say New York’s laws on midwifery are too restrictive—so much
so that they’re driving women across state lines to give birth
By Nancy Guerin
Photos by Teri Currie
has been just over six years since two undercover cops showed
up at Roberta Devers-Scott’s job, in Onondaga Hill, New York,
to arrest her for practicing midwifery without a license.
Though Devers-Scott was working as a family planner for the
state Department of Health, she had also worked underground
as a direct-entry midwife for 11 years, an occupation that
led to her arrest. Direct-entry midwives are women who do
not have nursing degrees but have received extensive training,
through midwifery programs and apprenticeships, to assist
families in delivering their babies at home.
Devers-Scott recognized the arresting officers who showed
up at her job as David and Eileen Grogan, a couple who had
come to see her at her home two months earlier, seeking assistance
to have a home birth. Devers-Scott remembers being suspicious
of the couple from the get-go, but still decided to discuss
their options for a home birth.
knew something was up when they first came to see me because
they did not seem as educated about home births as most people
who want to go that route,” says Devers-Scott. “People seeking
home births are usually the best educators amongst us, and
they just did not seem to know much.”
Scott says that she asked the Grogans what they did for a
living, a question she usually doesn’t ask potential clients.
When David Grogan told her he investigated fires, she replied
by asking if he investigated midwives as well.
A couple of months passed before Devers-Scott met up with
the couple again, but on Dec. 13, 1995, they came to arrest
as I had suspected, they were investigators, and I was picked
up on two felony counts for practicing midwifery without a
license,” says Devers-Scott. “I had not actually done anything
more than meet with them, but if you call yourself a midwife,
and you are not licensed by the state—which I did—it constitutes
a felony. I was looking at three to five years in prison.”
Devers-Scott was the first direct-entry midwife to be arrested
for practicing without a license under New York’s 1992 Midwifery
did not even know how to process my case at the police station,”
After months of deliberation, the charges against Devers-Scott
were dropped down to attempt to practice, rather than actually
practicing, midwifery. She was fined $900, given three years
probation and ordered to cease practicing midwifery. She tried
for a year to get licensed in New York state, but to no avail.
Devers-Scott finally decided to leave New York and move to
Rutland, Vt., where the laws were less stringent and where
she did not have to practice midwifery in hiding. She has
opened her own practice, called Beechwood Midwifery. In fact,
after she assists women in delivering their babies, she places
a sign on their front lawn that reads, “Beechwood Midwifery
welcomes a beautiful baby . . . born at home.”
have gone from essentially being handcuffed with felony charges
in New York, to introducing a bill here in Vermont to protect
the profession from what happened in New York and having it
pass,” says Devers-Scott. “I am now a licensed midwife and
a Medicaid provider. I have a thriving business where people
know me and respect me. I was appointed by the secretary of
state to be one of the advisors to the rules process for midwifery
in Vermont, and I’ve become licensed in four states since
New York, and no one has turned me down.”
Although life for Devers-Scott may be much different in Vermont
than it was in New York, just 30 miles across the New York-Vermont
state border, handcuffs and prison still await other direct-entry
midwives practicing in New York—if they get caught.
Technically, there is nothing illegal about giving birth at
home. Home births are legal when a state-certified midwife
is in a collaborative situation with a physician who allows
her to attend out-of-hospital births. But New York laws make
it virtually impossible for expecting couples to choose home
birthing as an alternative to hospital-based care. For one,
the licensing procedure in New York state makes it difficult
for direct-entry midwives to become certified to practice,
and it is impossible for them to legally get training in home
births. Instead, they are forced to receive all of their birthing
practice in schools that train in hospitals.
The second obstacle, according to Carolyn Keefe, cofounder
of BirthNet, an organization that works to educate the public
about maternity care, is that once midwives get licensed,
the only way they can practice is by collaborating with a
physician, a situation in which the doctor is held responsible
for the midwife’s practice. Very few doctors permit the midwives
they work with to do home births. In fact, there is not one
midwife in the Capital Region at this time whose collaborating
physician permits her to do them. Devers-Scott is one of the
closest midwives that women in this region can go to who can
help them have their babies at home.
As a result, many women in New York are either renting houses
in Vermont or Massachusetts so that they can give birth the
way they want to, or are having home births illegally with
midwives who are “underground.”
The passage of the Professional Midwifery Act in 1992 made
practicing midwifery without a license a felony in New York
state. It also appointed a Board of Midwifery, through the
state Board of Education, to over see the licensing process.
New York state law makes those who have the most experience
with home births felons if they get caught,” says Tisha Graham,
co-coordinator of the New York Friends of Midwives, an advocacy
group working to change New York’s laws. “But the programs
that they have set up do not allow women to gain experience
in a home-birth setting.”
According to the Professional Midwifery Act, only two types
of midwives can legally practice: certified midwives or certified-nurse
midwives. The first is a person who has received her training
through the state’s two-year program offered at the State
University of New York in Brooklyn; the other is a certified
nurse who has completed an additional course of study in midwifery.
Graham says that when it was first introduced, many midwives
praised the notion of a certified midwife because up until
then, only certified-nurse midwives were granted permission
thought this meant that all of these women with years of experience
who had received their training either through other schools,
like the Seattle School of Midwifery, or abroad would be able
to get licensed,” says Graham. “The hope was that through
an equivalency process, the direct-entry midwife would be
recognized.” In fact, she adds, already-
practicing midwives were even invited to fill out applications
to practice legally.
However, very few experienced midwives were allowed to continue
to do their work: Of the 20 midwives that applied for licenses,
she says, only two were granted credentials and the rest were
“mysteriously” placed under investigation.
Alison, (not her real name), a direct-entry midwife certified
through the North American Registry of Midwives who has been
assisting families in the Capital Region for more than 26
years, points out that there is a fundamental difference between
the medical approach to birth and the midwife’s approach.
is looked at in this area as danger, danger, danger,” says
Alison. “But a midwifery model doesn’t look at birth this
way. We view birth, as a natural, normal part of life, and
to us, normal is huge. . . . We trust in a woman’s ability
to give birth, [and] a midwife’s job is to support that process.”
While all midwives promote natural childbirth and strive for
as little intervention as possible, the direct-entry midwife
avoids procedures such as ultrasounds, electronic-fetal monitoring,
medication, episiotomies and enemas. Direct-entry midwifes
rely on their hands, ears and intuition for guidance. They
often use a blood-pressure cuff, a stethoscope, a fetal scope
to listen to the fetus, a birthing stool and a birthing tub.
The women in labor call most of the shots during a home birth.
They do whatever they need to do to make themselves most comfortable.
If they want to walk, shower, squat, lay on their side, sit
in a birthing tub, laugh, cry or scream, they do it. If they
want candles, music, special friends at the birth, that is
all their choice. Whereas in hospitals, the rules are more
stringent and it is usually the doctor who dictates how the
birth will go.
Cindy, who had her two of her children at home and now assists
midwives at home births, says that she has seen midwives in
a variety of positions ready to “catch the baby.”
midwife goes where you go to catch your baby,” says Cindy.
“They get in showers, the bathtub, under tables. If you want
to lay on you side or squat, the midwife works around you.”
She says that allowing women to have mobility during labor,
and especially while delivering the baby, is more comfortable
for the woman than needing to stay in one stationary position,
hooked up to machines, like you must do in most hospitals.
Another important role of midwives is to counsel and educate
women and their partners about birth. Alison says that she
spends about an hour and a half each month with the women
she works with, and those meetings increase the closer they
get to the birth.
Many of the things that happen are preventable, says Alison,
but she thinks women need a level of care that helps prevent
average, a woman sees her OB/GYN for about 10 minutes, with
the CNM maybe 15,” says Alison. “I spend time with people.
I can be with someone and know if she looks off or funky.
I can figure out how they are really doing, and that is the
stuff that often physicians miss.”
Part of the time spent with the midwife is used to check how
the woman is doing physically, but just as importantly, it
is a chance to see how she is faring emotionally.
build a relationship with these women,” says Alison. “While
a physician may see 50 to 60 patients a month, I work with
only two or three a month. Birth is not just the physical
event of giving birth to the baby. There are emotional, social
and relational issues that all come into play here. If people
are deeply stressed or divided in their lives, birth will
be deeply stressed and divided.”
In that hour and a half, Alison says, the woman is likely
to talk about some of the fears or problems she may be having
in her personal life. In the end, she says, knowing a woman’s
emotional state helps her to help the women she is working
know we are mammals, and as mammals we respond to birth the
same way,” says Alison. “We need to feel safe and secure to
let go. . . . The body is wise and won’t go into labor if
it doesn’t know it will be safe.
And midwives know that at times, medical assistance is necessary—and
they’re not afraid to take advantage of it when it is needed.
trained midwife monitors a woman’s labor process very closely,”
says Alison. “They are watching, listening and are there from
beginning to end. If a midwife senses trouble, it usually
is detected early on, with plenty of time to get to the hospital.
If you are part of the whole process, there usually are not
too many surprises when the baby comes out.”
She also says that, if for any reason a woman has health problems
that infringe on her ability to have a safe out-of-
hospital birth, then a competent midwife would not take a
chance on performing a birth at home.
is not home birth or bust,” says Alison. “Midwives do believe
there is room for a medical model of care, when it is needed.
But that is needed a very small amount of the time.”
In her 29 years as a midwife, she averages about two to three
transports a year to the hospital; in all of the deliveries
in which she sought hospital care, both the baby and the mother
were just fine.
has always been good baby, good mother,” says Alison. “It
is about preventive care, and if the baby or the mother need
help then we go to the hospital, we get the prudent, intelligent,
smart, thorough help that is available. And we don’t wait
until it is too late.”
When she does need to transport a woman to the hospital, however,
there are only a few physicians she can call for medical backup.
Many doctors view home births as dangerous and look down on
women who practice midwifery without a license; some have
even said it is the first form of child abuse. Others are
afraid of losing their medical licenses if caught helping
an “illegal” midwife. Further, the concern of malpractice
lawsuits, should problems arise once a woman is brought to
the hospital, contributes to a doctor’s fear of backing up
midwives doing home births.
Donna Williams, executive director of the American College
of Obstetricians & Gynecology, says the main reason physicians
don’t support home births is the potential health risks involved.
For example, she says that if complications start to arise
during the birthing process, such as fetal distress, it is
important for doctors to be able to attend to the patient
within 20 minutes. If the woman is at home, she says there
is no guarantee that she can be brought to the hospital in
a timely manner. Therefore, she says, home birthing poses
liability issues—not just financial, but physical ones. In
fact, most insurance companies will not cover the expense
of an out-of-hospital birth at all.
a woman delivers vaginally and some problems occur in the
birthing process, that would require an emergency C-section,
and if you are at home, that can’t be done,” says Williams.
Dr. Jeffery Altman, an obstetrician-gynecologist in Albany
who has two certified-nurse midwives at his practice, agrees
that there are safety precautions to consider when dealing
with the issues surrounding home births. But he also said
that part of the problem stems from the difference in training.
have a more rigid expectation for what a normal labor is supposed
to be,” says Altman. “I think that we pride ourselves on this
evidence-based medicine where we try to make decisions based
on what the evidence shows. We were trained in a way that
did not have any place for home births. . . . But I think
when we look worldwide, or even in this country, there is
very strong evidence that women can deliver at home in a safe
Yvette Riley, a certified-nurse midwife working with Altman,
says that while all midwives share the same model for birth,
she would personally not feel comfortable in a home-birth
setting because her training did not provide her with that
type of experience.
Altman doesn’t permit the midwives at his practice to do home
births. The main reason, he says, is that they are not covered
by his insurance plan. But another concern he raises is that
the system is not set up to make out-of-hospital births a
of the logistics could be worked out if we were open to those
kinds of ideas,” he says. “In other states and countries,
they are set up to do this at home. They have all the equipment,
they have insurance, they have the backing of the medical
community, and it becomes a very reasonable thing to do. But
I think what is happening in New York is that we have a bias
or perception that we don’t support this, and by deciding
we are not going to support this, we make it less safe.”
Keefe said that birth is big business in the United States.
She points to the United States Center for Health’s Web site,
which shows that the top four surgeries done on women are
obstetric procedures, with episiotomies, caesarian and artificial
rupture of the membranes leading the list.
the five most common surgical procedures in the U.S., four
are obstetric in nature,” says Keefe. “This is slightly fewer
than cardio procedures, except obstetrician procedures are
only done on women.”
The high level of surgical procedures in hospitals, many midwives
believe, goes back to the whole idea of what is a normal labor-and-delivery
a midwife, time is on her side,” said Maureen Murphy, co-coordinator
for New York Friends of Midwives. “Often if you are in a hospital
the clock starts ticking, if you are not progressing at their
expected timeframes, then they are going to say, ‘OK, we can’t
let you go any longer, we have to give you a caesarean or
induce your labor.’ But often with a midwife there are no
time constraints. The woman delivers the baby on her own time
and the baby’s own time.”
Keefe says that, ironically, other industrialized nations
that depend on midwife delivery consistently achieve better
birth outcomes and have lower mortality rates than the United
Altman agrees that money and power are motivating factors
as to why many doctors are against opening up the medical
system to permit home births.
you get below the surface of what is said, there is a tremendous
issue of power and money,” says Altman. “I think it is naïve
to think that obstetricians are going to support a system
that has a large amount of their patients delivering at home.
It cuts the obstetrician out of that process. I think that
clouds our impression of whether it is a safe thing to do.”
Ginger Swasey, who lives in the Adirondacks, is not letting
New York state laws stand in her way of having the birth of
her choice. She is traveling to Vermont this summer and renting
a house, and she is going to deliver her third baby—with Devers-Scott.
She said that five years ago, when she gave birth at home
to her second child, the situation was pretty much the same.
She was hoping that by the time she was ready to have her
third child, more options would be available to her. But instead,
she said, there are actually less.
one free-standing birth center within three hours of me is
now shut down,” says Swasey. “Almost all midwives in my area
work in group practices under the direction of a physician.
This means you can’t be assured of who you will get at the
time of birth, as it is whoever is on call.”
She says that now, as a result of such stringent laws, a women
must choose to give birth in settings they are not comfortable
with, births that are unattended, they must travel out of
state, or they must look for the very few women still willing
to risk everything to continue to provide services they strongly
have legislated, regulated and criminalized women that work
successfully as direct-entry midwives,” says Swasey. “Women
must now go to extraordinary measures to assure something
that should just be. . . . It seems that we have traded in
a woman’s freedom of choice for freshly painted pastel walls,
pretty pictures covering medical equipment and higher
For many advocates of direct-entry midwifery, much of this
all boils down to a women’s right to choose.
a pro-choice issue,” says Murphy. “Couples have a right to
have a baby out of the hospital with support. I believe New
York state establishes a situation making it impossible for
families to have that support and that choice. Should women
have to give up the right to make decision about their bodies
because of hospital protocols? Should they have to give up
these rights because labor is taking too long on somebody
else’s time clock? Should they have to give up decisions about
birth because there are no options available to them?”
you were going to have oral surgery, would you have
that done in your living room?”
This was my friend’s way of asking me why I would ever
think of having my baby at home.
I told her I wouldn’t dream of having a wisdom tooth
extracted, say, in my dining room. But giving birth
was a different story. After all, she was really comparing
apples to oranges. Surgery, I explained, is a medical
procedure, whereas, for a normal, healthy woman who
has had a normal, healthy pregnancy, giving birth is
a natural process. In most instances, medical intervention
isn’t necessary, even if it is the norm in the United
I didn’t arrive at these conclusions on my own. Rather,
some close friends who had had a home birth a few years
earlier pointed my husband and me in that direction
by sharing with us their experiences and piles of information
on the subject. When I became pregnant in 1999 with
my first and only child, I began to think seriously
about the kind of childbirth experience I wanted, especially
after reading Jessica Mitford’s The American Way
of Birth and Sheila Kitzinger’s Birth at Home.
I knew that I wanted to work with a midwife instead
of an obstetrician because I liked the idea of what
is referred to as the “midwife model of care,” where
a healthy pregnancy is approached as a natural process.
I also liked the fact that midwives—at least the good
ones—tend to spend more time with patients than the
average doctor, both during office visits and while
Halfway through the pregnancy, I decided to have my
baby at home—if I remained healthy and a good candidate
for a home birth. I was turned off by some of the rote
hospital protocols, and I found the environment of even
the birthing rooms rather unremarkable and cold.
If I had lived in Vermont or Massachusetts, where midwives
routinely attend births at home, it wouldn’t have been
such a big deal. However, since I live in the Capital
Region, things were more complicated. In New York state,
a tangle of legal and licensing regulations, not to
mention politics and sky-high malpractice insurance
rates, have made it virtually impossible for the majority
of even state-licensed midwives to attend home births.
When I had my daughter two years ago, there were no
state-licensed midwives working in the Albany area who
attended home births as part of their practices.
Because of this, I ended up working with two midwives.
The first was a state-licensed certified-nurse midwife
whom I visited throughout my entire pregnancy. She was
my connection to the medical system; for instance, her
office handled all blood work and prenatal tests, and
her care was covered by my health insurance. If I had
ended up wanting or needing to go to the hospital to
deliver my baby, she would have been there. (On this
count, she went above and beyond the call of duty, because
after I told her I wanted to have a home birth, she
could have refused me as a patient.)
The second was a Certified Professional Midwife, whose
credentials are not recognized by New York state. She
works outside the system, or underground, and, well,
illegally—in New York state, that is. She and her two
assistants attended my home birth. The cost for their
care—$1,800, determined on a sliding-fee scale—was not
covered by insurance. Even though that price might make
some people wince, my husband and I believed it was
well worth it. We especially felt this way after our
daughter was born, when postpartum home visits by members
of our home-birth team continued for almost two weeks—which
is routine. Anyone who’s had a baby in the hospital
knows that after two or three days spent as an inpatient,
you’re on your own. Doctors don’t stop by your house
to see how you and your baby are doing. They don’t call
to check in on you. You can’t call them in the middle
of the night when you’re having difficulty nursing,
and they certainly don’t say, “If things haven’t improved
in an hour, call me back and I’ll come over.”
The morning I went into labor, we called both midwives.
Later that morning, my husband and I walked to a nearby
florist to buy some flowers, and at home we set up candles
in key rooms. By early afternoon a member of our home-birth
team arrived; she would remain with us until the morning
after the baby was born. My home-birth midwife and her
other assistant arrived later in the afternoon, and
we all settled in for what would be an arduous and long
Of all the things I had contemplated before having my
daughter, the one thing I hadn’t really considered was
how long it could take. I knew from my childbirth class
that something like a 36-hour labor was in the range
of normal, but I figured I’d fall within the statistical
average of 12 to 18 hours for a first a first-time mom.
I was wrong. The baby that I thought would be born on
a Wednesday night or in the wee hours of a Thursday
morning didn’t show her pink, wrinkled little face until
9:30 PM Thursday.
In the hours previous, the midwife had advised me that
if I wanted to, I could go to the hospital, especially
if I wanted pain medication. But she also assured me
that things appeared to be normal and she was comfortable
staying put. My husband and I thought it over as I trudged
up and down the driveway in our backyard. I wasn’t afraid,
I was just in a ridiculous amount of pain; I didn’t
feel a compelling reason to leave home, since I was
adamant about not using pain medication. Hey, throughout
pregnancy, everyone’s on your back about staying away
from drugs and alcohol, so I wasn’t about to pump myself
full of controlled substances in the last hours before
my baby was born.
Above all, I was put at ease by the methodical and calm
nature of our home-birth team. While all the laboring
was going on, they offered encouragement, massages,
and suggestions of what might ease pain or get things
moving along. At night they rested and took turns keeping
an eye on me. One of my vivid memories is of the midwife
quietly sitting in dim light of the dining room in the
middle of the night, writing down notes on all that
had transpired. As for us, we moved around the house
to change the scene, and on the second day, when I felt
that the miracle of life was sapping mine, we took a
walk—it was more like a shuffle—around the block. The
fresh air helped clear my head and gave me new energy.
There are people who think I must have been crazy—even
masochistic—for staying at home to have my baby. And
then there are those who are totally opposed to home
birth, who think it’s akin to child abuse. I will agree
to disagree with them. I know home birth isn’t for everyone,
and for those of us who choose it, it doesn’t come without
There’s a certain amount of preparation involved: While
our midwife supplied a birthing kit with certain essentials,
we also had to assemble other items (towels and sheets
among them) and, of course, ready a place in our home
that was suitable for birthing a baby. As a first-time
parent, I had to find a doctor for my baby who didn’t
have a problem with the fact that I was planning to
deliver at home. Then there were our parents—what would
we tell them? (We solved that by not saying anything
until after the baby was born).
And, of course, foremost in our minds were the risks.
We thought long and hard about what could go wrong,
and how we would deal with it if things didn’t go as
smoothly as we had hoped. Since most portrayals of labor
and delivery in the media and entertainment—and even
from friends—lend it an air of panic and chaos, it’s
easy to think that it’s a miracle that any woman could
deliver a baby without hair-raising complications or
life-saving medical interventions. But the reality is
that most women do, and most children are born healthy.
When well-meaning friends tell me I’m “so lucky” that
nothing went wrong with my home birth, I gently remind
them of that fact, and of the real reason why I consider
myself fortunate: because of the group of women—my home-birth
team and certified nurse midwife—who helped me to have
the kind of childbirth experience I wanted.