It was waged in the courts at a time when the testimony of doctors was unquestioned and unburden by the necessity to prove any factual basis. It was waged in the public press with a viscous propaganda campaign disguised as a noble attempt to “raise the public consciousness”. This counterfeit excuse for public education completely ignored two crucial facts. First, childbearing itself in healthy women is not fundamentally dangerous. It was poverty, overwork and forced childbearing that were the genuine problems facing mothers and babies of the era, which contibuted to an alarming rate of death and disability. Secondly, they failed to mention the serious harm -- including the death of both mother and baby -- which could and did result from the routine use of medical and surgical interventions. Most unfortunate of all, those harmful interventions did not address the underlying health problems of poverty and overwork.
Strategies of Choice in the Suppression of Midwives
The strategy of first choice in this campaign was making the practice of midwives illegal through legislation. An example of this kind of law was one in New York that read “...no person other than a duly licensed registered physician shall practice midwifery or be registered as a midwife until she shall has received a license to practice midwifery from the State Commissioner of Health.” (New York) Note that physicians were authorized to practice midwifery where as midwives were not. In modern day financial terms, this would be described as a leveraged buy-out.
Many medical politicians reported that it was hard to get a judge and jury to take the “unlicensed” practice of midwifery as a sufficiently serious offense, so that charging midwives with the “illegal practice of medicine (instead of the unlicensed practice of midwifery) was more successful at getting convictions.
In Massachusetts, the medical establishment used circuitous and illlogical reasoning to achieve this dubious goal without publicly revealing their hidden agenda or having to fight for the passage of controversial legislation. It was a political strategy called "saying it makes it so". “In 1894, in the laws passed for the registration of physicians, there is no mention made of the midwife. Whether intentionally or not, she was thus excluded from the legal practice of her profession”. Emmons et al, p.259 The author uses the absence of the term “midwife” in a law related to the registration of physicians as proof that the midwife is “excluded from the legal practice of her profession".
Another important tool in the suppression of independent midwives was a policy of preventing the establishment of midwifery training programs and the licensing or certification of midwives. This was to keep midwives from acquiring the legal protection of an independent profession. Many “medical men” of the day complained that licensure “would give the midwife to much dignity and importance” (Mallott1907). In areas where midwives were already trained and licensed, the tactic was to suppress them by ever-escalating, educational requirements and ever-tightening regulatory controls.
"First, Catch your Rabbit"
A remark by J. Milton Mabbott, MD in his paper entitled “The Regulation of Midwives in New York” (American Journal of Obstetrics, 1907, p. 523) describes using the law as a trap to get rid of the unwary midwife. Dr. Mabbott says “ ...the best argument for a state law, namely, because a midwife once convicted of a crime would afterwards be disqualified to practice by reason of said conviction. First catch your rabbit.” This term borrowed from the vocabulary of hunting, describes a mentality of first trapping a small defenseless animal who means you no harm and then after the helpless “rabbit” is captured in the hunter’s trap, one can easily and leisurely polish “it” off however one pleases. Even worse, the concept revolves around using the Rule of Law to achieve an unethical goal. In modern law, this concept is referred to as “turning the patient’s shield into the physician’s sword”. In this instance, laws that were suppose to protect the midwife were used against her.
Midwifery licensure would also have required physicians to respond to requests from midwives for medical assistance in complicated cases and established legal penalties for those doctors who did not comply. This was one aspect that particularly irked the medical community --- the very idea of “medical men” ( as doctors preferred to be called) being “bossed” around by a midwife at a time when their own wives did not have the authority to demand their co-operation! One must remember the state of gender relationships in the late 1800 and early 1900s which was the social foundation of male sovereignty used to configure an equally sovereign practice of medicine which remains unchallanged and unchanged today.An added complexity in the physician-midwife relationship was the recognition by the medical community that many doctors did not effectively treat a patient referred to them by midwives because it was so easy to explain a bad outcome by simply saying that the midwife “should have called him sooner”. This tactic is still used today in event of a complication to charge midwives with criminal negligence . No matter how soon in the course of events the midwife transfered care, critical doctors frequently say "you should have done it sooner" and this personal opinion of the physicians becomes the basis of legal action against the midwife.
Removing the word "Midwife"
from the
Birth Certificate LawLast but certainly not least in the weapons of the medical establishment was a strategy to remove the word “midwife” from the birth registration statutes. {1911-A, p.261}This meant that only physicians could register the birth. This was very good for the statistics of the medical community, as there was no longer any category of “midwife-attend” birth to contrast unfavorably with physician outcomes. Conveniently, it also gave the medical board “proof”, in the form of a signed birth certificate, to use in disciplinary actions against doctors who "cooperated" with midwives.
This tactic is alive and well in California in 1996, which has a homebirth registration law that does not contain the word "midwife" (despite four categories of legally-authorized midwives practicing in the state) and so all nurse, p.a. and direct-entry midwife-attended births are statistically logged as UNATTENDED home births”. These false statistics are then sent into the federal government's vital statistics data bank. These inacurate statistics, obscure both the number of midwife-attended labors and the safety of home birth by not distinguishing between those mothers who deliver with a skilled person present from those who delivery without a skilled person in attendance.
Free & Low-Cost Substitutes for Midwives
-- A Tool of AbolitionThe successful abolition of midwives also depended on developing free & low cost substitutes for midwives. This was achieved by organizing obstetrical charities, financed largely by the Rockefeller and Carnegie foundations, to provide free antepartal clinics during pregnancy, free hospitalization in charity wards for birth and free obstetrical care by medical students as a part of their formal education. According to the New York Journal of Medicine 1915, p. 300 -- “The development of substitute agencies is the most essential factor in the elimination of the midwife, and the element of competition [free services] will do more to eliminate their practice than anything else.”
Many doctors of the era insisted that this system of free care in exchange for becoming a “teaching case” should be paid for by government out of tax revenues, in recognition of the "great benefit" derived from medical education by the public. By the 1960s this historical marriage of the medically indigent with medical education had been transformed into the federal Medicaid program.
Knowledgeable & Midwife-friendly physicians
Vocal in their support of midwives.The master plan by the medical politicians in the US to abolish midwives was not based on any categorical deficiency of midwives or any new medical “discovery” that made midwifery skills obsolete or substandard. Medical propaganda centered around the false idea that physician-attended deliveries were safer than giving birth with a skilled midwife. This was not true but few among the lay public realized this. While medical politicians promoted massive amounts of misinformation, a small number of midwife-friendly physicians and public health officials who knew first-hand of the excellent success of responsible midwives were vocal in their support of midwives. It is thanks to the honesty of these physicians and their concern for childbearing women and babies that we have the documents and statistical records which exposes the institutionalized prejudice against midwives.
For example, in 1915 Dr. P.W. van Peyma, Buffalo, NY, who reported 40 years of experience working with midwives and was a member of the Board of Examiners in Midwifery for Erie County for 25 years stated that: “The essential difference between a midwife and a physician is that (physicians) are free to hasten delivery by means of forceps, version, etc. This, in my experience, results in more serious consequences than any shortcomings of midwives. ... Time is an element of first importance in labor, and the midwife is more inclined to give this than is the average ... physician. ... The present wave of operative interference is disastrous. ... The situation would not be improved by turning (the clients of midwives) into the hands of such medical men ....”.
Dr. Louis Dublin, President of the American Public Health Association and the Third Vice-president and Statistician of the Metropolitan Life Insurance Company, after analyzing the work of the Frontier Nurses’ midwifery service in rural Kentucky, made the following statement on May 9, 1932:
“ The study shows conclusively that the type of service rendered by the Frontier Nurses safeguards the life of the mother and babe. If such service were available to the women of the country generally, there would be a savings of 10,000 mothers’ lives a year in the US, there would be 30,000 less stillbirths and 30,000 more children alive at the end of the first month of life.”
These statistics identify a total of 70,000 unnecessary deaths year after year that were simply preventable by skilled midwifery care. This means that half of all maternal deaths during the 1920s, 1930s and 1940s and 1/5 of infant death were avoidable. This was reported by a physician of impeccable credentials more than 60 years ago and yet, the contributions of midwives and the midwifery model of care continued to be ignored at best and eliminated where possible. In contemporary terms this prejudicial process is known as a “pre-cognitive commitment” and describes making a commitment to a plan of action prior to having full or accurate information. Modern day obstetrics is still predicated on this erroneous “pre-cognitive commitment” set into place during this time period and remaining unexamined by mainstream medicine today.
German Allopathy -- then as now--
the “Gold Standard” for US Doctors.Unfortunately, this corrective information was ignored by those who were committed to their professional self-interest. The underlying motive was to compete with German medical schools, which included clinical training in obstetrics for their students in the large charity hospital of the European continent and enjoyed a superior reputation as compared to the United States. As Dr. Zeigler put it in 1912: “So much is needed before we can hope to give to the students graduating from our medical schools adequate training in obstetrics and before we can hope to compete with the German medical schools.” [1912-B, p.224]
In fact, European countries generally had midwifery-based models of care and very much better maternal-infant outcomes than the US. The bottom line in the War on Midwives was that medical politicians coveted the “clinical material” (i. e., potential teaching cases) of midwives' clients for the instruction of medical students. Better educated and well-to-do women patients ("paying customers") were not deemed “appropriate” for the training of medical students. However, the “class” of childbearing woman traditionally cared for by midwives, described as “poor, ignorant and foreign-born” was seen as “suitable clinical material” for young medical students. One must never forget that this educational commodity repeatedly referred to as "material" was actually the warm human bodies of poor women with few other options who offered their childbearing processes for instructional purposes in exchange for "free" care.
The campaign to achieve parity with German allopathy also included the idea that routine use of chloroform, episiotomy and forceps were an important “improvement” in maternity care and that it was “unethical” to deny such “advantages” to the women who employed midwives. Many modern-day obstetricians still believe that episiotomy is an advantage denied to women who choose natural birth or a midwife.
Every
birth attended by a midwife seen as
a “waste” of “good clinical material”.
Physicians soon convinced themselves that every birth attended by a midwife was an obvious “waste” of “good clinical material”. This plan sought to kill two birds with one stone. First, it usurped the clients of midwives as teaching cases for medical students, making medical school administrators extremely happy. Second it “elevated” the status of obstetrics by removing “stigma” of being associated with non-medical women practitioners. The common perception was that the practice of midwives, (mere “women”) reflected negatively on physicians and was considered to be bad for physician “morale”. If a mere woman, not formally educated in medicine, could deliver babies, then childbirth as managed by doctors was not a really “respectable” practice of medicine nor worthy of a higher fee than the customary pittance paid to the midwife ($2.50). Getting rid of midwives eliminated free market forces and thus helped to drive up fees for maternity services to $10-15 (an increase of 4 - 6 times).
The clock was ticking for independent midwifery
and the end was just a matter of timeUnfortunately, this ignoble plan increased the risk to childbearing families which were denied access to skilled midwives while being forced to use doctors who were not trained in the art of midwifery and routinely employed medical and surgical intervention to hasten the birth. As the number of practicing midwives declined, there was a significant increase in birth injuries and maternal and perinatal mortality which closely tracked the increasing number of physician-attended births which was always accompanied by an increased number of operative deliveries. It was the “natural” consequence of replacing non-interventive midwifery care with dangerous procedures such as chloroform and operative deliveries.
What defeat looked like up close
Until the end of the 19th century, both midwives and physicians had been equally entitled their occupations, a legal relationship not unlike owning a house. Legal title to a piece of real estate entitles the owner to the right of unlimited access and the right to say if or under what circumstances it is disposed of. This is to contrast ownership with what it means to being a “mere” renter, dependent on a landlord who can changed the rules without notice, raise the rent or evicted a tenant without cause. Without the knowledge or permission of either midwives or the general public, medical politicians began scheming to illegally acquire control of the occupational “property” of midwives. Thus the independent profession of midwifery was usurped by eliminating the midwife from her own profession. Since the early decades of this century, midwives have experienced the same “civil death” (loss of civil rights) as convicted felons and illegal aliens, reduced to the impotent status of “mere tenants”, evicted from a socially valuable vocation at the whim of the medical profession, locked out by nursing-based educational programs.
Those midwives who capitulated to nursing-based midwifery licensure found themselves forced to sign “rental agreements” that stripped them of the basic right to practice independently through unworkable and restrictive physician supervision . A well-known medical politician in 1907 stated that he "favored legislation requiring supervision of the midwife by a physician who should be called in every case of labor and holding the physician responsible for malpractice." The only thing that the mandated supervision of midwives by physicians accomplishes is to re-create the “borrowed servant/Captain of the Ship” -- an obsolete legal theory that describes vicarious liability . In this "legal fiction", the doctor is the Captain of the Ship, held ultimately responsible for everyone and everything and the midwife is the "borrowed servant. Physicians are forced to withhold themselves as “supervisors”as a direct result of the artificially-created liability. This unnatural conflict of interest was configured expressly as a “dis-incentive” to doctors, thus achieving the hidden agenda of organized medicine -- the continued suppression of midwives and eliminating the competition to the hospital industry from home-based maternity care.
Historical Mechanisms of Accountability for Midwives.
vs. contemporary "Physician Supervision"The truth is that doctors don't have SUPER-vision -- not even doctors can see in the dark! The idea that a physicians who is at home asleep in his bed is "supervising" a midwife-attend labor and birth is fallacious. And to hold physicians or (anyone else) as "vicariously liable" for circumstances which they have no input is absurd.
History of Accountability
If historical documents are to be believed, midwives as a class were generally cooperative and even anxious to please public health officials. They took their role seriously and were not adverse to being held accountable for their care. In the early part of this century and in other jurisdictions (Europe) midwifery practice had a variety of accountability measures instituted by state and local governments. These were primarily the registration of midwives with the health department, mandatory registration of births attended by the midwife, midwifery in-service education by the health department, protocols that defined the scope of practice for midwives to be non-surgical assistance at “normal childbirth”, mandates for transferring care to a doctor or hospital if complication became evident, reporting any infections of mother or baby, and all stillbirths or other unusual circumstances. This was a midwife-centered type of supervision/accountability that was usually user-friendly. In our time, most of the attributes of accountability are built in to the licensing laws themselves and into birth registration statutes. For instance, the registration of births attended by midwives makes it easy to monitoring her outcome statistics and to investigate if the information on the registration form indicates that she was operating outside her scope of practice (prematurity for instance).
The concept of supervision, as defined by the authors of the anti-midwife campaign was a mechanism to ensnare the midwife and make her practice either directly impossible or to reduce her autonomy by mandating a dysfunctional relationship of “borrowed servant/Captain of the Ship”. As we know already, the captain of the “ship” got the gold and the servant did the work. In contemporary times, “supervision” has become synonymous with “physician control”, which is identical with suppression of independent midwifery.
There are major problems with this physician-centered, user-unfriendly system. First, midwifery is a independent profession that historically precedes the professions of medicine and nursing. The body of knowledge as preserved by midwives in early midwifery textbooks was the foundation for the original obstetrical textbooks.
Secondly, obstetricians are not trained in the principles, the philosophy or the skills of midwifery. They don’t value midwifery as a model of care nor do they value midwives as persons. They have little to offer in the way of advise to midwives. Doctors don’t study the principle of midwifery as part of their medical school education, don’t learn midwifery skills or participate in home-based maternity care as part of their clinical training, and don’t attend home births after graduation. Since the early 1900s the socializing process of medical schools has exposed doctors to blatantly anti-midwife propaganda and a massive body of misinformation about normal childbirth. This pre-cognitive commitment remains unchallenged to this very day. Contemporary obstetrical textbooks do not even contain the word “midwife” or “midwifery” in their index. Virtually 100% of obstetricians have never attended a home birth, and in fact, the American College of Obstetricians and Gynecologists (ACOG) considers “home birth to be the earliest form of child abuse”.
Physicians lack role-models or leadership from their professional organizations for building a cooperative and egalitarian relationship between themselves and midwives. They consider midwives to be economic competitors and that anything done to limit or eliminate that competition is laudable. Physicians are uniquely unsuited by education, temperament, experience, economic interest and malpractice limitations for the role of “midwife supervisor”. Unlike the common-sense forms of accountability of historical midwifery supervision, the modern version has little to recommend it. Now days many states even preclude the midwife from registering the births she attends so that the natural forms of accountability have been scrubbed from the system and replaced with ones that don’t work for anyone. The purpose is to continue supressing independent midwifery, predicated on the same hidden agenda as the Hundred Years War against women as midwives and mothers.
Physician Supervision --
Newer, Better Ways to Catch a RabbitPhysician supervision as defined by the state regulatory process in New York, California and Illinois does not require the doctor’s physical presence or on-going participation. Again it must be noted that not even doctors have SUPER-vision! The relationship with a supervising doctor is no different than with any other careprovider or specialist that a midwife might consult -- pediatrician, chiropractor, etc. The physician is not directly involved, does not see or provide care to the expectant mother unless a complication is detected by the midwife and it is the midwife who refers the mother to physician care. All primarily decision about involving the physician lie with the family and/or the midwife. The only thing the mandated supervision of midwives by physicians accomplishes is to re-create the “borrowed servant/Captain of the Ship” --- not to get free work out the “servant” -- but to create a vicarious liability that no physician in his or her right mind would enter into voluntarily. This artificial liability was configured by its legal authors expressly to as a “dis-incentive” to doctors and therefore a strategy designed to block home-based, midwife-attended birth services. We should not be surprised to learn that physicians are indeed unwilling to make themselves unnaturally and unnecessarily vulnerable to litigation and thus decline to provide the mandated supervision to midwives.
Contemporary Physician Supervisory Laws Unethical
To appoint someone who is not educated or experienced in midwifery as ultimate authority over a discipline they know little or nothing about and have no sympathy for, makes no more sense than mandating physician supervision for dentists, acupuncturists or chiropractors. Physicians in general, and obstetricians in particular, are quite clearly economic competitors. Granting live or die authority over the professional lives of midwives by a competing profession is as wacky as appointing the board of directors of Bloomingdale’s to “supervise” the day-to-day operation of Macy’s Department stores. It is also the substance of unfair business practices imposed by the forces of organized medicine.
Obstetrics and obstetrical nursing are as different in origin, education and practice from independent midwifery as Judaism and Catholicism are from one another or Republicans and Democrats. And like religion and politics, it carries with it many of the same deep-seeded and irrational prejudices. Catholic bishops are not mandated by the state legislatures to run Hebrew synagogues, nor vice versa. For the same reasons, mandated physician supervision is an illogical violation of fair business practices which creates a repugnant and insurmountable barrier to practice disguised as a “pubic safety measure”. It is not.
This is just the most recent weapons in the arsenal of tactics to eliminate the competition of midwife, a newer “better” form of the old “first, catch your rabbit”. Midwives unable to obtain the mandated supervision are caught in a no-win situation -- either locked out of their own profession OR ensnared -- a rabbit in the trap of midwifery licensing laws. Without the mandated physician supervision, the practice of midwifery again becomes a crime and the midwife is again reduced to a small defenseless animal who means no harm but after being captured in the hunter’s trap and at the leisure of the medical (or unrepresentational midwifery board), is easily polished off. In the grand plan to eliminate the competition of midwives via death by a 1000 razor cuts, mandated physician-supervision laws for community-based midwives is the last swipe of the blade.
Faith
Gibson |
