Court case over births pits preference vs. public policy
By Angela Couloumbis
The Philadelphia Inquirer
NEW PROVIDENCE, Pa. — Diane Goslin misses the feel of a pregnant belly beneath her hands, the tiny beats of life pulsing inside.
Months have passed since she has guided a woman through the pains of childbirth in the way she believes nature intended: at home, without drugs, surrounded by family and friends.
Though she keeps busy tending her organic garden, home-schooling the youngest of her five children and renovating the two bed-and-breakfast inns that she and her husband run in Lancaster County, the 50-year-old midwife is consumed by the controversial legal case that has brought her career, her way of life, to an uneasy halt.
"I feel like every cell of my being is dying," said Goslin, who has helped deliver more than 5,000 babies in the last quarter-century, many to women in Lancaster County’s Amish communities.
Since August, Goslin has been under a cease-and-desist order from the Pennsylvania State Board of Medicine, which charged her with practicing medicine and midwifery without a license. The action was spurred by the 2005 death of an Amish baby she had delivered a day earlier. The county coroner determined she was not at fault.
Goslin is fighting the order. Her appeal, in Commonwealth Court, has brought together an array of allies, including Amish families and advocates of home-birthing.
Outside the Capitol on April 9, hundreds of Amish from across the state silently rallied for Goslin, who is neither Amish nor Mennonite. The sea of white bonnets and yellow straw hats was a striking sight against the backdrop of the statehouse.
They and other supporters believe Goslin’s case is about larger, more fundamental questions:
Does a woman have the right to give birth where she wants, attended by whom she wants?
And is birth a medical procedure, requiring a nurse or doctor? Or is it a natural process, as inherently a part of life as breathing?
Midwifery is an ancient profession, referenced in the Bible and other religious texts. The midwife’s role was to travel to a laboring woman’s home to provide support and coax a baby into the world.
Not until the 1900s in the United States did childbirth start moving into hospitals, said Marsden Wagner, retired director of women’s and children’s health for the World Health Organization.
Births began to be attended by doctors and so-called nurse-midwives — women with nursing degrees who specialized in childbirth. Today, those nurse-midwives almost always collaborate with obstetricians or other physicians.
Goslin is not a nurse-midwife. She is a certified professional midwife, having obtained certification through the North American Registry of Midwives 12 years ago. Twenty-two states, including New Jersey, recognize the certification in their licensing and regulatory requirements.
Pennsylvania does not. Only nurse-midwives can be licensed to practice, and there are 356 of them in the state, compared with an estimated 100 non-nurse midwives in the 67 counties. The state has previously cited other non-nurse midwives with cease-and-desist orders.
Goslin and other non-nurse midwives believe birth need not occur in a hospital. They say most pregnancies and births are normal; when there are complications, they refer women to doctors.
"Women have been scared into believing that they can’t have birth anywhere but in a hospital," said Wagner, the retired World Health Organization director. "That couldn’t be further from the truth."
Goslin and other non-nurse midwives say they don’t want to become nurse-midwives, which they believe would lock them into treating birth as a medical procedure.
Because they collaborate with obstetricians, nurse-midwives are subject to restrictions, many dictated by malpractice concerns. Many of them do not attend home births, but work in hospitals, where laboring women are more likely to get medical intervention, including cesarean sections and labor-inducing and pain medication.
The American College of Obstetricians and Gynecologists argues that childbirth has become safer for mothers and babies in the last 60 years because of medical technology and improved access to trained providers and emergency obstetrical and neonatal care. The group opposes out-of-hospital births, advising that if women "choose to assume the risk of home birth," they should do so with a licensed professional.