“Arrest the Midwife” Documentary Illuminates Prenatal Care Desert Of New York’s Invisible Constituents: Mennonites Who Eschew Medical Care Being Denied Preferred Care

“Arrest the Midwife” Documentary Illuminates Prenatal Care Desert Of New York’s Invisible Constituents: Mennonites Who Eschew Medical Care Being Denied Preferred Care

For those who aren’t familiar with the Mennonite communities, they are similar to the Amish in their traditions and customs. While some among them have regular jobs, use electricity and running water, along with modern conveniences, a large portion of them use none of these things. If you want to journey back in time to the 15 or 1600s, a visit to these communities will bring you right there.

So there are large groups of men and women in upstate New York who aren’t counted. They don’t use electricity, they don’t have running water and use an outhouse in many cases, and they write their letters to the editor and statements to make before the assembly (super rare occurrences in themselves) using a pen in freehand on paper.

Now for the crux of it and what this film is primarily focused on: their parenting traditions. So each family has an average of ten kids, with 14 being perfectly normal and seen quite often. As mentioned in the title, they eschew medical care. But midwifery isn’t medical care in their traditions. They actually seek out and hire midwives, who are usually kept super-busy – and underpaid. And that’s where an issue that isn’t really expressed in the film, and which we are investigating a few questions about, comes in.  We’ll be trying to determine how much they were paying these midwives. The average cost of midwifery care in New York State is $5,000. Is this because it should cost that much? No; it’s because the midwives in these positions are either independently wealthy or supported by family or marriage – or they have a huge student loan burden. In both cases, they’re unlikely to offer large discounts just to serve these women.

Most members of this community have no health insurance. Even if they did, since the American College of Obstetricians and Gynecologists (ACOG) changed their guidance about home births (stating with very flimsy evidence – two studies countering hundreds performed over decades), insurance companies won’t cover it. So these people would have to pay an out of pocket cost of at least $5,000 PER CHILD ten to fifteen times over. Who could afford that? These small time farmers? Really?

From their guidance, which includes, in an unknown proportion, UNATTENDED home births (which, as discussed below, are statistically inherently more dangerous – but with a midwife, not so much): “Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although planned home birth is associated with fewer maternal interventions than planned hospital birth, it also is associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000). These observations may reflect fewer obstetric risk factors among women planning home birth compared with those planning hospital birth…These factors [that affect the outcomes]  include the appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives’ Global Standards for Midwifery Education [i.e. a Certified Professional Midwife].”

Note also that in red above this guidance is the following quote: “INTERIM UPDATE: This Committee Opinion is updated as highlighted to reflect a limited, focused change in the presentation of data regarding perinatal mortality in planned home births.” This may be based on a large scale study that came out in 2024 showing that home births attended by a midwife are MUCH safer than those in a hospital regardless of attendants, among other research.

But one more thing about the ACOG: doctors, hospitals, and insurance companies only do what they say when they like it and want to. For example, the ACOG has also stated that every woman who has had a c-section for her first birth should NOT be automatically scheduled for a second and third surgery for additional children. Instead, she should be allowed to try to have a VBAC (vaginal birth after c-section). But, since hospitals don’t like this rule (because they make less money for a vaginal delivery), they simply ignore it. Even though it’s been reiterated many times, no changes to policies occur. They create their policies as if the ACOG never said any such thing. Just try to get a VBAC anywhere in the US. While not always the case, you’ve probably got a better chance of seeing a real life unicorn.

On the other side of the financial equation: The cost of a midwifery education after the 2010 bill passed is in excess of twenty thousand dollars (likely much higher with books and supplies). That’s the cost of a SUNY Master’s degree – the cheapest place a New York resident can go – and there is no CUNY program yet. But Master’s degrees are NOT funded by the Pell grant (federal grant based on income) and there aren’t many options for those who don’t have that kind of money lying around to pay for college. They must get student loans, to be paid back with interest (and now with many fewer options to do so if one can’t find work that pays their bills).

When a midwife is thus saddled with debt, she will usually begin to work it off in a hospital with its relatively better pay than a birth center.  Least profitable and most difficult to get insurers to cover is the home birth.  If a person has a Master’s degree, they may also want the prestige of a hospital position with its opportunities for advancement and higher pay.

According to Jennifer Block’s article recently, many in the Mennonite community have no money at all. And like the families in The Country Doctor, about a rural Oklahoma doctor who was the only physician serving his whole community, they pay their midwives in trade or barter. So they’ll give them a stack of fruit or vegetables from their harvest or handmade items of value. They do sometimes pay in money, and apparently were writing checks to some of them, which is what was used in the case against them.

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Wait, case against them? Oh, yes, quite the number of cases, in fact. Literally every midwife who was providing services to the Mennonite community was hunted down by state investigators, arrested, and charged with felonies. The first midwife this happened to was charged with 95 felonies.

Let that sink in. No midwife had ever been charged with 95 felonies. In fact, murderers and rapists aren’t even charged with 95 felonies! When you consider that the infant whose death she was charged with died due to the gross negligence and incompetence of the obstetrician and NOT the midwife (who literally did everything properly), it might make you very angry.

This vapid, vengeful obstetrician – who, it should be noted, has definitely been responsible for MANY infant deaths – would NEVER be arrested for one of them. She’d be in jail for life if that was actually the case. And what, exactly, was Elizabeth Catlin’s crime? Was she experienced and trained as a midwife? Yes. Would she have been perfectly legal to practice in 37 other states outside of New York? Yes, again. How about before 2010? Yes, again.

To be clear, Ms. Catlin had not gone through the sudden and radically changed requirements that were passed without warning in 2010 – and immediately made EVERY midwife practicing in New York under the previous rules suddenly ILLEGAL. In 2010, the Midwifery Modernization Act – heavily lobbied (i.e. paid for) by the conventional medical establishment and the nursing boards – made it necessary to be not only a nurse to be a midwife, but made it necessary to have a Master’s degree – an incredibly high bar that has not ever been demonstrated to be necessary or even helpful in the skillset of a midwife.

In fact, it should also be noted that the type of midwife that Ms. Catlin was (Certified Professional Midwife) actually have better outcomes and fewer interventions than the Certified Nurse Midwives do. Just look at the nurse midwives at NYU Langone Brooklyn. They proudly state their statistic of 20% C-section rate. But births without midwives are only at 30%, so it’s not that great of a difference. In addition, the World Health Organization has stated that c-section rates in excess of 10-15% are not being done for the benefit of the mother or baby, aren’t necessary, and are in fact problematic. This is due to complications with subsequent surgeries. When you compare this to statistics for CPMs, the difference is shocking. They have an average c-section rate of 5%. That’s insane, and doctors don’t even bother to try to come near it? Why? Money money money. $10k versus $50k (vaginal vs surgical). But that’s a story for a different day.

Here are some results from the largest home birth midwife study conducted between 2004-2009: Low intrapartum and neonatal fetal death rate overall (2.06 per 1000 intended home births) (this contradicts the ACOGs newer study) 

Low rate of low APGAR scores

5.2% cesarean section rate (compared to 32.1% in the US)

Less than 5% used Pitocin or epidural anesthesia

The 2024 study states unequivocally: “Planned home births are as safe as planned birth center births for low-risk pregnancies. Current [ACOG] guidelines advising against planned home births are not supported by these data.”

In Ms. Catlin’s case, she had been working as a midwife for 35 years. So in 2019, when the prosecutor of this small New York town decided that midwives were public enemy number one and needed to be eradicated, she had been working illegally for nine years. She was legal up until 2010, but her practice of home birth was illegal. So she realistically faced the same risks for her whole career. While there was a requirement to be a CNM, there was also a grandfather clause allowing those who were previously licensed to upgrade their license without going for a Master’s degree.

However, in 2010 when the new bill was passed, there was no grandfathering at all. If you didn’t have a Master’s degree, you had to quit working for at least three years and go get it. I say at least because if you weren’t a nurse midwife, you had to go to school for that too, for another four years. During this time, one would be drawing attention to themselves and might get in trouble if they continued to work. If they couldn’t pay for school without working, they were out of luck

So the prosecutor, who was a man – certainly above average in terms of wealth – decided that the requirements were absolutely reasonable, and every midwife practicing outside of them must be stopped in his witch hunt style takedown of the practice of midwifery in his county. Investigators were assigned, and midwives started getting arrested. Every one that was helping the women in this community birth their children.

So now, congratulations to the prosecutor, nearly all births in his upstate Mennonite community are UNATTENDED. Why is that important and disturbing? Well, the biggest reason is discussed above: higher infant death rates when unattended births are included in the study data.  And, of course,  the American Heart Association. The CPM from Pennsylvania who trained the New York midwives in neonatal resuscitation cited a concerning statistic that was verified as having come from the AHA: 1 out of every 10 babies born will need assistance breathing upon delivery.

Let me repeat that: ONE OUT OF EVERY TEN babies will need assistance breathing upon birth. 1% of neonates need extensive resuscitation.  What happens if they don’t get that assistance? In many cases, they die. So this prosecutor is single handedly responsible for the certain jump to a 1% and possibly 10% infant mortality rate in the Mennonite communities. Because guess what? They weren’t going to go to a hospital before, and they’re still not going to one. Without a midwife – whether a CPM or CNM – present as a birth attendant, no one will know what to do and the newborn will not live. What will the family do with that infant whose death they can possibly be charged with murder for, especially in New York? That’s unknown. They might get a death certificate and have a burial. Or they might just bury the body on their property and move on.

I called the Mennonite communities (Amish too it should be noted – and there are some of those upstate too) Invisible Constituents for a reason. This is based on my own research outside of the film. They don’t have electricity, running water, etc. What else don’t they have or do?

They don’t participate in the Census. The only way to know how many people there are is to check the church records. They do get a birth certificate for every child because they’re legally required to, but that’s it. It’s really difficult to concatenate that information, which is housed with the community’s church. They do presumably get death certificates as well. However, when you check the church records, there is no way they’re accurate. If each family has an average of eight kids, then the church census number should be multiplied by ten every 20 years or so (every generation). Since that’s not happening (the ones I’ve seen don’t show that), this information is not being shared. Maybe they don’t want their communities sizes to be known since they do prefer to keep to themselves.

In addition, they don’t purchase or get health insurance, but they may not be counted in the surveys. For example, a survey of health insurance status in Yates County (the county these midwives were pursued in) shows an 88% insured rate. The percentage of Mennonites in the county may be 12% of the population, but its impossible to know. So they’re just ignored and either not counted or nothing is done to fix the poor numbers. I’m not saying they mind, but it does make it more likely that they’ll be passed over and not helped because no one really knows they’re there and that they exist.

And for a community that doesn’t participate in surveys or medical care, it should have been admirable that they were at least trying to take care of their pregnancies and newborns properly. For those who have an understanding of midwifery and childbirth, they know that the CPM credential is just as good (and many would say better) than the CNM standard. It’s a more holistic method. But most importantly, it requires AT LEAST 200 births to be attended, in addition to rigorous education standards and a written exam. Being thrown into the thick of a delivery is the best way to learn about this incredibly unpredictable (but totally normal and usually positive) process of bringing life into the world. CNMs do mostly classroom work and attend many fewer births before they graduate and take their test.

People who have had deliveries with both a CNM and CPM have often reported that the CPM birth was more pleasant and relaxed, much less stressed and anxious, than that with the CNM. Since CNMs nearly always work in hospitals, that’s not surprising.

But in New York, the CPM credential and all the education and hours put into it are worthless. New York should join the vast majority of states getting better birth outcomes and resolving maternity deserts by accepting this credential. It will benefit all women to have this choice of a more holistic, less medicalized birth experience, but it would especially benefit the Mennonite communities. It would allow them to deliver their large families safely instead of alone or with an unskilled, untrained neighbor who wouldn’t know what to do if the baby comes out not breathing.

It would also be incredibly simple to make this change. The bill that is in the Assembly at the moment has been referred to the Education Committee. This was a completely unnecessary step, but has served to stall the bill. It hasn’t moved in over a year – likely because of the medical lobby, who line the pockets of our local lawmakers as much as they do our National politicians – with so far the same outcome: the lobbying companies win while pregnant women in New York lose. Pregnant women in these communities have now languished for over five years with NO MIDWIVES. No neonatal care. Nothing. The medical community should learn about the skills that CPMs bring to the table – and the excellent outcomes they provide.

While Yates County isn’t considered a maternity care desert officially, there are no midwives there that offer home births, there’s only one hospital (which most Mennonites won’t use), and there’s one birth center in the whole county. If every Mennonite woman in labor came to the birth center, it would quickly become short staffed and overwhelmed.  If they opened the practice of midwifery up, then this community would quickly become served.

All that is needed to be changed in the current or future law is the acceptance of this credential from out of state and in state midwives.  They must have the credential which they’ve earned, and they can work in the state.

It should be noted as well that another birth attendant, in particular a doula, cannot substitute for a midwife. Though trained in physiologic birth, they are not allowed to actually deliver the baby. And if a family was able to convince a doula to help coach them with their birth which they’d deliver themselves, that practitioner could easily face the same consequences (delivering a baby without a license) as these midwives did. Their certifying organization doesn’t allow them to deliver babies, since they’re not clinical providers. So that’s not an answer either.

One other thing I’ll note here that I will be trying to verify: if this one infant death caused such an uproar that the offending midwife (and every midwife in the area) had to be pushed out, there must not have been any infant deaths prior to that. If that’s the case, then allowing these midwives to practice would immediately lower the infant mortality rate – which is rising alarmingly, along with maternal mortality, nationwide. Statistically speaking, as mentioned previously, the infant mortality rate in that area is likely now 1-10%higher than before 2019. And the maternal mortality rate is likely rising as well in that community, because while most births are normal, there is a small percent that isn’t. If no one is there to help these women, then easily resolvable health conditions when a midwife is present will become reasons for death. Very few people are talking about this, but it’s really happening, especially in states where abortion is illegal.

Oh, and just for the record, it’s way easier in New York to kill a fetus than it is to have a safe birth at home with the provider you choose. Just saying.

This film is an excellent primer on this incredibly important issue, and underscores the need for immediate change to the law to bring New York into the modern era with regard to childbirth, maternal safety, and the latest scientific research. I would give it five stars and recommend everyone see it. This is definitely a Must-See movie!

Below are some quotes from the film:

Melissa: No OB or midwife would ever want to lose a mom or baby. But when an OB has a death, the OB isn’t carted off to jail in her slippers. And there have been very very severe and unnecessary deaths due to negligent care. When i was in my 20s I had wanted to be an OB. But i could not believe over and over and over again what i saw in the hospital. The abuse particularly towards women of color…horrible…This battle this isn’t just about childbirth. This is a war against the right for bodily autonomy. History has proven: Criminalizing women’s choices has never produced the outcome they want. You can outlaw abortion and say ‘you cannot have an abortion!’ Then they’ll go back to hiding in alleys. If a woman wants an abortion, she will get one. And it’s the same thing for childbirth. If a woman does not want to go to the hospital, she won’t.

Lawyer: What i came to understand is that in conversations with family members who were inquiring as to what went on, the doctor in essence said, ‘I should have done a C-section when she came in.’ In other words acknowledging some situation that required intervention. What later became the mantra was that the midwife had failed

Mennonite woman (aunt of Baby Joseph which precipitated the whole case): They are not blaming anybody, but they do wish that the doctors would tell the truth. They do wish that the truth would be told.

Banner Image: Arrest the Midwife promo. Image Credit – PBS