In her 15 years as a midwife in Pennsylvania, Judy Mentzer has delivered nearly 1,000 babies.
She's proud of her record: 876 normal births, 24 breech births, 13 sets of twins and 13 Caesarean sections. There have been eight stillborn babies, but no maternal deaths.
But those statistics haven't impressed the Maryland Board of Nursing. Ms. Mentzer is scheduled to appear in Carroll County Circuit Court on Tuesday to face charges of practicing nursing without a license and misrepresenting herself as a nurse.
Ms. Mentzer was charged in March after the nursing board learned that she had attended a birth in Finksburg.
Under state law, only certified nurse midwives may practice in Maryland. Ms. Mentzer is not a nurse and says she has never claimed to be one, although she has delivered about 45 babies in Maryland.
If convicted, she could be sentenced to a year in jail and fined $5,000 on each of the two counts.
"A criminal is somebody who hurts you or steals from you, and I've done neither," said Ms. Mentzer, 46. "I haven't even lied, yet I'm in a criminal court. It's very confusing."
The Maryland Board of Nursing doesn't see it that way.
"She's evidently had no problems that we're aware of, but it's our belief that in order to practice as a midwife in the state you have to be a certified nurse midwife," said Donna Dorsey, executive director of the nursing board.
Certified nurse midwives can legally attend home births, but lay midwives say that only one in Maryland is willing to do so.
As a result, lay midwives say, women in Maryland who want to give birth at home are faced with giving birth unattended or hiring an illegal health care provider -- the non-nurse or lay midwife.
That's what got Ms. Mentzer into trouble. She said Maryland women sought her out to attend their home births and that she didn't have the heart to turn them down.
"It's not right that I can't choose who delivers my baby," said Carol Rhein, who has delivered two children at her Finksburg home with Ms. Mentzer.
Thorny issues
The nursing board's action against Ms. Mentzer illustrates the issues surrounding the role of nurse vs. midwife, midwife vs. obstetrician and a woman's right to choose who delivers her baby and where.
Several of Ms. Mentzer's clients and non-nurse midwives in Maryland, all of whom practice illegally, have come to her defense. About 40 supporters showed up at the Westminster courthouse last month for her trial, which was postponed. They plan to be there for her rescheduled court appearance Tuesday.
Anne Thompson, a certified nurse midwife and head of the Maryland chapter of the American College of Nurse Midwives, supports national licensing and certification for lay midwives so that they can practice legally.
Ms. Mentzer "had been practicing safely for a very long time and was targeted and used as a scapegoat for something the state wasn't sure how to handle," said Ms. Thompson, who practices at the Baltimore Birthing Center.
While waiting for her court date, Ms. Mentzer continues to practice midwifery in Pennsylvania.
Midwifery is based on the theory that childbirth, in most cases, is a natural process that doesn't require medical intervention.
Midwives vs. obstetricians
Midwives say that obstetricians, fearful of malpractice suits, are too willing to interrupt the normal birth process with surgery, high-technology equipment or drugs.
Pregnant women under the care of midwives are encouraged to play an active role in their prenatal care, labor and delivery. Midwives say they can offer much more personal attention than obstetricians can.
"The midwife's responsibility is to make sure the client has the birth she wants as safely as possible," Ms. Mentzer said.
Supporters of midwifery also say it offers a less costly alternative to birth in a hospital.
Although certified nurse midwives are gaining increasing acceptance in the health care field, obstetricians are generally critical of lay midwifery.
"To ensure quality, one needs adequate training and preparation, and the only way to quantify that is through certification," said Dr. Hal Lawrence, a North Carolina obstetrician/gynecologist and co-chairman of the American College of Obstetricians and Gynecologists' collaborative practice group.
Certified nurse midwives are legal in all states. In 13 states, including Maryland, lay midwifery is illegal. At least 14 states have statutes that provide for licensing or some form of legal recognition of lay midwives.
In the remaining states, the profession falls into a legal gray area in which midwives are not regulated but also aren't prosecuted.
In Pennsylvania, where Ms. Mentzer is based, a judge found in a 1989 ruling that state law was ambiguous regarding midwifery. The judge dismissed charges against a lay midwife accused of delivering a baby without a license.
Ms. Mentzer came to the attention of the Maryland Board of Nursing through birth certificates she had filed for her Maryland clients.
In 1991, according to court records, a state health investigator told her that she could not legally practice midwifery in Maryland.
Ms. Mentzer said she continued to see clients to accommodate women who wanted home births.
"I tried to get out of it," she said. "But when you have women that you've served, it's very hard to say no."
The Maryland Board of Nursing has taken action twice against women for delivering babies without licenses, said Ms. Dorsey, the board's executive director. In neither case was the mother or baby harmed.
The Mentzer Prenatal Center is off a wooded road in Orrstown, Pa.
One wall of the waiting room is covered with footprints of some of the babies Ms. Mentzer has delivered. A bumper sticker on the wall reads "Happiness is a Home Birth Baby."
Career began in 1979
Ms. Mentzer's introduction to midwifery came in 1979. A woman at her church asked her to serve as a midwife to some Amish and Mennonite women in the area who rely on midwives for their maternal health care.
Ms. Mentzer had attended nursing school and had been a practical nurse in California.
She apprenticed with an Amish midwife for seven months, observing and assisting with deliveries before attending her first home birth in January 1980.
When she began her practice, Ms. Mentzer worked with a local physician who examined her patients to make sure they were good candidates for home birth.
Like other lay midwives, Ms. Mentzer stresses that if a patient develops complications she can't handle, she will send the woman to the hospital.
"Most women don't need to have babies in the hospital unless they're high-risk," she said.
Her practice grew by word of mouth, and Ms. Mentzer began attending births in other states, including Maryland.
A growing segment of her non-Amish clients includes women such as Mrs. Rhein, who are dissatisfied with their childbirth experiences in hospitals.
Mrs. Rhein has had midwife-attended births for her four children -- three of them at home.
She learned of Ms. Mentzer after her certified nurse midwife left the area and she couldn't find another who would attend a home birth.
"I certainly care about the safety of my baby and myself during delivery, and I felt much safer with Judy than I ever did with doctors," Mrs. Rhein said.
Many midwives say home birth is important in the practice of midwifery. But in Maryland and other states, certified nurse midwives are reluctant to attend births in the home because they are unable to obtain malpractice insurance, said Chuck Honaker, a spokesman with the American College of Nurse Midwives.
Also, nurse midwives must have a physician who can be called in if a problem arises, and most doctors won't agree to home births.
Certified nurse midwives in Maryland generally practice in hospitals or in the state's two birthing centers, in Baltimore and Bethesda.
For 12 years, the Midwives Alliance of North America has been working on certification that would set a national standard of skill levels for lay midwives. Members say they hope that setting a minimum skill level will persuade states to legally recognize the profession.
The certification process will acknowledge different training backgrounds as long as midwives can demonstrate that they meet minimum skill levels.
Meanwhile, the American College of Nurse Midwives is in the early stages of developing accreditation for education programs for lay midwives.
Still, the organization is uncertain about the future role of apprentice-trained lay midwives, who often serve poor women in rural areas.
"The apprentice-trained midwife says, 'I know what I know and I can pass that on,' " said Deanne Williams, director of professional services with the American College of Nurse Midwives.
"In some cases that's good, and in some cases that may not be enough."