Dana Albillo is doing something no one in St. Louis' underground home-birth network ever dared.
Soon after the Missouri Supreme Court ended the state's 48-year prohibition on non-medical professionals helping to deliver babies, Albillo bought an ad in AT&T's Yellow Pages for her fledgling business, Common Ground Midwifery Services.
"I've lived in other states where midwifery was legal and legitimate and was advertised in the yellow pages," says Albillo, a 35-year-old St. Louis native who moved back to the area in 2005. "I don't want it to be a culture of fear.
"There's never been a midwife listed in the St. Louis market before," she adds. "So I get a discount."
A petite woman with long blond hair, Albillo delivered her own fourth child, six-month-old daughter Perla, in the bedroom of her Richmond Heights home. She plans to see clients for prenatal checkups in her small, tidy living room and hopes to average two births a month. Her fee will range from $1,200 to $2,500.
On June 24 the state's highest court upheld 2007 legislation that had drawn fire because its author used obscure vocabulary to slip it past the Senate: John Loudon, a Republican lawmaker from St. Louis County, had quietly amended a health-insurance bill and made it legal for anyone who has "tocological certification" to work with pregnant women. "Tocology" is derived from the Greek tokos, meaning "childbirth," and refers to the practice of obstetrics or midwifery. (For more about Loudon's legislative end run, see "Life Support," published in these pages in May 2007.)
Previously, Missouri was one of nine states, including Illinois and Iowa, to ban midwives outright. Beginning in 1959, Missouri law called for midwives to be prosecuted for practicing medicine without a license — a felony.
With the Supreme Court's ruling, Missouri became one of 23 states that allow professional midwives, also known as "lay" midwives because they have no formal medical training. Most of those states require the national certification plus a state license, according to Mary Ueland, grassroots coordinator for a nonprofit advocacy group called Friends of Missouri Midwives. Besides Maine, Missouri is the only state to have legalized midwifery before setting up state-level oversight. (Statutes in the remaining nineteen states make no mention of midwifery.)
So far Albillo is the only nationally certified professional midwife (CPM) in the St. Louis area. Any others who were working as midwives before the ban was lifted won't be legal under the new legislation until they acquire national certification.
Nor does Missouri's new law alter the fact that most obstetricians vehemently oppose home birth. The American College of Obstetricians and Gynecologists in February reissued its statement against the practice, which concludes, "Choosing to deliver a baby at home...is to place the process of giving birth over the goal of having a healthy baby."
Tom Watters, executive vice president of the St. Louis Metropolitan Medical Society, says lay midwives lack sufficient training. "I don't know if you've looked into the requirements of what the lay midwives have to achieve to be certified — it's laughable," Watters says.
Dr. Gordon Goldman, an obstetrician at St. Luke's Hospital, agrees. Moreover, Goldman says he won't condone or collaborate in home births because they're too risky, regardless of a midwife's qualifications. "There are women, in hospital, where the situation changes in minutes," he says. "Membranes rupture, and [umbilical] cords collapse. It doesn't take too long before that winds up in a disaster or death."
The Missouri State Medical Association had argued that lay midwives could expose doctors to lawsuits, a claim the Supreme Court dismissed. Goldman begs to differ with the court's take. "I know they said the doctors aren't going to be liable," he says. "You tell the plaintiff's attorney that. They drop the problem off at your doorstep, and if you're on call, you're it."
Dr. Elizabeth Allemann, a family physician in Columbia who oversees a birth center there, is one of only a handful of doctors in Missouri who work with lay midwives. Under the ban, Allemann had to be present at every birth, and the midwives were her "assistants." As she describes it: "As far as the legal system is concerned, I would do it all."
Dr. Mike Vlastos, an obstetrician, helped deliver three of his own four children at home after his wife declared that she wouldn't give birth in a hospital again "unless it were a life-and-death situation." Adds Vlastos: "People who think this is a willy-nilly choice, please read the extant literature."
Vlastos' contrarian views led to a split from his doctors' group, Midwest Maternal-Fetal Medicine at St. John's Mercy Medical Center, in February. Vlastos says that while he never worked with a midwife, he would not discourage low-risk patients who wanted to deliver at home. "I've always been an advocate of choice," Vlastos says. "That advocacy is not always well-received in the world of obstetrics."
Vlastos, who's looking for a job, says he won't be collaborating with any midwives, partly because his specialty is high-risk pregnancy, but also for fear of liability. "The medical-legal climate is so horrific, I'm not going to take that risk, personally," he says.
Dana Albillo, a registered nurse, began training in midwifery in 2000, apprenticing in several Midwestern states and working as an intern at birth centers in Miami and El Paso. By 2005 she had logged more than 1,500 hours of training and attended about 200 births. Though she'd planned to open a practice in Colorado, when she became pregnant with her third child she moved back to Missouri to be near family.
Still unsure of whether she'd be able to practice here, Albillo went to Kansas City in February to take a written test. She'd already traveled to Wisconsin, where a certified professional midwife administered a clinical exam that involved performing two checkups, one on a pregnant woman and another on a woman with a newborn. Albillo likens the process, which is administered by the North American Registry of Midwives, to clinical training for nurses, during which supervisors sign off on trainees' work. "It's based on the CPMs before you," she says. "It's kind of an honor system."
Gordon Goldman, the St. Luke's obstetrician, scoffs at the process. "Theoretically, you don't have to graduate high school, and you could become a CPM," he says.
But Daniele Pasatieri, a St. Charles mom in search of a midwife to help deliver her third child, says she's glad to see the trade move aboveground. "There aren't many to choose from," Pasatieri says. "I'm glad there's going to be a professional route."
Albillo says the first thing she'll tell clients is that she can't afford malpractice insurance. "Most people who are going to be litigious for litigiousness' sake, they're not going to come to a home-birth midwife because they know we're not the gravy train."
In the meantime, Albillo works nights in Barnes-Jewish Hospital's intensive-care unit, where she's grateful that the contentious topic of home birth does not come up in conversation. "I think we're better off finding common ground," she says, "than fighting each other."