Because several paragraphs were inadvertently dropped from Tuesday's editions of The Washington Post, a story on midwifery gave an incomplete account of the career of one of those individuals discussed. The following paragraphs were among those missing: Fran Ventre, Maryland's only licensed lay midwife, is currently enrolled in the Georgetown (nurse midwife) program and is a firm believer in more midwife training. Like many in the home birth movement, she first became a teacher of natural (unmedicated) childbirth (before she) began the arduous process of becoming licensed in Maryland. She was duly licensed and signed the Montgomery County midwife register two years ago. Altogether, she has delivered about 45 babies, charging $100 or less for each birth, she said.
In the Amish countryside of St. Mary's County, Md., a grandmotherly woman travels from house to house delivering the babies of the plain people who reject health insurance along with electricity and telephones. She is a midwife, who is paid $50 a birth.
She is not licensed, however, and what she is doing is against the law. In fact, no "granny" midwife has signed the dusty county courthouse register at Leonardtown in 15 years. But legally or otherwise, the woman insists she will carry on, like a circuit-riding preacher ministering to the needs of the people.
"They're gonna have babies at home anyway," she shrugs, as certain as tomorrow.
In suburban Bethesda, there's another breed of midwife: certified registered nurses, charging a flat $550 fee for their professional services, are operating with the law under the corporate name of Maternity Center Associates, Ltd. Backed up by two local physicians, who themselves did home births before the center opened in 1975, the nurse midwives have so far delivered 420 middle-class babies.
To the Amish it is a way of life dictated by both custom and economics. To a growing number of sophisticated urban and suburban couples, it's a "movement" against what they regard as the depersonalization of institutionalized childbirth in hospitals.
Movement or way of life, the age-old practice of midwives continues to confound the health establishment, which sees no need for it in this day of accessible, modern hospitals, and indeed, sees some risk to maternal and infant health in midwife-attended home births.
The home birth-midwife advocates, for their part, decry medical "intervention" and see behind opposing arguments the specter of financial self-interest. "Midwives are very threatening to obstetricians, especially since the birthrate is down and malpractice is such a problem," acknowledged one Washington physician in a recent Georgetown University medical newsletter.
The midwife does in fact take the place of a doctor at birth, receiving the baby as it emerges. The midwife stays to deliver the afterbirth and assure the health and comfort of the mother and newborn. This seemingly simple procedure has sent shock waves through the medical community.
"We're having a great deal of trouble about this whole thing," said Dr. J. King Seeger, chief of maternal care for the Maryland State Health Department.
Seeger, who is on record as opposed to lay (non-nurse) midwives and to home births generally, told a reporter recently, "I have nothing to say. I'm trying to find out what's going on."
What's going on, from several accounts, is a boom in the ancient practice of midwifery, despite official efforts to curb it.Virginia outlawed lay midwives two years ago, but still allows the practice by nurse midwives. The District of Columbia is reviewing its midwife regulations for the first time since 1929, when the last one was licensed.
Maryland health officials, including Seeger, tried unsuccessfully to ban lay midwives two years ago and remain unhappy over the 1924 law still on the books.
Maryland's only licensed lay midwife now is Fran Ventre, a 36-year-old, self-described "nice middle-class suburban lady" who is intimately familiar with the underground network of illegal midwives.
"There's a lady in Columbia, Md.," she said. "There's a few in Baltimore I know of. One is a young girl who's kind of a hippie type into astrology and stuff like that. She went to a few births, led a home birth meeting and started going to births.
"In Virginia, all around the hills, I know of maybe 10 or 20," she said. One, a Jehovah's Witness, "claims she got her training at a conference in El Paso, and she's been to maybe 10 births and done some reading. She's gotten herself known as the Jehovah's Witness midwife and she really has very little training . . .
"I mean, anyone could come along and say, 'I'm a midwife," Ventre said. "That's how a lot of midwives are doing it. I did it that way, too."
The revival of home births, considered the misfortune of the poor in the days when doctors routinely made house calls and these were few hospitals, is a national phenomenon in which Washington is a hub of activity.
The Maternity Center, with offices wedged between those of doctors and dentists in a medical town house complex near the National Institutes of Health, is the nation's first incorporated nurse-midwife service.
The Takoma Park home of Esther C. Herman serves as national headquarters for another group known as HOME, for Home-Oriented Maternal Experience. HOME was founded by a handful of homebirth enthusiasts here three years ago, and now has 44 chapters in 19 states.
In this area, where no known physicians deliver babies at home, home births usually mean midwives and principally the Maternity Center. HOME and the Center are close allies in this movement.
So fervent is the belief of home birth enthusiasts, bordering almost on the religious, that 30 people from as far away as Pennsylvania turned out on a recent rainy week night for a HOME meeting at a Silver Spring library.
The pronouncements of the urban back-to-home birth advocates are an interesting blend of radical and conservative ideas. A recent newsletter of the Princeton, N.J.-based National Midwives Association offers the following advice on how to lobby lawmakers on belief of "the childbirth constituency:
"There are values we hold that are very difficult for a politican to argue with - feel free to throw these phrases in frequently: the privacy and sanctity of the family against government encroachment; freedom of choice in health care . . ."
In some places, the medical establishment has begrudingly accepted the presence of nurse midwives working under supervision of physicians in hospitals. There remains, however, almost universal opposition to lay mid-wives performing home deliveries, and quite frequently, to home births, period.
"The fact that it can be done doesn't mean it ought to be done," said Dr. Raymond Scalelettar, president of the D.C. Medical Society. He understands the increasing demand for a "warm, humanistic type of association" in home birth, he said, "but a risk is present."
Jody Creager, who gave birth to a daughter at her Arlington home with midwife assistance on Oct. 24, said the concerns she and her husband shared concerning any risk disappeared the more they read about childbirth. "It became clear," she said, "there are very few life-threatening circumstances that can't be dealt with" at home.
Just in case, the Creagers visited nearby Arlington Hospital. "On hospital tours, I was kind of freaked," she said. "At home, I was with people I knew. Nobody grabbed the baby away . . . It was great, no problem at all."
Opponents and proponents of home births with midwives have so far been unable to agree on statistics of infant and maternal mortality related to the home or hospital setting.
The Maternity Center nurse midwives have had one infant death in 420 deliveries, according to Janet L. Epstein, one of the center founders.
There have been no maternal deaths. "I'll quit when that happens," Epstein said. The center had 80 other patients, she said, who were "risked out" - told that the problems of their particular pregnancies mandated a hospital delivery.
Midwives performing home births constitute a "hot economic issue," Epstein said. Many, if not all, doctors agree.
"With hospitals on the brink of insolvency," Dr. George I. Lythcott, the assistant surgeon general, wrote Epstein, "they can ill afford the short-run consequences of stimulating even less utilization . . ."
Doctors quoted in a recent Georgetown University medical newsletter complained that nurse midwives operating in teaching hospitals would "cut into student and residency training."