A large crowd of people, many of them Amish, gather outside the LaGrange County Courthouse Monday to show support for Ireena Keeslar of Howe, center. Keeslar was arrested March 31 on a charge of practicing midwifery without a license. Staff photo by PATRICK REDMOND
LAGRANGE — When a Howe woman was arrested for allegedly practicing midwifery without a license, it put LaGrange County in the center of a long-running political and medical debate over the practice of home births and midwifery.
Last Monday, more than 100 people showed up on lawn at the LaGrange County courthouse to show their support for Ireena Keeslar, who was arrested on the Class D felony charge, and protest the state’s ban on certified professional midwives.
While many in the crowd drove from out of state, a large number were Amish women.
Home birth is becoming more common among the Amish, said Mary Ann Griffin, midwife and president of the Indiana Midwives Association. LaGrange County averages just under a 100 home births a year, according to statistics kept by the county’s health department. Those statistics, however, don’t show who delivered each of those babies and how many of those deliveries were children born to Amish parents.
Midwives provide care to women during pregnancy, birth and post-delivery. In Indiana, a midwife must have a nurse’s license as well as additional specialized training in order to practice as a certified nurse midwife.
Keeslar, 49, allegedly assisted Delores Jean Stanley, 47, of Albion, in at least one home birth. Stanley had been arrested earlier for allegedly practicing midwifery without a license. Allegedly, neither woman holds a current Indiana nursing license.
Keeslar once held an Indiana nursing license and has participated more than 1,500 births, but allowed her nursing license to expire in 2004, she said while walking out of the LaGrange County Courthouse last week.
Keeslar maintains she does the bulk of her work in Michigan, which allows midwives who are not nurses to attend births. Her name, however, appears on the website of the Indiana Midwives Association as a member of its board and Educational Guild chair. The initials CPM — certified professional midwife — follow her name. The association has been lobbying the state legislature for 30 years to change Indiana law and allow certified professional midwives who are trained, but are not registered nurses.
“Twenty-eight other states have seen the wisdom in offering the practice,” said Griffin, also a CPM. She said it’s time for Indiana to recognize CPMs, regulate the field and license those midwives.
State Sen. Sue Glick, R-LaGrange, said last week’s protest did prompt some people to write her letters and call her office. Glick said the Legislature has looked into allowing certified professional midwifes many times, but always hits the same roadblocks.
“It comes down to questions about malpractice insurance, liability, questions about training and what are we going to do when something really bad happens,” Glick said.
The senator said she’s probably heard all the arguments for and against midwives, and legislators simply worry about making sure everyone is safe.
“The safety factor is a big issue. How safe is anyone when the nearest medical facility is miles and miles away?” Glick said. She thinks legislators need to hold more hearings before deciding one way or the other on certified professional midwives.
“We’ve got to know what the risks really are, and how to avoid those risks,” she said.
Griffin maintains midwife deliveries for low-risk pregnancies are as safe as hospital deliveries, and says she has research to prove it.
Griffin points to a research paper published by the Centers for Disease Control that says “home births have a lower risk profile than hospital births,” in part because few home births involve teenage mothers and unmarried women, and home births have fewer pre-term, low-birthweight and multiple births.”
But LaGrange County physician, Dr. Rhonda Sharp, said the debate is about ensuring the health of mother and child in all situations.
“As in all things medical, the body doesn’t always follow the rules, and complications happen quickly and unexpectedly, Sharp said.
Griffin counters, saying those events are so rare as to not likely happen in low-risk deliveries. She adds that a properly trained and licensed CPM would know how to deal with emergency situations and be able stabilize the mother until a transfer of care can occur.
Sharp said she worries that home deliveries can put the patient miles away from the nearest hospital or birthing center and the medical care necessary in the event of an emergency.
“My profession says I will protect the patient,” Sharp added.
Sharp has testified before the state Legislature, lobbying against certified professional midwives. Among the biggest problems she sees with CPMs is a lack of supervision and training.
“They have no oversight,” she said. ‘In every branch of medicine, we have oversight and should have oversight. We need people to be accountable.”
A LaGrange County Amish woman who asked that she not be identified said home births with midwives are a matter of convenience and comfort. Her first child was born in a hospital, and the rest were born at home.
“This is pretty important to me,” she added. “I don’t have a real problem with the hospital. Yeah, the bed was uncomfortable, and always having a light on was uncomfortable, and having people come and out of my room all the time was uncomfortable. Delivering a children is a lot easier when you’ve relaxed. It makes all the difference in the world.”
Griffin said there’s been a 20 percent increase nationwide in home births, with the largest demand for home births coming from college-educated women. She said the real obstacle to legalizing professional midwives is money, saying births are the largest source of hospital income.
“It’s the No. 1 generator of income for hospitals,” she said. “It’s a lot of money.
The Amish woman said a midwife comforts her by being with her throughout the delivery process.
“The doctor is only there for the actual delivery,” she added.
Finally, she said, it’s a matter of being able to do what she thinks is best for herself and her baby.
“We should have our choices,” she said.
Admitting she didn’t know about the illegality of CPMs practicing in Indiana, she said she wouldn’t be comfortable with breaking the law and is considering going to Michigan to have her baby.
“Those letters behind the name don’t mean that much to me,” she said. “What matters, it’s all about the care.”