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Until Monday afternoon, July 10, Karen Hunter had a job. And until Monday afternoon, it didn’t seem to matter that Maryland law did not sanction her occupation. But if she goes to work again, she could end up in jail.
For the past 10 years, the 34-year-old Hunter has worked as a lay midwife, delivering babies in her clients’ homes. Unlike certified nurse-midwives (CNM), lay midwives in Maryland are not licensed or certified by any state agency, and generally do not possess a formal nursing degree or license. On Monday, Hunter was found guilty in Carroll County circuit court of practicing nursing without a license for her role in a birth in which the child died. Circuit Judge Raymond Beck gave her a suspended sentence of six months in jail, plus three years supervised probation. She may not have to go to jail, but Hunter is specifically prohibited from practicing as a midwife, which may imprison her from an occupational perspective.
The status of lay midwives has been controversial in Maryland for some time (see “Midwife Crisis,” 3/3). Lay midwifery is an ancient tradition—the word comes from the German for “with women”—but lay midwives have steadily been replaced by doctors and hospitals in the past century. The practice is against the law in a handful of states, including Maryland and Virginia. (Maryland outlawed lay midwifery in 1980.)
Hunter was one of about two dozen lay midwives who operate outside the law, roaming the state and quietly carrying out home births. Lay midwives work on the fringes of the medical profession, eschewing painkilling drugs and other technological trappings of modern birth. Given the questionable legality of their profession, most lay midwives keep a low profile, never signing birth certificates or other smoking-gun documents. They don’t advertise, relying instead on word of mouth. And when all goes well, the state authorities are none the wiser.
But the birth of Jonathan Caleb Morgan last December did not go well. Two weeks past due, the baby was stillborn after a long labor. Hunter was charged with practicing nursing without a license for her role in the birth, plus two counts of reckless endangerment: one for the baby and one for his mother, Cynthia Morgan.
Morgan, however, doesn’t believe that Hunter did anything wrong. “She had nothing to do with Jonathan Caleb’s death,” she says. Morgan and her husband were subpoenaed to testify by assistant state’s attorney Theresa Adams as Hunter’s putative victims; they resisted the subpoena, which led Adams to drop the two more serious reckless-endangerment charges.
Hunter went to trial on the third charge of practicing nursing without a license, in a courtroom packed with midwife supporters. Her lawyer, Sally Cromwell of Baltimore, argued that Maryland law does not specifically outlaw lay midwifery, but simply outlines the requirements for becoming a certified nurse-midwife. Since Hunter did not profess to be a certified nurse-midwife and was not practicing nursing, she was not breaking the law.
“The law itself is completely unclear,” Cromwell says. “Nowhere in the statute does it say you have to be a CNM to deliver a baby, and other people deliver babies every day: doctors, police officers, firemen.”
The prosecution argued that if Hunter had been a trained nurse, she might have spotted something wrong with Morgan’s pregnancy. “We’re like, hey, this baby died needlessly,” says Adams, the lawyer for the state. “Our goal was not to put [Hunter] in jail, but to put her out of business until she can satisfy authorities in Maryland that she is competent to perform this activity.”
“The board of nursing had a victory,” concedes Maureen McIvor, a spokeswoman for Maryland lay midwives. “The pursuit has been very hot for the past 15 months, and I presume that it will remain hot.”
Hunter is the third Maryland midwife to be criminally prosecuted in the past 12 months. Last September, Judy Mentzer was tried in Carroll County for assisting at a home birth. She was caught when someone at the state Board of Nursing noticed that she had signed a birth certificate. Mentzer pleaded guilty, but received a light sentence—100 hours of community service, to consist of counseling pregnant women. Mentzer is based in Pennsylvania, where lay midwifery is legal, so her practice there was not affected.
In January, Adelphi midwife Judie Pradier was charged with practicing nursing without a license for her role in the birth of Shannen Clemmons-McKay, who was born with a broken shoulder. Charges were dismissed at trial in May because of a technicality: The Howard County state’s attorney failed to identify Pradier as the defendant. A fourth lay midwife has been charged in Montgomery County, but she has left the state.
Hunter was the first to be convicted, and thus the first to be put out of a job. Her sentence means she cannot practice for three years (unless she is licensed by the state), or she will risk jail. “This is something I’ve been doing for 10 years,” says Hunter, a divorced mother of three. “I haven’t been doing anything but. I’m kind of at a loss.”
Her options are limited. Completing nursing school and midwife certification, as the law requires, takes several years and thousands of dollars. Hunter can appeal the verdict, which her lawyer plans to do. Or, finally, she can wait until the next state legislative session opens in January, when the lay midwives will begin a campaign to change the law.