(Bob Williams/Philadelphia Inquirer/Newscom)
Laboring to save home births
Amish groups rallied politically against state closure of midwife Diane Goslin's practice.
By Mary Beth McCauley / July 22, 2008 edition
Correspondent Mary Beth McCauley explains the Amish preference for home birth.
Mary Beth McCauley
Bradley Bower/AP
Time of need: Pennsylvania Amish groups rallied last year to save Goslin’s practice. Susan Rocca, with her son, Nicea, supported Goslin at the state capitol.
Midwife Diane Goslin’s farmhouse office bustles with activity this summer morning. Horse drawn buggies line the driveway, while pregnant women line the waiting room inside – their hair tucked into bonnets, their dark dresses covered by black aprons.
A mother expecting her 11th child arrives with her daughter, who is expecting her first. Women do mending as toddlers scoot around their ankles. Childhood friends reunite, chattering in Pennsylvania Dutch. Sisters shriek with laughter at the unexpected sight of their expectant aunt.
Outside, on the porch – in a waiting room of his own – a lone, straw-hatted man rocks, amused, pretending not to overhear the women.
The Amish here in Lancaster County may go to the hospital if they break an arm or need surgery, but when it’s time to give birth they stay home. Usually, they deliver their babies with the aid of a midwife, and the women in this waiting room half-joke that if Ms. Goslin goes out of business, they are through with childbearing.
It appeared to be coming to just that last fall when the Pennsylvania Board of Medicine ordered Goslin to cease and desist assisting her mothers, deeming it “practicing medicine and nurse midwifery without the appropriate licensure.”
Though the case arose because an infant delivered by Goslin died a day after birth, it was never considered her fault, nor has there ever been any suggestion that her rates of death or complication are unusual. If she were practicing in any of the 24 states that recognize her status as Certified Professional Midwife (CPM) by the North American Registry of Midwives, she’d have proceeded with her usual 200 to 300 deliveries a year.
But Goslin’s case illustrates the debate about whether childbirth is a natural bodily function or a medical event necessitating hospitalization. As in all ethics-meet-medicine turf battles, one party’s science is often another’s smokescreen.
Indeed, this isn’t new for the Pennsylvania midwife. Last fall’s case was the third time similar charges were brought against her in 18 years, and the third time they were dropped. In May, a 5 to 2 decision by the Pennsylvania Commonwealth Court overturned an $11,000 fine and lifted the cease-and-desist order. All three cases were brought after the state received complaints that Goslin was violating its licensing regulations. Simply doing what she does is against the law, maintains the state. And her business card, on which Goslin “is advertising her services,” is “clearly evidence of unlicensed practice,” says Leslie Amoros, of the Pennsylvania Department of State, which oversees the board of medicine.
Though cleared, Goslin’s work continues under a legal question mark because Pennsylvania recognizes only nurse midwives. Most of those are hospital affiliated and unavailable for home birth.
• • •
In the Amish farmhouses of this rolling hill country, Goslin is considered family. For some women, she’s delivered a dozen babies. And, in Goslin’s own time of need, this community rallied to help – a departure for the reticent Amish who generally refuse to be photographed or be quoted by name. But on behalf of their midwife, they protested at the state capitol, staged benefits and teas, and filed an amicus brief.
Non-Amish – who make up 35 percent of Goslin‘s practice – also turned out, as did advocates of women’s right to give birth in whatever setting and with the attendant of their choice.
The home birth debate has been joined recently by such participants as talk show host Ricki Lake, with her pro-home-birth documentary film, as well as by traditional players such as the American College of Obstetricians and Gynecologists, which recently reiterated its opposition to home birth.
“The [issue of] the medicalization of childbirth has been around for a long time, now,” says Arthur Caplan director of the Center for Bioethics at the University of Pennsylvania. “There will always be [people like] the Amish, who want no technology” on one end of a continuum, and those who will refuse to have a baby “if they can’t deliver at University of Pennsylvania” on the other. He argues that the home-vs.-hospital argument should be removed from the ideological push and pull, and instead be driven by safety data specific to the woman‘s age and risk factors as well as the availability of emergency backup care.
But it’s not always that simple. Such data are everchanging, and, debatable. Research, reports the Midwives Alliance of North America, suggests that safety rates of home births are equal to or better than those of hospital births for low-risk women (with no other health problems). Even so, that’s a difficult comparison, because the total – 40,000 to 45,000 babies born at home each year, according to alliance statistics – remains only about 1 percent of all US births.
• • •
But demand is still high enough that in her 28 years of midwifery, Goslin has never advertised, nor had to hang a shingle.
The world of medicine, for Goslin, is no enemy. Raised in an extended family of doctors, and the mother of a physician as well, she became interested in home birth, she explains, when a hospital-acquired infection she sustained at the birth of her oldest child left her infertile.
Seven years later and about to begin medical school herself, Goslin learned that – in spite of her diagnosis – she was pregnant and decided against medical school.“I wanted to raise my miracle baby myself,” she says. She delivered with a midwife and, believing that such care shouldn’t be solely a counter cultural option, began to apprentice with a midwife.
With 5,000 babies under her belt, Goslin seems to have encountered every twist and turn that childbirth can take. She points out that CPM certification requires attendance at more than double the number of births required for nurse-midwife licensing. Many of these births are required to take place outside the hospital, thus affording rare experience in successfully delivering breech babies, twins, and handling many other conditions that in a malpractice-minded age often trigger automatic cesarean sections in hospitalized patients. But, she adds, “I never had a baby that I could say ‘if that baby had been born in a hospital it would have been OK.’ ”
Now a mother of five, Goslin has been married 34 years to her junior-high school sweetheart, a teacher who is so familiar with her work that she calls him her “armchair midwife.”
She is a member of a conservative evangelical church. “I’m a Christian. I pray for each of my patients. I ask God for wisdom.”
During labor, Goslin’s mothers find that Scripture reading often calms them, and in the packet of instructions on diet and exercise she gives new patients are suggested Scripture passages. She says she feels called by God to her work, and assisted by God in her work.
• • •
On Wednesdays, once again, the gentle, dark-haired Goslin presides over her office as staff prepare the women – taking belly measurements, recording vital signs, and screening for conditions requiring special instructions or referral to an obstetrician. They lend books on pregnancy, answer questions, and make appointments – “You say you all want to come back in on the same day?” Though she has been paid in quilts or livestock, the customary charge is $1,000 per delivery.
When labor begins, parents will lay out linen, basins and other supplies, and contact Goslin, who, with an assistant, heads out into the hills, her 2003 Subaru already loaded with delivery bag, emergency equipment, and – the mothers’ favorite – Goslin’s personally designed birthing chair.
After checking on the patient, she may tidy up a kitchen, cook for a husband, or read. “Most of the time, if truth be told, we’re not needed,” she says. But at other times she is perhaps actively directing a mother through an arduous delivery, or removing a wrapped umbilical cord, or suctioning a baby that has breathed in meconium.
Annie (who, agrees to be identified by first name) is expecting her seventh child, and she knows the drill. “I pace my kitchen floor, lean over my chair, say my prayers…. When Diane comes, she’s my boss.” Even Annie’s most difficult delivery was met with a sunrise, a moment so tranquil, she recalls, she gave the child the middle name of “Joy.”
An Amish mother expecting her sixth child recalls how Goslin strapped her birthing supplies on a toboggan and walked uphill to her farm when the road was impassible one winter. “I didn’t even think to be worried. I figured she’d get here. She always does.”
2. Gwen Holladay | 07.22.08
Thank you for this beautiful article. I wish I had known someone like this when my son was born. The whole hospital experience was so cold & impersonal.
Gwen Holladay
3. Jody Ward | 07.22.08
It is becoming more and more apparent that women from all walks of life and every level of education are choosing to birth their children gently, in their own homes, with the attendants of their choice. Across the country midwives like Diane are making that option accessible to women in the United States. The U.S. has the 2nd highest infant mortality rate in the industrialized world, in spite of the fact that 99% of births here occur in hospitals. Midwifery is good for mothers, good for babies, good for families, and good for the economy.
4. JodiB | 07.22.08
Wow! Go Mrs. Goslin! I am grateful to have had both of my children in the luxury of my own bedroom, thanks to a nurse-midwife practice that does home births in the D.C. area. Christian Science folks love to have home births too, traditionally. I send much much love & prayerful support from Virginia to you & all midwives everywhere. 2 of my 3 brothers were also born at home, as was my step-mom, and many of my cousins, one set of cousins was twins born at home! Very exciting.
6. David Nelson | 07.22.08
My wife (and I), RN and professional engineer respectively, have had 5 home births, including one breech and one where the child came so quickly that I got to be midwife. It seems positively hypocritical that our society accepts that a woman can terminate her unborn child, then get proscriptive about how and where she births it. At any rate, the statistics on home birth indicate that it’s safe when practiced by women who are otherwise healthy and physically capable. On the other hand, our research and direct experience led us to the conclusion that the insurance-related issues that distort medical care in general definitely affect hospital births for the worse: when our son persisted in presenting as breech at 34 weeks we explored the option of hospital birth but were turned down by every obstetrician in town, who in so doing determined that my wife would first be seen in the emergency room! How do you spell “C-section”? We sought out the advice of our state’s leading perinatologist (that’s an obstetrician who specializes in difficult pregnancies) who said “The midwives can do it”, whereupon he gave them special instructions that he himself had learned while studying with african-american midwives down in the bayous of Louisiana.
Midwives are intelligent and communicate the risks to their clients. Parents are intelligent and want the best for their children. And birth is a natural process that only requires hospitalization if and when problems arise. Managing and balancing risks is the kind of thing adults do every day, no government-mandated professional assistance is needed.
Americans, demand your liberty back. Thank God for the Amish, whose revulsion for the shrink-wrapped life should be an inspiration to us all.
7. Pregnant Man » Laboring to save home births - Christian Science Monitor | 07.22.08
[…] Google Inc. wrote an interesting post today onHere’s a quick excerpt […]
8. Diana | 07.22.08
Having been a midwife myself for many years I have much sympathy for Diane. The beauty for the new family, the safety of midwifery has long been established yet many of us are no longer in practice not due to the lack of interest from families, nor poor health care delivery, but due to the exorbitant cost of legal representation when we are spuriously taken to court and medical bias that continues to limit our scope of practice. As with Diane, many are harassed by uninformed MD’s, Medical organizations, hospitals and the insecure legal system. Many of us put our families in jeopardy as we practice without malpractice insurance due to medical ignorance. After years of fighting an uphill acceptance battle, we retire. Perhaps then the medical establishment has won? Midwives wait until the atmosphere improves or until we can go to Europe and other countries where our acceptance is unquestioned. What a poor state of affairs for United States medicine that inspiteof postive statistics, in birth the US remains limited.
9. Debbie | 07.22.08
Thank you for giving us an insight into the life of this dedicated midwife. I can certainly see why her clients would rally around her. I wish all mothers had access to such a skilled midwife.
I live in one of the other states where midwives are prosecuted for helping at home births. All the recent movies on birth and the national media attention on the access to care crisis for home birth families is giving me hope that perhaps my daughters will have access to the same quality care that Diane Goslin gives her clients. I think the quality of births in the United States would greatly improve if there were more midwives and they were an integrated part of the health care team.
10. K. MacKay | 07.22.08
I so agree that women should have a choice about home births. I had four at home very happily, three born in England where home birth is more common. My daughter was so pleased she was able to have her third at home. A midwife drove at topspeed through the Bozeman pass in Montana to get there on time. (She says the police know her car and never pull her over!)
11. Joyce Krings | 07.22.08
I think what Diane Goslin is doing to help deliver babies is more then
OK. The people that want to make trouble for her, should spend more
time trying to STOP abortions, and not worry about Diane trying to bring
new little lives into this world. God Bless her.
12. Heather | 07.23.08
This article is so touching. And I absolutely love the photo. On a side note: I’m not Christian, but feel so passionately about this issue that I am glad *someone* is talking about it and in such a positive way. Good for The Monitor.
13. C. Casperson | 07.23.08
Women surely have the right to choose where to have their babies. It is a natural event, not a medical event. Midwives may guide a woman to go to a hospital if there is a problem necessitating medical intervention. The medical world should not be allowed to act as “The Big Brother” . The Ricki Lake dvd “The Business of Being Born” is highly recommended for any who may have doubts.
14. Lifestyle | Do the Amish use batteries? — Recycle Email | 07.23.08
[…] Laboring to save home births Christian Science Monitor - Boston,MA,USA By Mary Beth McCauley / July 22, 2008 edition Time of need: Pennsylvania Amish groups rallied last year to save Goslin’s practice. Susan Rocca, with her son … See all stories on this topic […]
15. Nerisis | 07.23.08
The debate about home births vs hospital births is really a matter of women being able to make a choice, a well-informed decision, about what is best for them and their child. Women should always have the choice- which is something the American Medical Association wants to take away.
16. Joyce Vanselow | 07.23.08
Thank you for such a balanced picture of homebirth as an option for which women continue to assert as their right as well as of midwifery as an appropriate mode of maternity care, and of Diane Goslin, as an integrity-filled community-based care professional, who has rightly earned the trust of so many. The love and respect she receives from those she serves reflects the integrity, heart, skill and care with which she serves.
J.
17. Eireann Kiley | 07.23.08
Thank you for publishing this very important story. The ability to make safe birthing choices is a human rights issue, and it’s amazing that women in the United States must struggle so hard for this. Whether a woman is a member of the Amish culture, or simply prefers a peaceful and safe birth at home without the constant threat of coerced or even court-ordered surgery (which carries too many risks to be safely considered a “default”), she should be assured of the freedom to choose a skilled and experienced midwife like Goslin.
18. Muhammad | 07.23.08
Goslin is a true hero. I found this article very inspiring. I think what Goslin is doing is simply amazing. By charging a meager $1000 and going out her way to assist those in need, she is not only touching the lives of the mothers but also those who she is helping to come into this world. I’m appalled at the fact that her license is being taken away. I hope she gets to keep her license. Midwives have been delivering babies for thousands of years pretty successfully without the need of any hospitals. For someone like me, a hospital might be a necessary measure but we ought to realize (and respect) the religious concerns of the Amish community and we, as a nation, need to support them in whatever we can.
19. jennifer beck | 07.23.08
Once again the medical establishment thinks they are the ones to invent safe childbirth. They are morons, they make me sick. Dear God, please save me from the ones who are trying to “save” me.
20. bioethics.com » Blog Archive » Laboring to save home births | 07.23.08
[…] groups rallied politically against state closure of midwife Diane Goslin’s practice. (Christian Science Monitor) Posted by Bioethics Pundit Posted in Healthcare, News […]
21. Sally | 07.23.08
Beautifully written. Thanks for fairly showing the safety, beauty and personal nature of birth.
22. G. Heckenbach CNM | 07.23.08
God bless her for all she does for these women. I totally agree with her and what she does. It is not a crime to assist women in bringing their babies into the world. I thank God every day for all that He helps me to do for the women that I care for. I commend her for her strength in giving of herself in the way that she does. There is a reason that she was chosen to do what she does. There should be more women like her to do what we as midwives do everyday. Unfortunately, sometimes we have to “follow the rules” and abide by the laws that have been put forth by men. That’s why I chose the route I’m on in assisting women in birth. But I am glad that there are women who have the strength to do homebirth as some of us don’t have that advantage. God bless.
23. Elizabeth Heeter | 07.23.08
As a mother who chose to give birth at home under the care of a professional midwife, I read this article with great interest and appreciation. Considering our nation’s deplorable infant and maternal mortality rate and an ever-increasing surgical-birth rate in hospital births, I hope to see more stories about women’s birth choices.
Like the women in the article, I have also attended rallies to support the licensing of professional midwives. And I observed that homebirth families include a very broad range of conservative, liberal, religious and non-religious individuals.
I would like to point out that while safety rates are clearly of utmost importance when it comes to childbirth, there are many other factors worth comparing between home and hospital birth experiences: quality of prenatal and postnatal care, childbirth education, breastfeeding support, nutrition education, etc. These aspects need to be evaluated in order for consumers (pregnant women) to be able to make informed choices.
I would be very interested to read more on the subject of childbirth in the US– perhaps with some comparisons to other nations in which home birth is the common choice.
Thank you again for this informative article.
24. Elena Karplus | 07.24.08
Rather than give Ms. Goslin a hard time, we should be working on cloning her! How lucky the Amish women are to have her and how sad for us that we have to depend on the medical establishment to birth our children. Childbirth in this country has become major abdominal surgery and the fear that women feel about something as joyful as giving birth is enormously sad.
25. Cathy O’Bryant | 07.24.08
This article is soooooooooo sad. I can’t believe that the other midwives in the area are not sticking up for this woman. I am a midwife with 26 years of experience, as the years go by, I see the government getting more and more involved with the practice of midwifery. This is a natural normal physiological process and should not be considered a medical phenomenon. Please protect this woman’s rights as far as supporting her and her clients for the right to choose. Cathy
26. Health Care Tips » Blog Archive » Christian Science Monitor Examines Debate Surrounding Home Births | 07.24.08
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[…] the National Partnership for Women & Family Website: The Christian Science Monitor on Tuesday examined the debate over whether “childbirth is a natural bodily function or a […]
31. Marvin L. Zinn | 07.25.08
We need Amish women sent to government positions to stop others from interfering with our life. Mid-wives do a much better job than medical doctors and hospitals. I do not care what “degrees” they don’t have, they are just plain smarter.
32. Amish groups rally against state closure of midwife’s practice | 07.28.08
[…] according to the article, Laboring to save home births, Ms Goslin grew up in a family of doctors and she planned on going to medical school herself, but […]
34. Claire Veisseire | 08.01.08
Thank you for your article on Midwife Diane Goslin. Having been raised in a conservative western medical system with a mother working as a surgeon and performing Csections, one would think I would be the last one to be in favor of home births. However my mother choose to give birth to her 4 children with midwives including my twin sisters. Thanks to her trust in birth I feel that it is up to women to have choice. Most women need to be able to give birth where they feel the safest. Some that choice will be at the hospital, some it will be at home. Either place is safe, but if one does not have the choice her body may be under so much stress that she will not be able to release the hormones necessary for her to have a safe vaginal delivery. Having a hospital as the only place to birth can be as limiting as having no hospitals at all. I wish Pensylvania could see that Diane Goslin’s practice is an important link to a healthy birthing society.
Yours sincerely,
Claire Veisseire
35. Michelle Wilbert | 08.01.08
As a Midwife who recently gave up her practice due to the recent “crack down” by the AMA/ACOG; I am delighted to see the Christian Science Monitor, one of my favorite daily papers– I somehow did NOT receive the July 22 paper in the mail ( sometimes happens ) but in reading my paper today ( Aug 1 ) noticed a letter to the editor regarding this piece and came online to read it; I’m so glad I did–I have been involved with Midwifery and homebirth since 1981 and having to decide to “retire” early was heartbreaking to me. I would be very happy to be a “licensed Midwife” here in Michigan but, unfortunately, our State seems to be more interested in shutting us down than in providing the legal over site and protections that would make homebirth, and Midwifery, the safest possible option for everyone involved. As Midwives, we do indeed, become “part of the family” during those precious months and I too, have attended many families over and over and each time; it’s a joy. Homebirth and Midwifery are simple, sustainable and sane healthcare that, at a moment in our history when “health care reform” seems to be the watchword; would seem to deserve some serious consideration. Thank you for a lovely and fair, article on homebirth.
36. Lyta Venn | 08.08.08
As one of the above comments indicated, I too had an atrocious first birth in a “medical hospital” populated by bored and self motivated medical practitioners. They even lacked knowledge and experience with breast feeding.
I spent a great deal of time investigating alternative birth opportunities. Living in California also limited my access to a midwife. I was lucky to find a pro-home birth pediatrician. My education came from several home birth organizations and the LaLeche league. I had two beautiful pain free experiences at the births of my two sons, nearly sleeping through the youngest. My husband “caught” both and his bonding with each boy is strong to this day nearly 30 years later. We new the statistics on complications, he studied the fireman’s manual on births and we also completely accepted the possibility of calling in emergency help should an indicator of complication raise it’s head. We made peace with every possibility including our child’s death. Thus we entered our pediatrician on birth day and received a standing ovation. Not all medical practitioners are against home births.
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[…] August 9, 2008 Laboring to save home births | csmonitor.com […]
1. Jennifer M. Cain | 07.22.08
Thank you for giving the homebirth debate much needed media attention. My first birth at a hospital was so fraught with medical intervention, I decided to try a homebirth for my second. Besides helping with understanding my labor and birth, my homebirth midwife gave me the confidence in birth, the most natural of events, and in my body’s ability to do it. In the hospital, the doctor delivers the baby; at home, the mother gives birth with a midwife’s help. We must keep both choices legally available.