Laboring to save home births
Amish groups rallied politically against state closure of midwife Diane Goslin's practice.
Midwife Diane Goslin’s farmhouse office bustles with activity this summer morning. Horse drawn buggies line the driveway, while pregnant women line the waiting room inside – their hair tucked into bonnets, their dark dresses covered by black aprons.Skip to next paragraph
Subscribe Today to the Monitor
A mother expecting her 11th child arrives with her daughter, who is expecting her first. Women do mending as toddlers scoot around their ankles. Childhood friends reunite, chattering in Pennsylvania Dutch. Sisters shriek with laughter at the unexpected sight of their expectant aunt.
Outside, on the porch – in a waiting room of his own – a lone, straw-hatted man rocks, amused, pretending not to overhear the women.
The Amish here in Lancaster County may go to the hospital if they break an arm or need surgery, but when it’s time to give birth they stay home. Usually, they deliver their babies with the aid of a midwife, and the women in this waiting room half-joke that if Ms. Goslin goes out of business, they are through with childbearing.
It appeared to be coming to just that last fall when the Pennsylvania Board of Medicine ordered Goslin to cease and desist assisting her mothers, deeming it “practicing medicine and nurse midwifery without the appropriate licensure.”
Though the case arose because an infant delivered by Goslin died a day after birth, it was never considered her fault, nor has there ever been any suggestion that her rates of death or complication are unusual. If she were practicing in any of the 24 states that recognize her status as Certified Professional Midwife (CPM) by the North American Registry of Midwives, she’d have proceeded with her usual 200 to 300 deliveries a year.
But Goslin’s case illustrates the debate about whether childbirth is a natural bodily function or a medical event necessitating hospitalization. As in all ethics-meet-medicine turf battles, one party’s science is often another’s smokescreen.
Indeed, this isn’t new for the Pennsylvania midwife. Last fall’s case was the third time similar charges were brought against her in 18 years, and the third time they were dropped. In May, a 5 to 2 decision by the Pennsylvania Commonwealth Court overturned an $11,000 fine and lifted the cease-and-desist order. All three cases were brought after the state received complaints that Goslin was violating its licensing regulations. Simply doing what she does is against the law, maintains the state. And her business card, on which Goslin “is advertising her services,” is “clearly evidence of unlicensed practice,” says Leslie Amoros, of the Pennsylvania Department of State, which oversees the board of medicine.
Though cleared, Goslin’s work continues under a legal question mark because Pennsylvania recognizes only nurse midwives. Most of those are hospital affiliated and unavailable for home birth.
• • •
In the Amish farmhouses of this rolling hill country, Goslin is considered family. For some women, she’s delivered a dozen babies. And, in Goslin’s own time of need, this community rallied to help – a departure for the reticent Amish who generally refuse to be photographed or be quoted by name. But on behalf of their midwife, they protested at the state capitol, staged benefits and teas, and filed an amicus brief.
Non-Amish – who make up 35 percent of Goslin‘s practice – also turned out, as did advocates of women’s right to give birth in whatever setting and with the attendant of their choice.
The home birth debate has been joined recently by such participants as talk show host Ricki Lake, with her pro-home-birth documentary film, as well as by traditional players such as the American College of Obstetricians and Gynecologists, which recently reiterated its opposition to home birth.
“The [issue of] the medicalization of childbirth has been around for a long time, now,” says Arthur Caplan director of the Center for Bioethics at the University of Pennsylvania. “There will always be [people like] the Amish, who want no technology” on one end of a continuum, and those who will refuse to have a baby “if they can’t deliver at University of Pennsylvania” on the other. He argues that the home-vs.-hospital argument should be removed from the ideological push and pull, and instead be driven by safety data specific to the woman‘s age and risk factors as well as the availability of emergency backup care.