by Erin Odom and Courtney Price

Stephanie Keach’s baby died during an attempted home birth 15 years ago.

After the stillbirth, a local certified nurse-midwife called for the attending midwife to be charged with manslaughter, Keach said.

Keach’s midwife was a certified professional midwife, known as CPMs, a certification not recognized in North Carolina.

Keach, who lives in Asheville, doesn’t blame her midwife for her child’s death. An autopsy revealed the baby had a heart condition, and it was unclear whether doctors could have saved the baby’s life, anyway.

“Sure, I could have ultra-sounded, found the defect, C-sectioned and (had an) open-heart-surgery for my child …but that is not my way,” Keach said. “I believe in God and trust in the natural order of things. It doesn’t mean it wasn’t and still isn’t a painful ache in my heart.”

It’s becoming more common for parents to seek out direct-entry midwives – who practice illegally in the state – to deliver their children in the privacy of their own homes, rather than a hospital. To legally give birth under midwife care, parents must find certified nurse-midwives, who are licensed to practice in North Carolina.

The growing trend has opened up a debate among parents and medical professionals, as some believe direct-entry midwives should be allowed to practice.

Popular local midwife arrested

Medwin was charged with practicing midwifery without a license and resisting arrest, both misdemeanors. She has since been released from jail on a $100 secured bond and is scheduled to appear in court in Rowan County on Wednesday, March 23.

WBTV, the Herald Weekly’s news partner, reported the Mecklenburg County Sheriff’s Office recently issued an additional warrant for Medwin’s arrest for illegally practicing midwifery.

Court records say Medwin was at an east Charlotte home on Allister Drive last month when a baby was born. He had to be rushed to the hospital with serious injuries, WBTV reported.

Dr. Susan Roque and CNM Marcia Ensminger, from All About Women in Mooresville, support local direct-entry midwives and have served as back-ups to deliver home-birth mothers’ babies at Lake Norman Regional Medical Center in the event that something did go wrong. They are both disappointed in Medwin’s arrest.

“It’s a shame,” Roque said. “Amy Medwin is absolutely one of the best lay midwives that are out there.”

Tanya Bailey, president of North Carolina’s chapter of the American College of Nurse-Midwives, said the issue isn’t Medwin’s skill level.

“Licensure essentially ensures public safety,” she said. “If you need a license to practice, you need a license, and she knowingly practices without a license.”

Direct-entry vs. nurse midwives

North Carolina law doesn’t outright prohibit direct-entry midwives; instead their training does not meet the requirements set by the state’s nursing board to obtain a license.

In 1983 the state General Assembly passed the Nurse-Midwife Law, which placed the administration of midwifery under the Board of Nursing. In the same legislation, those who practice without a license are guilty of a misdemeanor.

Midwives in North Carolina – CNMs – must first be trained as a nurse. Nurse-midwives then achieve a master’s degree in science with a specialization in nursing or midwifery.

For those states that do recognize the direct-entry midwife licensure, midwives must have an apprenticeship with a reputable midwife or complete a program that is accredited. Direct-entry midwives, which are sometimes referred to as CPMs or lay midwives, are nationally regulated and can legally deliver babies in 26 states, including Virginia, South Carolina and Tennessee, according to the Midwives Alliance of North America. The certification doesn’t require college-level education.

“There’s been a rush to judge the entire direct-entry midwife profession as uneducated and unsafe,” said Manisha Cavendish, a Huntersville resident who is a clinical psychologist. “Trained and experienced (direct-entry midwives) … fill a need no other provider does at this time in the Charlotte community.” Cavendish planned a home birth with midwives for her second child, but delivered the baby before help arrived.

Home versus hospital

Both programs require midwives-in-training to actively participate in births under the supervision of a licensed obstetrician or midwife. However, the nurse-midwife certification does not require training in birthing at home.

In fact, most who practice in North Carolina – midwives and doctors alike – are hesitant to offer at-home birthing services.

Within the medical profession there is some disagreement on which is safer.

Roque, the Mooresville obstetrician, supports home births.

“Across the world home births are being carried out,” she said. “A lot less happens at home than at a hospital. It’s a safe environment, and we should be pursuing more home births within the states.”

Ehab Sharawy, a doctor at Huntersville OB/GYN, said, “The most important driver this subject has is patient safety. It’s a fine line between the autonomy of the patient and the concept of ‘Do no harm.’”

CNM Beverly Holmes, of Lake Norman OB/GYN, believes women should have the choice but feels most comfortable attending natural births in a hospital setting.

“Most of the time birth goes well regardless of the setting,” she said. “I like going all natural as the day is long. But if mama or baby needs anything, it’s good to know safety measures are behind the curtain.”

Nurse-midwives must have a back-up physician for home births, partly for cases where emergency surgery might be necessary. Midwives are not trained or licensed to perform surgery.

Mooresville resident Christine Lampel believes her nurse-midwife saved her life after she delivered at Lake Norman Regional three years ago.

“I hemorrhaged immediately after the birth,” she said. “The bleeding was profuse, and the pain was unbearable. If I had chosen a home birth in this situation, I would have died.”

A home birth with a qualified professional is safe for low-risk women, said Ensminger, of All About Women.

But, Lampel said, “In a home setting, you can’t always predict these types of situations or be prepared.”

Still, Ensminger, who delivered Lampel’s baby, believes it could be safer for a low-risk patient to deliver at home. “Labor and birthing are normal physiological processes. Hospitals make it a medical process,” she said. “Fetal monitoring doesn’t increase mortality, but it increases the C-section rate.”

“Right now you’re not comparing apples to apples,” Sharawy said.

Generally, patients identified as high risk would choose to deliver in a hospital. The state has mandated steps to reduce the rate of cesarean births, which hovers around 30 percent in North Carolina.

In 2008 the American Medical Association submitted a letter to the Missouri Supreme Court opposing the state’s lack of midwifery regulation. According to that letter one study “showed that the incidence of neonatal death was twice as high (3.5/1,000) for planned home births as for hospital births (1.7/1,000).”

But a 2000 British Medical Journal study of North American home births showed that women who planned to deliver at home experienced lower rates of medical interventions.The study also showed home birth to be as safe as hospital birth for low-risk women.

Keach, the Asheville mom who lost a child, went on to birth three healthy children in a home setting. “Birth is, has been and will continue to be a time of magic, mystery and forces beyond our control,” she said.