The death of a southern Utah mother has rekindled a long-standing controversy in Utah: Should someone or some agency be overseeing the practice of lay midwifery?
The response of the director of the Utah Department of Health is an emphatic "yes."Dr. Suzanne Dandoy wants to see some kind of minimal training and mandatory knowledge base for people to qualify for service as lay midwives. But, she candidly admits, it doesn't seem feasible - in Utah, anyway.
"The lay midwives do not want any kind of law of that dimension. There doesn't seem to be a strong feeling among people involved in home births that they want us to do something," she said in a Deseret News interview. "The medical community, I believe, would balk at giving any official recognition to lay midwives.
"We are the only people who seem to think there's a problem and something should be done about it."
Discussion on the issue heightened recently following the trial of a Cedar City man whose wife died during a home birth, while he allegedly performed ritualistic chants and gave her herbal tea.
James Edward Peiffer, 48, also known as Gentlewind, was sentenced to 18 months probation on his guilty plea to negligent homicide. He pleaded guilty to the reduced charge during his trial for the death on July 4, 1987, of his wife during delivery of a healthy baby at home.
In exchange for his plea, prosecutors dismissed a single count of manslaughter.
Prosecutors claimed Eileen Fuhriman, 39, who had difficulty delivering the placenta, allegedly bled to death while her husband said chants and offered her tea to stop her bleeding. They said Peiffer, a Caucasian, claimed to be a medicine man. But he had been warned not to participate in home births because his wife had difficulty in five previous childbirths, prosecutors said.
A lay midwife delivered the child.
According to prosecutor Keith F. Oehler, the midwife was charged with manslaughter, a second-degree felony, and in January a preliminary hearing was conducted in the cases of the midwife and Peiffer.
Oehler said the circuit judge determined that Peiffer knew about the substantial risk of death to his wife. The midwife didn't actually know about the risk, but should have, the judge concluded. The charge against the midwife was reduced to negligent homicide.
However, Oehler, a former assistant Iron County attorney now in private practice, said he asked that the charges against the lay midwife be dropped, pursuant to the plea bargain agreement with Gentlewind.
He since has moved that the court dismiss all charges against the midwife.
But the incident further sparked the already heated issue.
"As far as we are concerned the case illustrates that there are dangers in home births; these are not easy practices, and both mothers and babies can die," Dandoy stressed. The Health Department has been notified of the deaths of three or four babies delivered at home.
"Secondly, it illustrates that if there is someone else responsible for what happens, they can be held legally responsible for the death that occurs. Both are significant pieces of information."
A task force of doctors, certified nurse midwives, lay midwives, attorneys, Health Department staff, University of Utah faculty members and representatives of the public, was appointed by Dandoy to study midwifery issues in Utah.
The task force, which finished its work in 1986, made a number of recommendations to the Utah Department of Health. None, however, has been implemented.
"We have been informed (by the Utah attorney general's office) that we have no legal authority to register lay midwives or provide information to people who inquire about which lay midwives might be better informed," Dandoy said.
The department had hoped to establish a system by which complaints about lay midwives could be handled. The message from the attorney general's office is that the department could be liable is such a system were initiated.
Thus the situation in Utah is this: Anyone who wishes to work as a lay midwife may do so without any oversight by any agency.
The Legislature has the authority to assign that responsibility, but, unlike lawmakers in other states, Utah legislators have chosen not to do so.
A few states, like Arizona and Texas, have legislated either a licensure or registration program. Other states have completely outlawed lay midwives. Still others remain silent as they have determined lay midwifery is not an issue.
But Utah, Dandoy said, has a considerable number of home births. In 1984 (the latest statistics available), at least 488 children were delivered by lay midwives.
"It is a significant issue here, particularly when we have mothers and babies dying," the executive said. "I don't think we are going to be in a position to abolish home births in Utah. That would be unrealistic."
But Dandoy wants better education for Utah families about the potential dangers of home births.
"They ought to know whether the persons they have asked to serve as lay midwife assistants do have the training, do know how to summon emergency help, do know what to do in an emergency situation," she stressed.