Part Two
The Present Situation -- Roberta and
other Midwives in New York State, Illinois & California

Events in the early part of the century set in motion a series of legal and cultural responses that totally eliminated any possibility in modern times that Roberta or other midwives in New York, California and Illinois would have access to the elements of an autonomous midwifery profession. These elements are common to all professions but absent to non-nurse midwives.

These qualities are:

For the profession of independent midwifery, this would mean community-based educational programs with traditional (non-nursing) curriculums which included experience in both home and free-standing birth centers. These educational programs would be staffed by midwives who had been similarly trained and who had extensive experience providing normal maternity care in a domiciliary setting. Last but not least, it would mean a licensing mechanism based on the national certification process by NARM and the presence of Certified Professional Midwives on the Midwifery Examining Board of NY. Nurse-midwifery enjoy all of these elements of professional control. For direct-entry midwives, they are all missing.

Anyone familiar with the history of the illegal campaign detailed in the professional literature between 1910 and 1930 could easily predicted the contemporary outcome. There would either be the outlawing of independent midwifery -- (the situation until 1993) or there would be an artificial "midwifery" profession that required an advanced university degree after a lengthy, nursing-based education (regardless of whether the adjective "nurse" is employed). And of course, this nursing-based midwifery would be functionally subordinate to allopathic medicine. The regulatory process for this artificial profession would be in the hands of medical politicians and appointments to the governing board would be by the same partisan politicians who are supported by the AMA, the hospital industry and other segments of the medical elite.

It doesn't really matter whether midwifery licensure is based on a nursing degree OR the educational process is co-opted so that it conforms to and reflects the customary curriculum of hospital-based nurse-midwifery practice. In both cases, traditional, non-nurse midwives are not represented nor participants in either setting educational requirement or participating in the regulatory process. Even thought the title of "Certified Midwife" granted to graduates of NY's ACNM-designed program doesn't directly acknowledge the qualities of nursing-based education, it is in fact a virtually identical, advanced sciences curriculum that is not based on a job analysis of hundreds of practicing midwives but rather on the conventional curriculum of nursing and pre-med students. It is a licensing scheme designed to maintain the lop-sided power structure to the detriment of the citizens of New York.

The psychometrically-based job analysis by North American Registry of Midwives (NARM) legally establishes the knowledge base and practical skills that constitute the true practice of midwifery. A legal occupation is a protected property right. In order for a new licensing law to be implemented, currently practicing midwives must constitutionally be provided with an opportunity to demonstrate that they possess an appropriate knowledge of midwifery principle and the practical abilities as established by the NARM job analysis. This body of knowledge, technical skills and the mechanism to demonstrate competency does not require a Baccalaureate degree. Unless a midwife is professionally employed as an instructor or administrator of midwifery program, such a degree is irrelevant to the practice of midwifery.

Dividing up the Profession of Midwifery
Between Physicians and Nurses

"Of the 3 professions---namely, the physician, the trained nurse and the midwife, there should be no attempt to perpetuate the last named (midwife), as a separate profession. The midwife should never be regarded as a practitioner, since her only legitimate functions are those of a nurse, plus the attendance on normal deliveries when necessary." [1915-A; EdgarMD p. 104]

It is important for citizens groups to understand the historical strategy to eliminate traditional (non-nurse) midwives from the profession of midwifery by dividing midwifery up between physicians and nurses -- a piece of whole cloth taken from midwives and then torn into two unequal pieces. The big piece went to doctors (the independent and high-paying end) and the smaller, subservient (and low paying) one went to nurses and/or nurse-midwives. Even though nurses and nurse-midwives get the smaller part of the pie, there is a fundamental agreement on the part of the nursing profession to keep themselves as the "preferred provider", which is actually the "assistant of choice", by doctors. {link} In addition to the personal cost to individual midwives, it costs us dearly as a culture to have lost the common-sense principles of midwifery . The same discipline used by those European countries with superior maternal-child safety record is now unavailable to citizens of the US. Physician politicians initially set out to merely usurp midwifery to be shared with the nursing profession) but instead it has been functionally destroyed. Now days the principles of midwifery are absent in hospital-based obstetrical care and rendered inoperative and/or illegal in the case of domiciliary midwifery.

Politically-effective Acts of Civil Disobedience

If it were not for this historical backdrop, there would be no sentencing hearing for a midwife whose only "crime" is being a good citizen, brave enough to have engaged in a politically-effective act of civil disobedience. We can tell that this political act is effective for if it were not, the state of NY would not be wasting its finite prosecutory resources on midwives. Were it not for viscous and vitriolic campaign of medical politicians to eliminate the competition of midwives, Roberta would have been able to train formally in a school of traditional midwifery run by non-nurse midwives who taught the classical principles of midwifery. Were it not for the shameful propaganda campaign to abolish the independent practice of midwives, Roberta would be a nationally certified or state licensed midwife. Were it not for the pre-cognitive commitment of the obstetrical community to ignore the values of home-based maternity services, Roberta would be enjoying a collegial relationship with physicians in her community. When the arrest and conviction of Roberta is seen in the context of the historical campaign to dismantle the independent practice of midwifery, the motives of the medical and regulatory agencies looks very different. The expression -- "The more things change, the more they stay the same!" -- certainly appertains!

What is next?

If the response to this situation is to passively depend on the cooperation and "good will" of the midwifery board, then we are dead in the water. Mothers in New York state will have to choose between an unwanted and unnecessary hospital births, risky unattended labors OR illegal practitioners. Parents will be unable to obtain birth certificates for their home-born babies without risking criminal charges of child endangerment. Midwives will be routinely prosecuted any time a home birth comes to the attention of the authorities. Undercover agents will trap them in covert sting operations and prosecute them with a vengeance in order to make an "example" out of them to strike fear into the hearts of everyone associated with home-based birth services.

Roberta's case is one of the very best to challenge

After years of research into the historical campaign to "Eliminate the Midwife", I am of the opinion that Roberta's case is one of the very best to challenge these decisions being made in the name of the citizens of New York which, in truth, are not in the interests of the citizens of New York. A large quantity of archival records are already identified -- many specific to the state of New York -- and available in the public libraries. They document the historical blueprint of this conspiracy to do away with the economic competition of midwives, the efficacy of care by midwives, the school for midwives in New York City and its superior statistics, the increase in maternal and infant mortality as midwives were progressively eliminated from practice. These documents, written at a time when women did not have the right to vote, were for "professional eyes only". Their authors assumed these records would never be subjected to public scrutiny nor would the medical establishment be made accountable for the unethical actions described unambiguously in great detail.

Midwifery -- Intellectual Property of the Commonwealth

The art and science of midwifery is the intellectual property of midwives, no less so than any modern-day body of knowledge. Our long cultural tradition, starting with the Hebrew midwives in the first chapter of Exodus, makes this intellectual property a valuable commonwealth of the public, not the private purvey of the medical community. The underhanded methods chosen and disseminated nationally through professional journals of the day describe the theft of this intellectual property by the medical profession. Historically this included a criminal conspiracy in violation of federal nti-trust laws. The spoils of the Hundred Years War against mothers and midwives still fuels the on-going campaign of unfair business practices, restraint of trade, and violation of the right to contract. More to the point, laws intended to protect the public -- which is the legislative intent of the medical practice act and health & safety statutes -- are being used instead to increase the risks to consumers by disallowing safer forms of maternity care (the midwifery model) and forcing parents into unwanted, unnecessary medical care and expensive, risky hospitalizations.

"Unsafe" Maternity Practices,
Unnecessary Risks to NY Citizens:

Sex is not the only aspect of reproduction that can be "unsafe". Hospitals not places of safety. In fact, 80,000 iatragentic and nosocomial deaths occur in them every year. (Dr. Jarvis, CDC, Atlanta) Some experts in the field give a figure as high as 120,000 unnecessary deaths annually directly attributable to the direct and indirect risks of medical care. While this is rarely reported in the newspaper, it is a number greater than all the plane crashes, fatal car accidents and house fires in the US nnually. Hospital-based maternity services are inappropriate for healthy mothers who don't plan on using drugs or anesthesia. Normal birth doesn't normally require medical services. What healthy mothers need primarily is supportive care -- a clean bed, hot meals, a sympathetic ear, a watchful eye, encouragement, teaching and appropriate socializing. For healthy mothers, hospital are particularly dangerous hotels, dangerous schools for new mothers, and dangerous social opportunities for new families.

Cesarean Prevention -- a Matter of Life and Death

Hospital-based, interventive obstetrics is directly associated with 4 to 6 times more cesareans than midwifery management. While cesareans surgery is safer now than ever before, it is still many times more risky than vaginal births.

Ratio of Deaths per 100,000
Spontaneous Vaginal Birth: ..6 deaths 1 per 16,666 deliveries
Auto Accidents: 20 deaths 1 per 5,000 women 14-34
Most Dangerous Occupation: 22 deaths cab drivers NYC
Breast Cancer: 26 deaths 1 per 3,846 women Dx
Cesarean Section: 31 deaths 1 per 3,225 surgeries

Cesarean surgeries are directly associated with increased rates of maternal mortality. This means that out of 4.5 million births last year, approximately 1395 new mothers died last year from the complications of cesarean surgery, compared to 270 for vaginal birth -- an "excess maternal mortality of 1125 women. Cesarean birth is more dangerous than the most dangerous occupation in the US -- driving a cab. Preventing unnecessary cesarean surgeries prevents maternal mortality. Midwifery management prevents cesarean surgeries. Prevention of medically-unnecessary reproductive surgeries also increases opportunities for valuable maternal-child interaction during the postpartum, promotes family bonding and wellbeing, increases the rate of successful breastfeeding and reduces the cost of maternity care.

This is not an abstract conversation. We had a maternal death recently in our local hospital after a medical unnecessary cesarean following a medically unnecessary induction because the doctor feared the baby might be getting "too big" To prevent a theoretical future complications, he first induced her and when labor didn't progress, he sectioned her. She died two days later of infection.

Obstetrics for Healthy Mothers is Experimental Medicine

Obstetrics for normal birth has always been experimental medicine in that common interventions and treatment modalities were never subjected to scientific proof before becoming routine protocols. Without any scientific data to back up such a move, obstetricians replaced the time-honored principles of midwifery with a surgical specialty. But there is no evidence-based rational for physicians as birth attendants, hospitalizing laboring women, prepping, IV, confinement to bed, using narcotics, anesthesia, operative are interventions, etc. However, there is lots of data recording the determent to mothers resulting when surgical interventions routinely applied to healthy mothers and babies. A recent US Supreme Court decision, Daubert vs. Merrill Dow, establishes a precedent for expert testimony, requiring it to be supported by scientific research or other published documents. This would include historical records, maternal-infant statistics from the US and WHO, etc. We are blessed with the elements for success in making a scientifically-valid case for independent midwifery.

Suggestions for Political Action

The Burning Question is this: "As midwives, mothers, fathers and others who recognize the valuable contribution of midwifery and the dangers of a system that systematically ignores the safe and common-sense contributions of midwives, what can we do to rectify the wrong historically perpetrated against the independent profession of midwifery?" Specifically, what can midwives and the politically-active friends of midwives do in the state of NY to counteract this Hundred Years War on childbearing women?

Last Segment

Recommendations -- What will and won't work

Action Plan Topics:

Public Information Campaign
Totally Birthing Barbie for Generation "X"
Widen the base of midwifery politics
Utilize the Statistical Superiority of Midwifery
to Influence Insurance Companies
Professional Education for the "Gatekeepers" of Public Opinion
Bold and Creative Use of the System
NARM Job Analysis, NAFTA & the
Legal Basis of Midwifery Practice
Citizen Oversight of Medical and Midwifery Boards
Fourth US Bio-ethics Commission
Political Networking with the Healthcare Freedom Movement
Raising Money$$$!
"There can be no alibi for not knowing what is known"
-- Foreword to the Davis Obstetrical Textbook, 1966

Complementary the relationship between
midwifery and the obstetrical world

Epilogue

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