Midwives Deliver a Choice at Gentle Birth Center

The word choice has become so synonymous with the abortion issue that we often forget that it has other implications in the fight for reproductive freedom.

Indeed, a different aspect of choice is at the heart of the curious case of the midwives of Glendale: Should women have the right to choose the conditions of childbirth?

Last spring, five midwives who worked at Glendale’s Gentle Birth Center were arrested and charged with practicing medicine without a license. The charges came about in the oddest way. Deputy Dist. Atty. Robert Dawson said an investigation was launched after fire department officials complained to Glendale police about an “excessive number” of 911 calls from the center. Police contacted the California Medical Board and the Gentle Birth Center was raided early one morning in January, 1991.

Two years passed.

Nearly 500 babies were born at the center.

Then the arrests.

In the records, authorities found that in 1990, one baby had died five days after birth and another born with brain damage. These cases are the basis of the charges. The midwives will protest their innocence. But if convicted, the Glendale Five face sentences of 16 months to three years in state prison.

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Since it opened its doors in 1984, the Gentle Birth Center has delivered about 1,500 babies, according to its director, Tonya Brooks, a defendant in the case. The center accepts only patients it considers to be low-risk. Its medical director is an obstetrician/gynecologist who is available as backup.

Brooks says a single perinatal death in 1,500 births is a fine record. The California infant mortality rate for low-risk deliveries in hospitals, after all, is at least six per 1,000.

The center called paramedics 11 times in two years, says Brooks, either for emergencies such as prolapsed umbilical cords or for women who were excessively fatigued by long labors. One of the reason she used 911, says Brooks, is that some women had no health insurance, but earned too much to qualify for Medi-Cal. Local hospitals would be forced to accept them for deliveries if they arrived via ambulance.

“If someone goes into labor who doesn’t have Medi-Cal or health insurance, most hospitals will turn her away unless she can give them a $3,000 deposit,” says Brooks.

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Midwifery is an ancient, honorable profession that was well on its way to dying out in the United States until about two decades ago, when women started demanding alternatives to the hospital labor experience.

It is legal in California, as long as it is practiced by a registered nurse, and this is the rub: Brooks and her colleagues come from a different tradition, one that is called “lay midwifery” or “direct-entry midwifery.”

Lay midwives are not nurses. They contend they don’t need to be, because most of the training received by nurses does not apply to what they do.

In 1949, California stopped issuing midwife licenses. In 1974, the category of certified nurse/midwife was created. Because they are not nurses, the estimated 300 California lay midwives deliver babies, essentially, at their own legal risk.

Brooks’ patients come to the Gentle Birth Center for different reasons: some abhor the medical Establishment, some want more control over the birth experience, some want to be surrounded by people they know and love, some cannot afford private doctors and hospital deliveries.

Brooks, who has 27 years experience birthing babies, charges about $3,000 for prenatal care, labor, delivery and postpartum visits. Many obstetricians charge more than that just for their services; deliveries and hospital stays can run another several thousand dollars.

Several years ago, a World Health Organization neonatalogist/epidemiologist gave compelling testimony on the importance of midwives to a California Assembly health committee.

The midwife, said Dr. Marsden Wagner, should not be thought of as a “second-class obstetrician” nor as someone to be used when there is not doctor or nurse available.

He testified that the five countries in the world with the lowest infant mortality rates in 1986 had in common the fact that more than 70% of births were attended by lay midwives. (The United States is always shamefully low on infant mortality lists; it has most recently placed 20th in the world.)

Midwives, said Wagner, balance the medical Establishment’s increasingly high-tech approach to childbirth. Caesarean section rates, for instance, are much lower in countries where midwives are commonly employed at births.

Brooks endorses the idea that women facing potentially risky deliveries should give birth in hospitals with all the backup modern medicine can offer, but, she adds, “The statistics prove that the high-tech model has failed. It is very expensive and did not produce the anticipated results. Where it has succeeded is in neonatology and with high-risk pregnancies. But that is a small percentage of the population.”

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The Gentle Birth Center is a modest, slightly shabby building that sits back from the street near Glendale’s tidy downtown. Its labor and delivery rooms look like comfy bedrooms, with fresh flowers and ruffled bedspreads. The armchairs are threadbare. No one is getting rich here.

“Most of us benefit from high touch,” says Brooks, surveying the homey rooms. “Not high tech.”

She and her colleagues are scheduled to appear in court for a preliminary hearing on Aug. 25. Her attorney will ask that charges be dismissed on the grounds that the prosecution is based on statutes that are unconstitutionally vague.

It should be of some cheer to the midwives that last month the California Senate passed a landmark bill that would legalize the practice of lay midwifery. The bill’s sponsor, Sen. Lucy Killea (I-San Diego) called it “a big step for women with low-risk pregnancies in California who are interested in a quality, low-cost alternative to hospital, doctor-attended births.”

Brooks would easily qualify for a license under the requirements set out in the bill.

But prosecutor Dawson is undaunted: “Who knows if it’s going to pass the Assembly or be signed by the governor? Or in what form? And also, you are--just like I am--required to follow the law that is in existence at the time you perform certain acts.”

The law, I dare say, has been known to be wrongheaded. Perhaps the court will agree in this case.

If choice is to have any meaning in the fight for women’s reproductive rights, lay midwives must be allowed to work, unfettered by the threat of prosecution.