Controversial Calling : State Will License Midwives but Debate Continues : ‘ What can be more holy than assisting the passage of the soul through the door from heaven to earth?’ Midwife Lani J. Rosenberger

In a matter of months, Lani J. Rosenberger will no longer have to worry about whether any of the women seeking her services are actually undercover cops trying to bust her for helping mothers-to-be.

She is a midwife, a member of an ancient calling, but one that was legally recognized in California this year after bitter controversy and long opposition by the state’s organized medical community.

“(The medical industry) would like everyone to think that . . . midwives are stupid, ignorant, barefoot old grannies. This is an old stereotype,” Rosenberger, 48, said from her Canoga Park home, where clients are seen for prenatal exams. “Many individuals within the medical industry do not believe that, but many do.

“This is nothing you just go do. All of us who catch babies have been trained in some way, some in a more informal way than others.

“It’s not a perfect law,” she added. “I would prefer the decriminalization of midwives, but it’s a step in the right direction.”

For decades, the profession has been placed in a legal quandary. No state law forbids midwifery, yet midwives can be prosecuted for practicing medicine without a license.

As of July 1, midwives may apply for state licensing and enjoy the right to practice freely, but under the supervision of licensed physicians. The state Medical Board, which will oversee the program, is now developing standards to regulate the practice for the first time since 1949.

In the meantime, many lay midwives will continue working underground to help women deliver babies at home, without the use of drugs or medical instruments.

The new law governs lay midwives--a term Rosenberger finds objectionable because she believes it implies that she has little or no experience. Instead, she refers to herself as a “direct-entry” midwife, whose only training came from being another midwife’s apprentice for about three years.

A second group, known as nurse-midwives, are now certified by the Board of Registered Nursing and usually perform deliveries in hospitals or birth centers. They have generally enjoyed a good working relationship with physicians, medical officials say.

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Lay midwives, on the other hand, are still untested commodities as far as the medical community is concerned. Some have formal medical training, but many do not. They practice underground at times in communities of Latinos, Mormons and Christian Scientists.

One goal of the new law--authored by state Sen. Lucy Killea (I-San Diego)--is to provide low-income women greater access to affordable prenatal services. California is the 15th state in the country to allow licensing of midwives.

Rosenberger’s clients are mostly middle-class women who already have health insurance, but are dissatisfied with the medical system. She declined to disclose how much she earns, but said that most midwives charge $1,500 to $3,000 a patient--thousands of dollars less than hospital births cost.

One client, Moira Bell of Canoga Park, is more than eight months pregnant with her fifth child.

“This is not an illness and doesn’t need to be treated as such,” said Bell, 36. “When I go to the hospital, I seem to relinquish myself to a system that believes, ‘You can’t possibly have a baby without us.’ ”

Rosenberger hopes to become licensed after performing about 150 home births in 15 years of practice. By this summer, she will be able to qualify for a license by passing a series of exams or completing a three-year accredited training program similar to the one now taken by nurse-midwives.

Until then, she remains fearful of prosecution and only takes clients who have been referred to her by someone she knows.

About 6% of the home births Rosenberger has performed involved difficult deliveries requiring hospital care, she said. But she said that figure is low when compared with the number of high-risk pregnancies taking place in hospitals.

“I consider midwifery to be a calling, very much akin to a religious calling. I don’t know a single midwife who doesn’t believe her practice is an extension of her religious beliefs.

“What can be more holy than assisting the passage of the soul through the door from heaven to earth?”

Details of the licensing program have not yet been settled, such as how much the Medical Board will charge for licenses, what type of information will be asked on license applications, and who will administer the exams.

But the most important issue that is still unresolved, many say, centers on a provision requiring each lay midwife to work under the supervision of a physician.

Killea agreed to add the provision in a compromise with the medical community that helped the bill pass. Now, she acknowledges it may work against midwives.

The Medical Board, she said, is “trying to require a written agreement between physicians and midwives. We know from experience that isn’t going to work. Doctors are most reluctant to sign anything that will affect their insurance premiums.”

The California Medical Assn., which represents about half of the practicing doctors in the state, offered its support for the proposed law only after a training requirement and the provision on physician supervision were added to the final bill.

“Our concern with the original bill was basically where physician supervision came into play,” said Danielle Walters, a spokeswoman for the group. “What if there was an emergency? We believe that is too late.

“The one thing is there is a shortage of obstetricians. . . . Once the standards are established, the more the merrier. There’s definitely enough delivery to go around.”

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In the past, Walters said, physicians have complained that one problem with home births is “patient dumping,” when a pregnant woman is dropped off at a hospital emergency room during complicated labor.

Midwives like Rosenberger oppose physician supervision partly because they say it interferes with their professional autonomy. And because insurance companies do not currently provide coverage for home births, Rosenberger wonders how many doctors would be willing to supervise lay midwives.

The Medical Board will try to define the terms of physician supervision--what type is needed and how much is enough--by the July 1 deadline, said Dixon Arnett, the board’s executive director.

“We’re trying to meet the time frame,” Arnett said. “One reason we may not is this one issue is mightily fought by the midwives themselves.

“One thing I can reasonably predict is if the board decided not to have regulations on supervision, leaving it open, insurance companies wouldn’t cover this.”

The medical industry estimates that about 200 lay midwives statewide would apply for a license given the opportunity, and up to 600 more are undecided.

In general, enforcement begins only with a complaint about the quality of care, said Linda Whitney, a special consultant for the Medical Board.

“If we never got a complaint and never heard about them, we’d do nothing,” she said. “We can’t take action against someone we’ve never heard of.

“I think after we have implemented the program and there is licensing, the board will look more seriously at people practicing without a license. But again, our major concern is quality of care.”

In a case 11 years ago, Karni Seymour, 37, of Ventura County was convicted of a misdemeanor charge for practicing medicine without a license after she helped deliver a baby at home who died. She pleaded guilty and was given three years’ probation, about 300 hours of community service and a fine of about $200.

“I can’t even begin to explain the three years of hell my family went through, the degrading humiliation,” said Seymour, a good friend of Rosenberger’s who declined to say whether she is still practicing. “I feel I handled (the birth) as efficiently and competently as a hospital would have.

“I can’t tell you the sense of relief I had when Gov. (Pete) Wilson signed the bill,” said Seymour, who says she is anxious about applying for a license. “We were validated.”