Women who want to give birth at home seek to change restrictive Md. law

Susannah Kipke, who is no fan of hospitals, had a wonderful experience when she gave birth to her first child at home with the help of a midwife 10 weeks ago.

It wasn't a legal experience, however. Maryland is one of six states that forbid midwives who aren't nurses to practice their ancient profession.


Kipke, the wife of House Minority Leader Nic Kipke, did her part to change that Wednesday by testifying in favor of a bill that would clear the way for midwives to assist at home births.

"There are a lot of women like me who are going to have home births no matter what," Susannah Kipke told senators as her son, James, slept peacefully on her shoulder. She hopes to have any future babies at home but worries that if something goes wrong, her midwife could face legal consequences.

For the past several years, Maryland lawmakers have been grappling with the reality that a small percentage of women — some for religious reasons — insist on giving birth at home if possible. And as the testimony of Kipke and others showed, there are trained midwives who are willing to risk legal consequences to help those mothers.

For now, there are few legal protections for these mothers or their babies because the profession of midwife, except for nurse-midwives, is not recognized by the state.

Over the past several years, midwives and their passionate supporters have come to Annapolis to plead with legislators to license and regulate practitioners known as certified professional midwives, as 28 states do.

"It's just common sense that this noble and ancient profession should not be illegal," said Margaret Syski, a mother of 10 who has delivered five of her children at home with midwives attending.

Each year, the combined forces of the medical establishment — nurse-midwives, physicians, the state health department — have successfully argued that the law should not be changed.

This year, however, proponents of midwifery and their past antagonists say they have resolved many of the issues that divided them, such as educational requirements, which conditions should preclude a home birth and how to transfer responsibilities to the medical profession when a delivery becomes hazardous.

There remains one sticking point that people on both sides agree could sink the bill: whether midwives could attend at a home birth if the woman had previously had a Caesarean section.

Pam Kasemeyer, a lobbyist for the state medical society and other physicians groups, signed up as an opponent of the bill but said that could change if talks with supporters reach a final agreement. While she contends that hospital births are safer, she says the medical society and other stakeholders have made "great progress" in talks since the last session.

"We understand that women are going to make that choice and deliver at home, and that's their right," she said.

But she said the doctors group would not agree to the bill without a prohibition against midwives handling cases of vaginal birth after C-section, known as VBAC, at home. She said doctors believe such births carry too high a risk of tearing of the uterus to be advisable except in a hospital or another setting with emergency facilities on hand.

"It is the one remaining very contentious issue," Kasemeyer said.

The physicians are backed on this point by the state Department of Health and Mental Hygiene, which opposed the legislation in the past but said it could support this year's bill with an extensive list of amendments.


Because proponents are adamant about the right of midwives to attend at vaginal births after C-sections, compromise remains elusive on a bill that otherwise has broad bipartisan support.

Two groups that did not come to Annapolis to support the measure this year were Southern Maryland's Amish and Mennonite communities. In past years, they showed up on the day of the bill hearings in their plain garb to lend mostly silent support to the midwifery legislation.

Sen. Thomas M. "Mac" Middleton, a Charles County Democrat who sponsored the Senate version of the bill, said the notice of the hearing came too late to spread the word among people who do not use phones or email.

Middleton told a hearing room packed with young mothers and mothers-to-be that the Amish and Mennonites make up a big portion of the farmers in Southern Maryland. He said those communities believe in home births attended by midwives and expressed concern that Maryland's laws were putting them under pressure to sell their land and move.

Nicole Jolley, a certified midwife who has worked with the Amish, said they prefer to avoid modern technology and ways of life when possible. But in a medical emergency, they will go to hospitals, she said.

The legislation would set stricter education requirements than past bills that failed, said Del. Ariana Kelly, the Montgomery County Democrat who is sponsoring the bill in the House. She said the legislation also spells out procedures for midwives to follow if what had seemed to be a low-risk birth took a bad turn.

"That's going to make women safer if something goes wrong in a home birth," she said.

Kelly said that even in states with licensed midwives, the percentage of women choosing to give birth at home rarely goes above 1 percent.

Shirley Devaris of Maryland's Board of Nursing said there are 243 nurse-midwives in the state but only six to eight do home births. There are 24 certified midwives in Maryland who are waiting to be licensed, she said. She said the board generally supports the bill but considers VBACs a "sticking point."

Lawmakers also heard from several women who testified that they had had vaginal births after C-sections at home with no problem.

Dr. Kirra Brandon, an Annapolis physician, said she had two vaginal births at home after having a C-section with her first child. She disputed the medical society's estimate that 1 percent of such births result in uterine tearing, saying medical literature shows a far lower figure.

"VBAC is something very low-risk regardless of the birth setting," she said.

Sen. Joan Carter Conway, the Baltimore Democrat who heads the Senate health committee, dismissed some of the concerns about home births, noting that giving birth in a hospital carries risks, too.

Conway said the bill's proponents are not budging on the VBAC prohibition and have told her they would prefer to see the measure fail.

In the House, Kelly said the outcome is far from certain.

"Medical licensing bills are brutal," she said. "They're turf wars."