What happens when the person who delivers most of the babies in her community is arrested? This is a tale of two midwives, separated by nearly four centuries of history, and yet remarkably alike.
Six months ago, certified professional midwife Elizabeth Catlin was arrested on the grounds that she was practicing midwifery without a license. Catlin had long served the Old Order Mennonite community of Yates County in upstate New York. It is common for Old Order Mennonite families to be very large, and for women to give birth at home. Many families live as traditionally as possible, and do not have cars or health insurance. Catlin provided a traditional style of home birth midwifery care, attending women throughout pregnancy, birth, and postpartum recovery for a reasonable fee.
Catlin has a midwifery certification that is recognized in 31 states, but New York is not among them. She had long practiced with tacit approval from authorities. Her lack of legal standing, however, became a liability when she transferred a laboring patient to a nearby hospital and the baby did not survive the birth. A physician at the hospital, blaming Catlin’s home birth methods for the tragedy, reported her to authorities, and suddenly her midwifery practice and her personal freedom were at stake.
While that physician might have disapproved of Catlin’s practice, her clients and their families rushed to her defense. They showed up in droves at her hearings, and passed a hat to raise bail. Many wrote indignant letters to the editor insisting that they knew full well what kind of practitioner they had hired, and that far from being dupes of an unscrupulous practitioner as the prosecutor alleged, they valued her skills and techniques and received exactly the care they sought.
Catlin’s story eerily echoes that of midwife Alice Tilly, who served the women of Boston almost four centuries earlier. In 1649 Tilly was jailed for allegedly causing “the miscarrying of many wimen and children under hir hand.” The women of Boston were dismayed by the imprisonment of their highly-experienced, well-respected midwife, the person they regarded as “the ablest midwife that wee knowe in the land.” They knew that birth sometimes went wrong no matter how skilled the birth attendant, and they trusted Tilly above other local practitioners. Hundreds of women signed petitions in her defense, and presented them to the General Court. The wives of leading citizens led the effort, begging that Tilly be pardoned, not just for their benefit, but for that of their future children.1
While the women of the community were willing to request simply that Tilly be given permission to leave jail periodically to attend births, and Tilly served in this manner for some time, Tilly eventually sought full exoneration. The authorities reacted with anger at what they regarded as Tilly’s “excessive pride.” Tilly continued to live and serve as a midwife in Boston, and the surviving record does not reveal whether she was ever fully exonerated.2
Like her seventeenth-century predecessor Alice Tilly, Catlin stirred the ire of authorities who found her arrogant and recalcitrant. After her first arrest, she continued to practice, because there was no one to take her place: she had been the only currently practicing certified midwife in her area, and when she briefly stopped, several women gave birth without any trained attendant. The district attorney piled on four more felony charges related to the lab work she ordered as part of her clients’ prenatal care, threatening her with consecutive sentences. She was brought to the courthouse in shackles, and the district attorney requested a punitively high bail, disingenuously suggesting that Catlin, whose entire family and work life was deeply embedded in Yates County, was a flight risk.
In her book Founding Mothers and Fathers: Gendered Power and the Forming of American Society, historian Mary Beth Norton characterized controversy over seventeenth-century midwife Tilly’s arrest as a battle along gender lines. At the time, pregnancy and birth were the province of women, and lawmakers were all men. These men seemed to have limited understanding of how pregnancy or birth worked, and in fact, often deputized midwives to investigate cases of alleged infanticide, where physical evidence of pregnancy and birth (or lack thereof) was crucial. After Tilly’s arrest, exasperated women, desperate for safe maternity care, petitioned the clueless all-male assembly to respect their judgment about who could best see them through the dangers of pregnancy and childbirth. The men responded with anger at this midwife who would challenge their judgment, even as they gave in to the women’s demands that she be allowed to practice.3
In Elizabeth Catlin’s contemporary case, the lines of conflict are no longer strictly drawn between a women’s community organized around the birth room and a male government. Women and men together begged that Catlin be allowed to attend births; entire families stood by Catlin at the courthouse, and men as well as women wrote letters to the editor. The governmental and medical authorities that sought to end Catlin’s practice contained a number of women. And yet the two groups, the government and the citizen-petitioners, stood in a similar relationship: they clashed because the government prioritized order and discipline, and the petitioners prioritized individualized care, affective bonds, and their personal knowledge of a practitioner’s effectiveness.
Is there a way to reconcile the two sets of needs represented by these two groups – the need for social order, and the need for individualized care? Catlin’s case suggests that we should be trying harder to figure that out.
Catlin and her supporters describe one possibility: that birth attendants honestly represent their skills, and explicitly describe the support they can and cannot provide. Home birth midwives routinely acknowledge that giving birth at home carries a specific set of risks, different from those in the hospital. As obstetrician Neel Shah has explained, evidence from Great Britain suggests that for first births, home birth is on average significantly less safe for mother and baby, while for later births in uncomplicated pregnancies, giving birth at home carries no additional risk. Evidence from an Oregon study, which did not separate out first and later-order births, found that home births were risker than hospital births, but that bad outcomes were low in both settings. The women who Catlin attends may reasonably want to judge the safety of home birth for themselves based on their particular situations: some travel by horse and buggy, which makes getting to the hospital much less safe and reasonable than for those who have cars. Many have large families, and each cesarean section substantially increases the risk of severe complications in future births. As well, the additional emotional and social support that Catlin provides as a longtime birth attendant in the community should be recognized as a legitimate reason to prefer her services.
I do think that regulations against unscrupulous medical practice are necessary. And in cases where the public health is at risk, when alternative practitioners discourage clients from being vaccinated for example, there are good reasons to interfere in individuals’ medical decisions. When it comes to birth, though, we need to acknowledge both women’s right to make decisions about their bodies, and also the broad rights we give to parents in caring for their children. Requiring practitioners’ transparency with regard to the safety of both their personal medical practice and the efficacy of their methods on a broader scale – records of outcomes as well as interventions such as cesarean section – would go a long way toward protecting the rights and the options of birthing women and families, wherever they choose to give birth.
Robie Davis-Floyd, Mainstreaming Midwives: The Politics of Change (Routledge, 2006) contains a long and insightful chapter about the complex politics that led to New York creating a category of midwifery licensure that is different from the direct-entry midwife licensure that is accepted in many other states.
Wendy Kline, Coming Home: How Midwives Changed Birth (Oxford University Press, 2019) (description and review here).
Mary Beth Norton, Founding Mothers and Fathers: Gendered Power and the Forming of American Society (Knopf, 1996).
- Mary Beth Norton, Founding Mothers and Fathers: Gendered Power and the Forming of American Society (New York: Knopf, 1996), 204-5, 224. Return to text.
- Norton, Founding Mothers and Fathers, 205-6. Return to text.
- Norton, Founding Mothers and Fathers, 224-7. Return to text.