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Tuesday, January 30, 2007Lancaster Online is running a story about Diane Goslin, a Pennsylvania lay midwife that serves the Amish and Mennonite community. Goslin appeared before the state Board of Medicine on Friday to face charges for practicing medicine without a license. (Pennsylvania does not license direct entry midwives.)
From the article:
The 15-minute hearing allowed Goslin's attorney and the state to review and agree on the facts of the case. There was no testimony, and a decision is not expected for at least six months.
Goslin admits she holds no license and does not have credentials required by the state to get a midwife license, including a registered-nurse degree and a passing grade on an exam.
But the 49-year-old says she is certified to perform midwifery by North American Registry of Midwives, a certification organization which she said is recognized by 28 states, but not Pennsylvania. She also has 25 years' experience in the ancient tradition of midwifery, most often serving women in local Plain communities.
She also disputes she helped deliver a child in 2005, an event from which the accusations against her stem, saying she was "present for the birth of the child, but did not 'deliver' the child."
Goslin faces $40,000 in fines if charged.
To note, Goslin is licensed by NARM, a certification that is recognized by 28 states. (My own state of Ohio also fails to recognize or issue licenses to NARM midwives.)
The problems here are three fold...
1.) Direct entry midwives are needed within the Amish, Mennonite and even English communities. For those without insurance, the cost of a home birth generally runs less than half that of a standard vaginal hospital birth. Since home birth has been proven to be every bit as safe as hospital birth for low risk women (and to have lower morbidity rates) direct entry midwives provide a safe and cost effective way to handle birth.
From the article:
One speaker, Daniel King, an Amish father of eight from Lancaster County, said lay midwives offer those in Plain communities a less-costly option of home birth — which Goslin said typically costs $800 to $2,000 — compared with a minimum cost of $6,000 for hospital births.
"(Lay midwives) can come to our homes any time of the day or night because we have no transportation," King said. "There are high costs in hospitals, more disease in hospitals. My wife is more comfortable at home. We have no insurances.
"My wife and neighbors are afraid of what will happen to them if Diane Goslin gets shut down."
2.) Direct entry midwives are currently "alegal" in states like Pennsylvania and Ohio. That means that they're not breaking any laws when they attend births (unless they perform a medical procedure like an episiotimy, stitching a tear or administering prescription drugs) but they also risk prosecution any time someone wants to claim that even catching a baby counts as "practicing medicine." In states where lay midwifery is alegal, most midwives DO carry life saving medicines like pitocin or methargine for dealing with hemmorage knowing that if they use them to save a mom's life, their own freedom is at risk.
3.) On the other hand, when direct entry midwives are brought "into the system" by state licensing boards they are usually forced to operate under much stricter guidelines. In most states that recognize DEMs they are unable to attend breech deliveries, multiples deliveries, births before 38 and after 42 weeks and in a variety of other situations. That takes control of birth out of the hands of the mother and places it in the hands of a doctor.
Of course there's also the issue of a small number of midwives going up against the huge ACOG lobby. The last recorded figure I heard put planned, attended home births at about 0.5% of births each year. That makes for a pretty small group of supporters fighting for the right to home birth. That said, there were more than 300 supporters gathered at the courthouse in support of Goslin.
I'd encourage any Pennsylvania readers to consider contacting their local newspapers and representatives to show their support for Goslin.
Labels: Childbirth Issues