Update: The Case of Indiana Midwife Ireena Keesler--and Why She Won't Be Practicing
In the past few months, two certified professional midwives have been arrested in Indiana for attending homebirths. As I wrote on BlogHer last week, Ireena Keeslar, 49, a diabetic mother of five, is one. Now this dedicated, experienced midwife who mostly works with low-income Amish women has said she will no longer practice.
In Indiana it is a felony for certified professional midwives, like Keeslar, to attend homebirths. “We have defined the delivery of babies as the practice of medicine,” said Representative Tim Brown, M.D., an emergency room doctor who is chair of the Public Health Committee in the Indiana House of Representatives, and who currently opposes the bill to license certified professional midwives. “That’s the law,” Brown said.
Like many doctors in Indiana, Brown believes CPMs are not qualified.“I don’t think they have the training and expertise that at this time renders them qualified that we should license them in the state of Indiana,” Brown said.
“The delivery of a child in a hospital or at home is the practice of medicine, and lay midwives do not have the educational training required in the event of an emergency,” agreed Mike Rinebold, director of government relations for the Indiana State Medical Association.“Even in the most routine births, things can go wrong in a heartbeat. You have to have the education and equipment necessary to be prepared for an emergency.”
But a spokesperson from the North American Registry of Midwives, the non-profit organization that provides national certification, disagrees. “Evaluating risk is part of the training,” said Debbie Pulley, director of public education and advocacy and a CPM in Lilburn, Georgia. “CPMs are certified in neo-natal resuscitation. They are trained in how to deal with hemorrhages, and they have knowledge when to transfer care to the hospital.”
CPMs must have 1,350 clinical contact hours with pregnant women, mothers, and babies, as well as the knowledge and the skills to pass a 4-hour skills exam and an 8-hour written exam. “Our certification insures that midwives meet core competencies for knowledge and experience,” Pulley said. “NARM requires both didactic training and clinical internship and passage of the national exam for certification.”
The average length of training to become a certified professional midwife is three to five years, according to Pulley. “The required number of births, prenatals, and postpartum visits that family practice doctors, certified nurse midwives, and certified professional midwives need is virtually the same,” said Mary Ann Griffin, president of the Indiana Midwives Association.
Keeslar, who lives in Howe, was arrested on Saturday morning, March 31. She spent the day in a jail cell with no access to her medications. There was someone else’s phlegm in the sink and she was served food inappropriate for a diabetic. She was released Saturday night on bond.
Keeslar’s daughter, Anastasia Griffith, was at her job at Hardy’s, a travel store on the south side of the toll road in Howe, when her older brother Nathan called to tell her their mom had been arrested. “My brother picked me up and went over to my parents so I could sit with my father,” Griffith said. “He was sitting at the house not knowing what to do. He was just as confused as I was.”
Griffith has been married for five years and is looking forward to starting a family. She believes women in Indiana should be able to choose where and with whom they give birth. “I’m definitely having a homebirth,” she said. “This cause means a lot for me personally to have my mother be the one who delivers my child in my home in Indiana.”
Griffith believes criminalizing certified professional midwives is unfair. “What hurts me the most about this is that now I don’t have that choice for myself anymore.”
Women in Indiana who want CPM-attended homebirths are crossing the border to Michigan. In Michigan certified professional midwifery is not expressly forbidden by law, though midwives say they are still vulnerable to harassment or prosecution.
America has one of the highest maternal mortality rates of any industrialized nation. According to Save the Children, the likelihood of a mom dying due to pregnancy related causes in the U.S. is seven times greater than in Italy or Ireland; the likelihood of her dying as a result of childbirth is five times greater than in Germany and Spain, and 15 times greater than in Greece. One recent study of maternal mortality in New York City found that 79 percent of women who died in childbirth had Cesarean births.