The perinatal death rate of Colorado's home birth midwives is horrific. Get the real story about these uneducated practitioners here:
By William Breathes
By Patricia Calhoun
By Michael Roberts
By Patricia Calhoun
By Michael Roberts
By Michael Roberts
By Michael Roberts
By Melanie Asmar
It was nighttime when the contractions started to come.
Indra Lusero wandered from the bedroom to the living room to the bathroom as she labored in the Highland bungalow she shared with her partner, Allison Lusero Hoffman. The birth had been carefully planned: A portable hot tub was set up so Indra could immerse herself in warm water to soothe the pain of natural, no-drugs labor. Luminarias — candles in paper bags — glowed outside. Allison and Indra's friend LuAnne was there to offer encouragement and massages. Geoffrey Bateman, the baby's biological father, tended to a ham cooking in a crockpot. And Indra's midwife, Flame, kept a watchful eye on all of it.
Later, as her labor intensified, Indra's brother, Jimmy, thumped out a rhythmic beat on a drum, while her sister Laura repeated a passage that Indra had selected by lesbian poet Audre Lorde: "This is a grave responsibility, projected from within each of us, not to settle for the convenient, the shoddy, the conventionally expected, nor the merely safe."
There are some who would say that what Indra was doing wasn't safe at all. Home birth has long been a controversial issue. Doctors and nurses say it's unnecessarily risky, and they criticize the midwives who deliver babies at home as amateur and insufficiently trained.
But to Indra, giving birth in her own home, with her trusted friends at her side, felt nurturing and awe-inspiring and secure. Which is why, very soon after Eliot Indigo was born, she vowed to become an advocate for Colorado's tiny midwife population. It's also why, eight years and a law degree later, she's launched herself into the middle of a tense battle between midwives and the medical establishment that's been simmering for decades.
The next round takes place this year, when the law that legalizes midwifery will expire unless the state legislature renews it. Senator Morgan Carroll, an Aurora Democrat, is sponsoring a bill to renew and revise the hard-won law. There are several changes on the table, including one that would allow midwives to administer drugs such as vitamin K to newborns, which they're trained for but prohibited from doing. Another provision would lift a ban on simultaneously being registered as a nurse and a midwife.
Indra hopes to have a say. She's started a coalition of people who support home birth — from moms who hired midwives to those who wish they had — to advocate for what they see as common-sense revisions to the law. A few of the changes they're pushing for, such as the ability for midwives to suture women who experience tears during childbirth, are ones that the Colorado Midwives Association has been willing to forgo this round in an attempt to play nice — which has put Indra at odds with the CMA leadership.
But while some midwives wish she'd leave them alone, others applaud her. And many are simply watching and waiting to see if this 36-year-old home-birth-mom-turned-lawyer can make a difference for the age-old, often misunderstood practice of midwifery.
"It was an incredible journey," Indra says of the day her son was born. "There were no special tools. There was hot water and there was a drum and there were loving hands...What are we doing that more people can't have this?"
Although her labor lasted through the night and carried over into the morning, Indra knew when it was time to push. Up until then, labor had felt like something that was happening to her. Now, she had a role; more than that, she had a job to do.
One of Indra's earliest memories is the day her brother Jimmy was born in her parents' ranch house in Longmont. It was 1977, and Indra (whose given name is Lisa; she changed it to Indra as an adult) had just turned three. Her parents, Rick and Sue Lusero, were high-school sweethearts who'd met in Longmont, gone to college together outside of Chicago and then moved back to Colorado, where Rick earned a law degree and became a municipal judge.
"We were conservative hippies," Sue explains now. "We wore jeans and flowered shirts, but we were hardworking kids and good students."
Sue had given birth to both Lisa and her younger sister, Laura, in hospitals, but hadn't liked the way she was treated the second time. When she showed up at Longmont United Hospital, fully in labor and ready to push, the nurses told her not to because the doctor wasn't there yet. It was dinnertime, and the hospital requested that Sue wait until afterward to deliver her baby. She did, but she was furious.
After that, Sue says, "there was no way I'd consider going back to the local hospital." So when she and Rick learned they were pregnant with their third child, they decided to have the baby at home. They began attending how-to home-birthing classes held at night in the foothills of Boulder; midwifery was illegal then, thanks to a 1941 law, and Sue recalls feeling somewhat cloak-and-daggerish. "It was this illegal thing we were learning about," she says now. "But the class was very informative and very empowering. I remember the moment, the fear of realizing the responsibility we were taking on."
The couple didn't hire a midwife. Instead, they began assembling a team of friends and acquaintances to help with the birth: a neighbor who happened to be a pediatric nurse, an obstetrics nurse whose husband worked with Rick, a family doctor who had a crush on Sue's sister. They considered hiring an ambulance to sit outside the house in case there was a complication, but the doctor talked them out of it. You'll be fine, he said.
Indra's recollections of the day are those of a three-year-old: She remembers eating Froot Loops. She remembers that her uncle was watching football. She remembers her nervous grandma trying to shoo her from the room, worried that the birth would be traumatic for little Lisa. Indra doesn't remember the actual birth moment, but she recalls feeling excited that her brother was born, safe and healthy.
Indra's mom got pregnant again four years later, and this time around she hired a midwife, even though midwifery was still illegal in 1982. But because the birth happened so quickly — little Anna was born 45 minutes after Sue's contractions began — even the midwife missed it. According to an often-told family story, Rick, who was half-blind without his contacts in, delivered Anna on the back porch with the help of the family dog.
"It was so wonderful," Sue says, "that in spite of Rick being blind, we knew what we were doing and we weren't afraid."
Although Indra was sad to have missed the big event, she was glad to have another younger sibling. "I was happy to be the oldest," she says. "I wasn't one of those kids who was like, 'Why are these other people here? Send them back.'
"I was like, 'Come on, gang!'"
"She was the leader," says her sister Laura. "We have old cassette tapes recorded of her leading us in different shows. 'Now, we're going to read this poem! And then dance! And sing a song!'"
Indra was always theatrical. She took dance lessons and had a part in a community-theater production of Oliver! She and a friend wrote their own newspaper, The Cow Chronicles, on a typewriter at her dad's office. One of her proudest moments was when she won a creativity award at the state Odyssey of the Mind championships.
"She was raised with the Marlo Thomas Free to Be...You and Me framework," Rick says. "If she was into one thing, we were fine with nurturing it."
But Indra was also stubborn — whether it came to taking out the trash or responding to her teachers. Although she loved reading and writing, she hated school. In eighth grade, she left the Longmont public school system and enrolled in the small, private Dawson School in Lafayette. Dawson suited her well: She played Helen Keller in the school production of The Miracle Worker and sat on the student council, where she campaigned against the dress code. Her junior year, she wore a black armband to school to protest the Gulf War.
She considered coming out in high school but decided against it. It was the early '90s, and though her family was accepting of gays and lesbians, she says she still considered it "risky" to admit that she was queer. But by the time she arrived at the University of Puget Sound in Tacoma, Washington, she was ready. During the first few weeks of her first year in college, she met a woman named Allison in her dormitory and fell in love..
Their courtship started with a case of homesickness. "She sent me a card saying, 'I saw you across the room, and I heard you were missing Colorado,'" says Allison, who grew up in the Denver suburbs. "I ran up to her room, up the stairs, and gave her a huge hug. After that, we spent a lot of time together." One day, Indra kissed Allison. "She was funny and beautiful and kind and courageous, and we loved Colorado," Indra says of Allison. What followed, Allison says, was "a coming-out process that we went through together."
That Christmas, Indra wrote her parents a letter, telling them she was gay. She slipped it under their bedroom door at night and then went to bed, worried about what they'd say. "My mom eventually knocked on the door and said, 'We got your note, and we want you to know we love you,'" Indra recalls.
Back on campus, Indra and Allison joined the gay and lesbian student group. It was a small group, with just one other freshman: Geoffrey, who was outgoing, loved literature and had been out since high school. The three had similar values and soon became close friends. "We just all had a similar sense of 'We're actually okay,'" Indra says, referring to being gay. "We're going to claim a life, and we're going to make it beautiful."
Together they put on LGBT-focused programming, including panels of gay speakers and forums on the intersections of race, Christianity and homosexuality. Those were the most controversial — and also Indra's favorites. One of the programs they sponsored was on gay families. The speakers included a lesbian couple and a gay man from Seattle who'd had children together and were co-parenting them. "That laid the seeds for us to think, 'Gosh, maybe we could do something similar in our lives,'" Geoffrey says.
"We were homing in on a plan," Indra adds, "which was basically that Allison and I would both get pregnant and Geoffrey would be the biological dad."
The three friends graduated in 1996, and Indra and Allison moved to Denver, where Allison got a job as a social worker and Indra enrolled at the University of Colorado at Boulder to get a master's degree in theater. Meanwhile, Geoffrey moved to Austria to teach English. The three wrote to each other often. "There were lots of ideal, visionary, dreaming-big kinds of discussions in those letters," Geoffrey recalls.
In 1999, the women approached Geoffrey about starting a family. After some initial hesitation — he was studying for a Ph.D. in English at the University of California, Santa Barbara, at the time and wasn't sure if he was ready to become a father — he agreed.
They decided that Allison would get pregnant first, and began attempts at insemination the next year. Their process was low-tech; the only tools were little plastic medical cups and one of those syringe-like plungers usually used to give cough syrup to babies. The only costs were plane tickets. On the third try, Allison conceived.
At first Allison didn't think about deviating from the normal prenatal-care routine. "I think I just did what many women do. It was just a given that I was going to give birth in the hospital," Allison says. She began seeing a doctor who was friendly to LGBT families; her pregnancy was normal and her appointments lasted five minutes. An ultrasound revealed it was a boy. But when the women started attending labor classes at a local hospital, something didn't feel right. "It was like, what's missing here?" Allison remembers. "The classes didn't teach the heart and emotions of labor."
That's when a friend recommended they talk to a midwife named Flame Dineen. Allison and Indra's first meeting with Flame changed forever the way Indra thought of pregnancy and birth. "Even in our first meetings with Flame, and Flame working with me, there was a real click," Allison says. "Not just for me, but an even bigger click for Indra."
She adds, "Flame spoke her language."
For much of the nineteenth century, midwifery was considered a respected line of work. But as the medical profession grew and doctors banded together to form medical societies and schools, they began making an effort to usurp the domain of delivering babies. They argued that obstetrics was technical, modern and safe — and midwifery was not.
In 1917, under pressure from doctors, Colorado enacted a law requiring midwives to pass an exam and apply for a license in order to attend births. In addition, midwives were forbidden to use any instruments to deliver babies or administer any drugs. Despite this, many babies were still born at home. But in 1941, state lawmakers passed a law preventing any more midwives from obtaining licenses; already-licensed midwives could continue to practice, but no new ones could join the field. It was an attempt to make midwifery disappear, and though the number of babies born in hospitals skyrocketed in the 1950s, the law didn't completely succeed. Midwifery just moved underground.
The profession experienced a national resurgence in the 1970s, fueled by feminism, the burgeoning health-rights movement, and government reports that anesthetizing women during childbirth could harm their babies. In Colorado, nurse-midwives — nurses who specialize in midwifery and deliver babies under the supervision of a doctor, often in a hospital — won legalization in 1977. A group of so-called lay midwives — midwives who deliver babies at home without medical intervention — wanted the same thing. They'd been practicing off the radar for decades, risking arrest and charges of practicing medicine without a license. In 1979, they formed the Colorado Midwives Association in Boulder.
For the next several years, they fought to legalize their profession. "We threw ourselves against the state legislature again and again," says Jennifer Braun, a midwife who started practicing in Boulder in 1982 and now runs a nonprofit called International Midwife Assistance that offers birth services in Uganda. "It was a David and Goliath story."
Bills to regulate lay midwifery failed in the legislature in 1983, 1984, 1985 and 1991. Each time, doctors, nurses and even nurse-midwives testified against them, arguing that delivering babies at home was unsafe. Meanwhile, supporters said that women were going to give birth at home regardless of whether it was legal. State regulation of midwifery would make it safer, they argued, not the other way around.
In 1993, after several midwives were arrested and one case reached as high as the Colorado Supreme Court, the legislature finally agreed. The resulting law decriminalized lay midwifery and set up a process by which "direct-entry midwives," as they are now called, could register with the state Department of Regulatory Agencies, or DORA. The law directed DORA to set education standards and rules for when midwives could and could not provide care, as well as a disciplinary process for when they broke those rules. The law also protected doctors and nurses from liability for a midwife's "mistakes."
It was a victory, but an imperfect one. The resulting rules included several restrictions: Midwives could not care for pregnant women with diseases such as diabetes, sickle-cell anemia or hepatitis. Midwives could not suture. Midwives could not administer common pregnancy-related drugs. Midwives could not deliver breech babies or twins.
The legislature also set a date — July 1, 1996 — to review the law and decide whether it should continue, in accordance with Colorado's sunset process. The 1995 sunset review report, written by DORA, illustrates that the attitude toward midwifery in Colorado was still hostile. Even so, DORA recommended that the profession continue to be legal.
"The practice of direct-entry midwifery poses a significant potential for harm to the health and safety of the public," the report said, adding that "the regulatory program provides the service of protecting the public's health."
On April 9, 2001, Allison gave birth to the family's first son, Zian Lewis. He was born at the hospital with Flame acting as a doula — someone who provides emotional and physical, but not medical, support during labor.
By the time Allison and Indra met Flame, Allison was eight and a half months pregnant and felt it was too late to switch her plan of giving birth in the hospital. But Flame agreed to help her labor at home, drug-free, for twelve hours until she was ready to push. Spending that time at home, Allison says, made a world of difference.
Though Allison delivered Zian without complications or many medical interventions — no epidural, no C-section — Indra wasn't thrilled with the hospital's care. As soon as Allison arrived, they hooked her up to a heart monitor that required her to lie still. "It felt constraining," Indra says. "Suddenly she's plugged in, and it's kind of like, 'Aaah! Does she need to be plugged in? She's okay.' There was just a shift in the texture and meaning."
And after Zian was born, nurses whisked him away. "The nurses are poking and prodding him and sticking tubes down his throat and giving him a shot in his heel," Indra says. "It felt harsh and abrupt, and it felt cold. It was completely counter to my instincts, and I didn't feel like I could do anything..
But Zian was healthy, and they soon took him home. Geoffrey was still living in California and had planned to stay there, but he changed his mind and moved to Denver when Zian was two months old. The women amended a parenting contract they'd drawn up in order to split parental and monetary responsibilities three ways. Soon afterward, Geoffrey met his partner, Mark Thrun, a doctor at Denver Health. (Thrun ran unsuccessfully for a state House seat last year.) Eventually, the contract was amended to include him, too.
Now the family lives in a charming Highland duplex: the moms (Mommy and Mimi) on one side, and the dads (Daddy and Papi) on the other. A doorway connects the two sides, and Zian and Eliot, now ages nine and seven, respectively, go back and forth: two weekdays with the moms, two weekdays with the dads, a rotating Friday/Saturday schedule and everyone together on Sundays for a big dinner. But their family, Indra insists, isn't just the six of them. Instead, she describes it as, "a big, chosen family consisting of co-parents, friends and lovers."
Back when Zian was the only child, Geoffrey lived in a row house next to Indra and Allison. Almost immediately after Zian's birth, Indra started yearning to get pregnant herself. "I was really excited for my turn," she says. It took only two tries, using Geoffrey's sperm and the same syringe method they'd used before. Once Indra found out she was pregnant, there was no question in her mind or anyone else's about what would happen next.
"When Indra got pregnant, it was a given that we'd spend the money to have the home birth," says Allison, who estimated the cost at around $2,000.
"Flame knew that I was going to have a turn and that I'd be calling her," Indra says. From the start, she says, "I never had a doctor's appointment."
Instead, she had hour-long appointments with Flame that she describes as "not even in the same universe" as doctor's appointments. In addition to measuring her belly and weighing her, Flame asked Indra about what she was eating and how she was feeling. They had in-depth conversations about Indra's fears and concerns, and Flame explained to her what natural birth would feel like and look like. Sometimes the midwife would give her a foot massage. "It was just nourishing and comforting," Indra says.
Eliot Indigo was born on February 21, 2003. With Allison on one side and LuAnne on the other, Indra squatted at the edge of her bed, her arms around their shoulders. For an hour, she pushed — until, without a cry, the baby appeared and Geoffrey caught him in his hands. Afterward, Flame put Eliot on Indra's naked chest, where he nuzzled against her skin. The umbilical cord remained intact; a while later, Zian, towheaded and dressed in Winnie the Pooh footie pajamas, cut it with help from the adults.
"Having Zian there immediately, cuddled up on her lap and my lap and all of us right there on the floor, it was one of those beautiful moments," Allison says.
Geoffrey had another post-birth job: making placenta smoothies. The placenta contains valuable nutrients that the mother loses by giving birth. Eating it to replenish them is a popular theory among holistic birth experts but not many doctors. To Indra, however, it made sense. So Geoffrey cut up the pound-and-a-half placenta with kitchen shears and put pieces of it into a Cuisinart along with yogurt, bananas and strawberries.
"Some people were like, 'Ooh, gross,'" Geoffrey says. "To be honest, I was like, 'This is kind of odd.' But I felt like my job was to be like, whatever is going to make her feel better." And it did. "It tastes amazing!" Indra says.
The next day, when Flame visited to check on them, Indra was fired up; her interest in midwifery had been piqued in a personal way, and she was hungry for more information. So she immediately began reading a book by French doctor and natural birth proponent Michel Odent. Other books followed, including Baby Catcher: Chronicles of a Modern Midwife and Immaculate Deception, a 1975 book that was key to midwifery's '70s resurgence. Together, Indra and Flame pondered why more lesbians weren't choosing home birth, and they wrote an article for the monthly magazine Weird Sisters West. "Where are all the dykes?" it asked.
"Just in writing that article and those moments after birth, I was like, I'm not just going to be the average client that goes away," Indra says. "I'm going to be an advocate, actually. That was just the beginning."
The midwife population in Colorado is tiny: There are 54 registered direct-entry midwives, according to a DORA report prepared in October, though the CMA now puts that number at 67. In 2009, direct-entry midwives delivered 637 babies, which was about 1 percent of the babies born in Colorado. That number has grown; in 1994, the first full year after midwifery was legalized, midwives delivered 253 babies.
The state also requires midwives to track how many babies in their care die during pregnancy or soon after they're born. In 1994, it was two. In 2008, the most recent year for which statistics are available, it was seven, up from five in both of the previous two years. That's a lower rate than with hospital births, partly because midwives can only attend low-risk births.
A DORA report from 2000 also contains statistics on infant health (while the 2010 report does not). On average, it says, babies born to midwives in Colorado had healthier birth weights, and better heart rates, respiration, reflexes and muscle tone.
But things can still go wrong. In 2009, DORA statistics show that ninety women attempting home births were transferred to the hospital during labor and thirteen babies born at home were transferred within 24 hours. Sue Townsend, a neonatologist at Memorial Hospital in Colorado Springs, says that in December, it so happened that the hospital saw two transferred babies: one with pneumonia and another with a tear in its lung. Both problems are common, she says, but it's safer to experience them in the hospital.
"If you're in the hospital, you have the ultrasound machine. Or you can do an emergency C-section," says Townsend, who is the immediate past president of the Colorado chapter of the American Academy of Pediatrics. "Many physicians and certified nurse-midwives are trained to recognize the risks."
So are midwives, say midwifery advocates. To practice in Colorado, they must graduate from a midwifery school or its equivalent and complete a year-long apprenticeship, as well as pass a national exam. In addition to becoming skilled in prenatal care, delivery and newborn health, they must know how to use equipment such as catheters and suturing tools, evaluate lab records, give a shot, treat blood loss after a delivery, administer oxygen and activate an emergency backup plan. "I always feel like doctors don't understand that midwives are educated," says Boulder midwife Elizabeth Moore, who served as the regional representative to the Midwives Alliance of North America for several years. "If they could understand that, I think things would be better. They just assume the stereotype — that we're just hippies in the alley. It seems like it's just this territorial thing, like you're bad and we're good."
That quarrel has been at the heart of the legislature's two previous sunset reviews of the midwifery law, in 1996 and 2001, and it's already playing a role in this year's review.
A sunset review works like this: DORA talks to all interested parties, including doctors and midwives, and prepares a report with recommendations for changes to the law. A legislative committee then holds a hearing, in which stakeholders testify and push for amendments, which are voted on by lawmakers in that committee. Legislative bill-drafters use the report and amendments to write a bill, which is subject to more hearings. Lawmakers eventually vote on whether to renew the law and which changes, if any, are made.
This time around, several of the DORA recommendations are familiar. Among them is granting midwives "limited prescriptive authority" to obtain and administer certain drugs to mothers and babies: Rhogam for pregnant women whose blood is Rh-negative, a condition that can be dangerous if their babies are Rh-positive; vitamin K shots to combat vitamin-K deficiency, which can lead to bleeding disorders in infants; anti-hemorrhagic drugs for mothers who bleed uncontrollably after delivery. All three conditions are treatable, and midwives must learn in the course of their training when and how to administer the appropriate drugs. But the law prohibits them from doing so. In the 26 other states where midwifery is regulated, all but three allow midwives to administer at least one of the drugs.
DORA is also recommending that Colorado lift the restriction on simultaneously being registered as a direct-entry midwife and a nurse. "There is no valid public policy reason" for the prohibition, the report says. A DORA spokesman declined a request from Westword to interview the author of the 2010 report, explaining that doing so might negatively interfere with the legislative process.
Several medical associations have already lined up against the recommendations. The American Congress of Obstetricians and Gynecologists is one of the chief opponents. "Even if you are the youngest, healthiest person, in any pregnancy, there is always the chance of a catastrophic event," says legislative chair and ob/gyn Eliza Buyers.
As for whether midwives should be allowed to give drugs, Buyers says ACOG hasn't supported it in the past. Midwifery training, she explains, "is not formal university-based training, which we consider to be the bar. That's the issue."
The Colorado Medical Society is still formulating its position, but spokeswoman Sara Burnett says the CMS "would be cautious about endorsing any expansion of [midwives'] scope of practice that is not consistent with their education and training, such as granting prescriptive authority."
Townsend, of the American Academy of Pediatrics, says the Colorado chapter plans to "reluctantly support" allowing midwives to give vitamin K shots. "We think that vitamin K is so important that it outweighs the fact that these are non-health-care professionals administering medications," she says. As for the other drugs, Townsend says pediatricians are staying out of the debate because it involves the health of mothers, not babies.
Meanwhile, the Colorado Midwives Association is supporting the DORA recommendations — and leaving it at that. "The report is very supportive, very positive. It's exactly what we want," says CMA president and Lafayette midwife Karen Robinson, without giving much detail. She says the CMA is happy that DORA is once again recommending that midwives be able to administer certain drugs and that the ban on simultaneous registration be repealed. And she's hopeful lawmakers will agree this time.
But Robinson also concedes that the DORA recommendations aren't everything the midwives asked for. She says that before the report was written, the CMA held midwife meetings across the state and came up with a wish list that it presented to DORA. Not everything on that list made it into the report, she says, though she wouldn't say what was left out.
"We're not focusing on that," Robinson says.
But some midwives are, and they think the CMA should ask for more.
"When you are a fringe group, you just kind of don't want to draw attention to yourself," says Fort Collins midwife Beth Karberg. "I think midwives have lived in a lot of fear of, if we ask for changes to our law that are in any way controversial, we could end up not getting a law passed and being illegal again."
Midwives say they're also afraid of losing the rights they do have, such as the ability to deliver babies at home to mothers who have had previous C-sections. Though that's not likely to happen, "the fear of it is real," Karberg says.
Enter Indra. In the years after her son's birth, she kept tabs on Colorado's midwifery community, weighing in on rulemaking and advocating whenever possible. In 2005, she started talking with the CMA about the 2011 sunset review and its legislative strategy, but she didn't like the cautious approach. "It just didn't feel right to me," Indra says. So she decided to do something about it. A few months ago, Indra started a midwifery consumer group called Delivering Natural Care for Families. She was partly inspired by her work with another organization, the Colorado Organization for Latina Opportunity and Reproductive Rights, or COLOR, which strives to increase young Latinas' access to reproductive choices, whether those choices are related to abortion or birth.
"I just knew, from my position, that there was a broader world of people who could get behind this issue," Indra says of COLOR. "I knew that even if the CMA ultimately decided to do something, they weren't going to do that kind of broader movement-building."
Some midwives think she's on the right track. "She's an amazing person," says Lakewood midwife Kathryn Raynes, who serves on the CMA's legislative committee. "She's going to be a unique force in our future."
But to others, she's meddlesome. "That young lady has a lot of notions that may have been closer to the truth when we were illegal," says Braun, who served as president of the CMA from 1985 to 1993. "I do not feel persecuted or hamstrung in the way Indra likes to talk about my profession. I think midwifery is doing way better than it was ten years ago."
Robinson, the current CMA president, is more diplomatic about it. "We are still trying to figure out how we can work together — if we can work together," she says of the consumer group. A statement recently sent out to members and posted on the CMA website, however, says that the group's interests "do not coincide" with those of the CMA.
At one point, Indra considered becoming a midwife herself. It was the fall of 2005, and she was working as a teacher at the private Logan School in Denver. But she was still deeply interested in midwifery, so she decided to take a day off of work to attend the annual Midwives Alliance of North America conference, which was in Boulder that year.
She'd also been kicking around the idea of becoming a lawyer, thanks in part to a psychic friend of her brother's who predicted she'd go to law school. Since she was going to be in Boulder for the conference anyway, she made plans to sit in on a law school class at the University of Colorado. She liked the class, and when she returned to the conference that afternoon, she attended a session in which one midwife was lamenting Colorado's laws. What we need, she said, is "a hot-shot legal team."
"I said, 'I think I'm going to go to law school to become that hot-shot legal team,'" Indra says. "And everybody was like, 'Yeah! You go!' So that really inspired me." On the drive home that night, she cried. "I felt a sense of purpose and like I made sense, and my skills and interests were coming together in a way that could make a difference."
Indra hurried to take the LSAT and apply to law school. She was accepted to the University of Denver in 2006, and, after being offered a scholarship, quit her teaching job and enrolled in the law school's night program.
In school, Indra pored over the midwifery law and wrote several papers on the history of natural birth in Colorado. She developed a reputation and started getting phone calls about birth-related law questions. Midwives asked her for help when a complaint was filed against them. One midwife consulted her on how to fill out the birth certificate for a baby born to a transgender couple. She was contacted by a pregnant attorney who wanted to know if it was legal for her to refuse to walk through a metal detector for fear it would harm her baby.
Indra graduated from law school in December, and plans to take the bar this summer. In the meantime, she's concentrating on other projects, including Delivering Natural Care for Families. The coalition isn't just Indra: Seth Donovan, a community organizer and reproductive-justice advocate, has been helping for months. Indra also recruited Jacinta Montoya Price, who recently left her job as director of COLOR to give birth to her son. Montoya Price had wanted to have a home birth, but her health insurance didn't cover it.
Together they developed a list of changes they'd like made to the midwifery law. Some are the same as the DORA recommendations, and thus supported by the CMA.
But a few go further; for instance, they're pushing for allowing midwives to administer local anesthetics and IV fluids, and to be able to suture women who experience tears during childbirth. Several midwives say they already do so, regardless of the legality. But Indra and others want it on the books. They're also asking to add language that encourages more collaboration between midwives, nurses and doctors.
"Right now, the law literally says that even though we're going to regulate home-birth midwifery, we don't feel good about it," Indra said to a group of home-birthing moms gathered in a funky Fort Collins coffee shop one recent Saturday afternoon. "We need to wipe the slate clean and then we can build from there."
Meetings like the one in Fort Collins are part of the strategy, too. For the past two months, Indra and Seth have been holding workshops. Though their numbers are still small, outside experts who are keeping tabs on the midwifery sunset review, such as David Swankin of the Citizen Advocacy Center in Washington, D.C., predict their mere presence will make a difference. "The idea that they're organized, even if they're small, is important," he says.
It appears that they're already making a difference. On January 19, the Senate Health and Human Services Committee held the first hearing to decide which recommendations will make it into the first draft of the bill. Representatives of the CMA, the obstetricians, the pediatricians, the certified nurse-midwives and the Colorado Nurses Association all took the microphone to oppose or support the changes.
As expected, the doctors, nurses and nurse-midwives testified against granting midwives "limited prescriptive authority" to obtain and administer certain drugs.
"To simply allow them to write prescriptions," said Steve Holt, an obstetrician and president of the Colorado chapter of ACOG, "that just is not appropriate."
Mary Ciambelli of the Colorado Nurses Association agreed. Direct-entry midwives, she told the committee, "don't have the appropriate training or skills in pharmacology."
Instead, the doctors and nurses wondered if there was another way to allow midwives access to certain drugs without handing them a blank prescription pad. "We'd be happy to discuss some different terms that could be utilized" other than "limited prescriptive authority," said Jessica Anderson of the American College of Nurse-Midwives.
Their opposition prompted questions from lawmakers and caused Senator Shawn Mitchell, a Broomfield Republican, to wonder whether the disagreement was "a fight over the symbolic high ground" rather than a concern over the drugs in question.
The Colorado Nurses Association also opposed allowing nurses to simultaneously register as nurses and direct-entry midwives. Dual licensure, Ciambelli said, would "cause even more confusion than there is today" about the difference between nurses, midwives and nurse-midwives. "We need to protect the title of nurse," she said.
Delivering Natural Care for Families was at the Capitol, too. And the most entertaining testimony of the entire two-hour hearing came from Indra. Using a voice honed in the theater and her usual blend of seriousness and humor, Indra laid out the changes that the coalition is asking for, including granting midwives the authority to suture.
"After giving birth, I felt more like an athlete than a sick person," she told the committee. "I fancied myself a boxer with a split lip who needed my trainer to just give me a quick repair so I could stay in the game." Many lawmakers chuckled.
Several other home-birth proponents testified, as well, including midwives, moms and a family physician who'd given birth at home. The lawmakers were largely sympathetic; Senator Kevin Lundberg, a Berthoud Republican, said his three children had been born at home with midwives, including one who was testifying that day.
But a few senators had doubts. "I'm concerned that there are complications that happen," said Senator Joyce Foster, a Denver Democrat. Foster said she herself developed preeclampsia during her pregnancy with her third child, a condition that requires medical attention. (In a situation like that, a midwife would make a referral.)
Despite some hesitation, the committee approved two amendments to the bill. The first, offered by committee chairwoman Senator Betty Boyd, a Democrat from Lakewood, would grant midwives the ability to suture. A vote to add it passed 7-2, with Foster and Senator Irene Aguilar, a doctor and Denver Democrat, voting against it. Similarly, an amendment by Boyd to allow midwives to administer IV fluids passed on a 6-3 vote.
Both were victories for Indra and Delivering Natural Care for Families. But the fight is far from over. The bill still has to go through more committee hearings, where it will be subject to further amendments, before it reaches the Senate floor. If it passes, it will endure the same process in the House.
Indra plans to be there for every step. But already, she's looking past the immediate future, plotting ways to continue the conversation around midwifery long after this year.
"Our focus is not just on this legislative moment," she says one recent evening.
Indra is sitting at a table cluttered with papers and art projects in the middle of her bustling kitchen as her family buzzes around her. A few feet away, Allison makes quesadillas for dinner, while Zian boisterously calls his dads on the phone, in search of a missing homework assignment. Eliot wanders over, giggling. He makes rabbit ears behind Indra's head and then crawls into her lap.
She continues talking as she wraps her arms around him. "We can have a bigger focus on, what do we need to do to be able to deliver natural care for families?"
The perinatal death rate of Colorado's home birth midwives is horrific. Get the real story about these uneducated practitioners here:
Women and babies suffer at the hands of doctors and nurses way more than midwives....unnecessary interventions leading to major abdominal surgery.....I am so sorry for every mother/family that has suffered at the hands of any provider....but it is no reason to throw the baby out with the bath water! Tragedies happen in all stages of pregnancy and delivery and the right people need to be held responsible. But it's not a good reason to ban all midwifery or to issue a blanket statement that women should only have their babies in the hospital. Do you research people and make an informed choice for you and your baby....instead of following blindly like sheep.
I've had a baby in the hospital and one at home....I will forever have the rest of my children at one....
I have suffered tremendous injuries from a Colorado DEM. They aren't required any formal education. My midwife is currently under investigation for negligence. She tried to offer someone else's prescription to induce my labor because I was post due. She was gravely uneducated in GBS protocol. She wanted to "sterilize" her instruments in a baking pan in my oven. She tried to "PowerBirth" me without my consent (I wasn't dilated completely when she told me to start pushing.) She forcibly broke my water with her finger. She yelled at me to push every ten seconds, that I was wasting my contractions, wasn't working hard enough, didn't want my baby enough. She kept saying she could see the head, but I didn't feel it. After 3 hours of pushing, I was weak. She put oxygen on me because I was going to pass out, but she forgot to turn it on and left me alone in my room. When I transferred to the hospital, she did not take me to the hospital in our emergency plan, but to a hospital farther away because she had a "better relationship with them." She refused to transfer my medical records to the on call OB. I was so swollen from pushing before being dilated that it took over a half an hour, two L&D nurses, and many, many tries to even insert a catheter. The "head" she saw was a blood clot that had formed on my bladder- I was only 6 cm dilated. "Oh, she must have undilated when we got to the hospital," was her response to the OB. After my csection, my surgeon said he had to literally pick my bladder up and put it back where it belonged, I was pushing so hard before complete dilation. My child almost died from her incompetence. He had to be recuisitated at birth. I suffered uterine trauma, a severe prolapse, and I'll be lucky to sustain another pregnancy. My body will never be able to vaginally birth a baby. Dare to call me an "uninformed skeptic?"
Families who have been injured by midwife care are beginning to tell their stories at "Hurt by Homebirth" (http://hurtbyhomebirth.blogspo.... These are horrific stories of gross incompetence resulting in needless deaths and injuries.
On this site, note "Zen's Story" about a Colorado "direct-entry midwife" (DEM) who apparently couldn't tell the difference between a blood clot and crowning of the infant's head (and had a woman pushing for three hours when her cervix was only partially dilated). This DEM also prescribed garlic as vaginal suppositories for Group B Strep infections, etc.
I urge families who have been injured by DEMs to come to the Capitol in Denver on Tuesday, April 19th to speak to the House Judiciary Committee (hearing starts 1:30pm in Room 107) on SB-088, a bill that seeks to expand the midwives' scope of practice.
"Regulation" of midwives has done nothing to protect the public, but only dupe the public that DEMs have the State's blessing to provide what is really alarmingly substandard care.
If you have suffered a loss or injury at the hands of a Colorado direct-entry midwife, please contact me: contact*at*childrenintherapy*dot*org
Grace S and other closed-minded, uninformed skeptics, please check out the documentary, and website, The Business of Being Born.
It just AMAZES me that people can be so self-absorbed and egotistical that they would take ANY risk with the birth of their baby, as if it's all about *them* and not their baby. And now these unprofessional midwives want to be able to "play doctor" by using medications and suturing in people's homes!? Why don't they just become OBGYN doctorsi if they REALLY want to help moms deliver their babies? It BOGGLES the mind!
Grace, I think you have never been at a midwifery birth. If you had, you would see the huge difference in quality of care -- by midwives. Here is my story. I've had both. A birth with a midwife and a birth with OBs. I would pick the midwife birth every time if I could.
I would recommend a mailing list of physicians.
If you would like your comment considered for our Letters to the Editor section, please e-mail me with your name and town (we don't print e-mail addresses)at firstname.lastname@example.org.
I pray for you and your family and hope this all happens in the best way. I want a midwife, so good luck!!
Because of the way the Department of Regulatory Agencies has collected information regarding homebirths in Colorado, information about perinatal demises is sketchy at best. Some midwives report first trimester miscarriages as perinatal deaths. DORA does not collect details on the surveys midwives complete, so we have no way to know what happened with the demises that have been reported. The Colorado Department of Vital Records also tracks homebirths and their reported demise rate for planned homebirth is less than 3 per 1000--which is what one would expect in the low risk population direct-entry midwives serve.
Karen Robinson, CPM, RMPresidentColorado Midwives Association
About that 3 deaths per 1000 births. Shame on Ms. Robinson for presenting this very misleading statistic.
I called Vital Statistics. The Colorado Department of Health Environment has data on direct-entry midwives for 2007-2009: For midwives, the department does not collect data on deaths for the usual perinatal period (i.e. week 20 of pregnancy through 28 days after birth), but only deaths in the neonate period (i.e. first 28 days of life). Then only deaths that occur at home go on the midwives' record. Any distressed infants transferred to a hospital and die there (or are declared dead there) are not added to midwives' kill rate.
And actually, infant deaths with low risk pregnancies should be more like 1 death per 1,000 births. An obstetrician may only see one such death in his whole career.
DORA's data also under-reports midwife-related deaths in a number of ways.
So much for midwives being "experts at normal deliveries." As someone said, "That's like being a pilot who is an expert at flying in good weather."
Ms Robinson's statement does not seem to jive with the data provided by DORA:
Where are those first trimester miscarriages of which you speak? I presume the demises are here, reported as required by Colorado law of register midwives.
Regarding the statistics by the Colorado Department of Vital Records: that rate must be largely for unassisted-by-midwife, spontaneous births. But DORA's data clearly shows that having a registered midwife assist at a home birth puts the death rate over three times that amount (11.3 deaths per 1,000 births).
And look at the huge number of transfers to hospital care. Presumably those are emergencies where lives and staving off injury are dependent on STAT care.
What is sketchy is the number and type of injuries suffered by newborns who survive home deliveries. DORA should be collecting that data as well.
I also note on websites of Colorado midwives that they generally state that home birth is "safe" and even imply that it is safer than hospital care. That is misleading the public.
I agree that adults should be allowed to risk their own fool necks, but putting infants at needless risk is another matter. Seriously, what is more important: having the best possible outcome for an infant or having a pasta party with friends after a delivery?
32 yrs ago, my daughter had a home birth with a midwife, nurse studying midwifery and a physician who approved of such and me holding a mirror so she could watch...important since I had been given that choice when she was born. It was wonderfull and within an hour we all sat around the table and ate lasagnia and toasted the great experience and new grandchild. Since then Ive had five grands waterbirths and a greatgrandson by 32 yr old gd.All have been happy and no problem events. New mexico and Colorado are with it....from a believer.
As long as tragedies have been brought to the table, here are a few more to add ...
One thing more...
When things go wrong with lay midwives and home births, there is now a new website for families to tell their tragic stories:
Hurt by Homebirthhttp://hurtbyhomebirth.blogspo...
These heart-rending accounts are a far cry from the hot-tub-poetry-drumming-birth-as-theater sort of event described in this Westword article.
What I don't see in the Sunset Review or this Westword article is a comparison of death rates -- the bottom line on issue of direct-entry midwives.
The incidence of death of newborns at the hands of direct-entry midwives is appalling high in Colorado, and climbing. The last figures put it at 11.3 deaths per 1000 births. That is DOUBLE the rate of the rest of the state. Also consider that the direct-entry midwives are not involved in high-risk pregnancies, premature births, etc.
For more info, see comments by Amy Tuteur, MD:http://skepticalob.blogspot.co...
Linda Rosa, RNLoveland, CO
Linda, I am trying to research these statistics. Can you give me your source for this number, as I've not been able to verify it? Thanks,Janelle Komorowski, CNMGreeley CO
The 2009 statistics are found in DORA's October 2010 newsletter for direct-entry midwives.
I heard Indra speak during the Senate hearing and she was absolutely amazing. I spoke too, but got too choked up a couple of times talking about how important home birth is for those of us who choose it. Here is the written version of my testimony: http://www.facebook.com/note.p...
"Home birth has long been a controversial issue. Doctors and nurses say it's unnecessarily risky, and they criticize the midwives who deliver babies at home as amateur and insufficiently trained." ------- How absurd! Women have been giving birth how long compared to the "Medical Profession" which has been established how long?
A great book on this is - Witches, Midwives, and Nurses, A History of Women Healers by Barbara Ehrenreich and Deirdre English- original publishing 1973 Feminist Press. It is only 48 pages and well researched and referenced.
"symbolic high ground" - without question.Research all vaccines before allowing them to be administered.
The baby on the cover doesn't have nipples or a belly button. Is this because of anti-obscenity laws?
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