Midwife Crisis

The screams rushing up the steps from the basement echoed in the snow-blanketed front yard and filled the small ranch house in North Canton.

In the candlelit basement-turned-birthing-chamber, the shrieks cut through the gentle white noise of lapping waves and the sweet scent of lavender.

Kelly Moscarello, a 37-year-old brunette whose stomach was swollen like an overripe fruit, was giving birth.

Her husband, Mark, a swarthy Italian body-builder, sat cradling her in the tub of water in which she was to deliver the baby. Carol, Kelly's birthing coach, a rosy-cheeked grandma, stood back, watching.

Brenda Scarpino, a slender woman with amber hair and electric-blue eyes, whose T-shirt bore the words "Addicted to Jesus," screamed from between Kelly's legs, "Push!"

The baby's head protruded, but its shoulder had become lodged behind Kelly's pelvic bone. The umbilical cord was pinched like a kink in a garden hose, cutting off vital blood and oxygen to the baby's brain.

"Get out of the tub!" Scarpino yelled. "Get out of the tub!"

Scarpino positioned Kelly on her hands and knees on the floor.

"Do you want your baby to die?" Scarpino screamed. "Push!"

Kelly fell forward onto her stomach, her body shutting down. "I can't do this anymore," she groaned.

Scarpino turned Kelly onto her back and directed Mark and Carol to pin her legs behind her head.

"If you don't push, the baby's going to die!" Scarpino screamed.

The baby's skin began to wrinkle and turn gray. Scarpino dialed 911.

"We have a mom giving birth," she said. "And the baby's stuck. "

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Until the postwar era of the 1940s, most babies were delivered by midwives, especially outside big cities.

But with the baby boom came advances in medical care, and the practice of midwifery fell out of favor. Of the more than four million babies born in 2003, a scant 23,000 -- or half of one percent -- were delivered at home, according to the National Center for Health Statistics.

Still, advocates of the practice claim that it makes for healthier babies. They say that the care provided by an attentive midwife is far superior to the impersonal touch of the hospital.

"It goes back to the beginning of time," says Abby Kinne, president of the Ohio Midwives Alliance. "Who caught Eve's baby?"

Hospitals have even tried to carve out a slice of this niche market by employing Certified Nurse Midwives, or CNMs, who are licensed and required to have direct doctor supervision.

But those looking for the true homebirthing experience opt for a lay, or direct-entry, midwife. The close-knit underground community of practitioners is completely unregulated, and unlike nurse midwives, isn't required to obtain any kind of certification.

"There's some very excellent lay midwives out there in the community," says Sandy LaCivita, a local CNM. "But there's not a single standard that any one of them are required to meet."

While the law doesn't specifically ban lay midwives from delivering babies, it does forbid the practice of medicine without a license. But just where those rules intersect is still gray.

"The way most of us look at it is that it's not illegal, it's alegal," says Brenda Hensler, a Dayton-area lay midwife. "We don't want somebody pushing that button to take it to court to make it more or less legal."

In the absence of any real oversight, midwives operate under a vague system of self-governance. Many, including Scarpino, are certified through the National Association of Registered Midwives. Unlike a traditional licensing board, NARM's only disciplinary authority is the threat of revoking its certification -- which isn't even recognized by most states, including Ohio -- and even that's only happened three times in the past nine years.

A 2002 study by the American College of Obstetricians and Gynecologists, which examined home births in Washington State between 1989 to 1996, found that the infant mortality rate for home deliveries was more than double that of hospital births.

And that doesn't take account of the "near-misses," says Dr. Charles Brown, an obstetrician with the Cleveland Clinic. "In most cases, when there's a nearly disastrous outcome, you never hear about it."

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Kelly and Mark, who works as a maintenance supervisor at Kent State University, met on a blind date two decades ago.

She'd recently gone through an ugly divorce; he had just lost his wife to anemia three months earlier. They fell in love quickly, married five months later on Valentine's Day, and started building a family.

Kelly turned to midwifery as many women do: after a traumatic birth at a hospital.

Her third child, Katie, was a big baby, weighing 9 pounds. She was so large, in fact, that she got stuck on the way out. Doctors had to push the baby back up into Kelly's uterus to hastily perform an emergency cesarean section.

In their rush, however, they didn't wait long enough for Kelly's anesthetic to fully kick in. She felt the blades slice through her belly -- first the skin, then fat, muscles, and finally the uterus.

"It's knives going through layers and layers and layers," remembers Kelly. "It's horrifying."