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Martha Hughes - Midwife Prosecuted for Breech Death

Prosecution Of Midwife Is Dropped

The Loudoun County prosecutor dropped manslaughter charges yesterday against a midwife who attended a failed breech delivery at a Middleburg cabin last year, saying he could not find the dead baby's parents to call them as witnesses for a scheduled November trial.

Commonwealth's Attorney Robert D. Anderson vowed to keep looking for the parents, Harrison and Nancy Miner, and said that once he finds them, he will reinstate charges against lay midwife Martha Hughes, of Huntley, Va. Prosecutors trailed the couple last month to Jacksonville, Miss., he said, but were told by a relative that they were on the move and did not say where they were going. The Miners have refused to cooperate with the prosecutor from the start, saying they believe that Hughes, 35, did all she could to save the baby born at their house in January 1995.

Prosecutors contended that Hughes had a "callous disregard for human life" because she did not summon paramedics until after the unconscious baby was born -- more than 20 minutes after the first sign of trouble. The baby girl's umbilical cord had become compressed, cutting off blood flow. She died the next day. Hughes was charged with involuntary manslaughter, in a case that has renewed debate among health officials over how far a state should go in regulating medical care during childbirth.

"I feel relieved," said Hughes, who said she has stopped working as a midwife since she was charged in April. "I feel like I did everything I could to save that baby's life." The dropping of charges was cheered by the Midwife Alliance of North America, an association based in Newton, Kan. "If the parents felt they had been wronged, they would have assisted the state in prosecuting the case," said Ina May Gaskin, president of the alliance. Health officials estimate that there are 1,400 to 1,800 lay midwives nationwide. Unlike nurse-midwives who work in hospitals, lay midwives are not certified and typically help women who want to give birth at home. Lay midwives are allowed to practice in 30 states and the District, according to the American College of Nurse Midwives. They are barred from working in Maryland and Virginia, except for a few who have been exempted from the law under a "grandmother" clause.

Anderson said that the Miners were "essential witnesses" in the prosecution of Hughes and that his office had added a second investigator, who would work on the case.

"There will be a time when we've exhausted all our resources, but we're not there yet," he said. Hughes's attorney said the couple had stayed in touch with his client, and that he told them yesterday by telephone that charges had been dropped. "They have been very supportive of Hughes," said David Bracken, her attorney. "They were pleased and happy."

Bracken and Hughes declined to comment when asked if the Miners were moving in an effort to dodge prosecutors. Anderson said an assistant prosecutor and an investigator had been looking for the couple for the last two months, and they thought they had found them in Jacksonville. On Aug. 22, they flew to the city and were told by Nancy Miner's brother that the couple had returned briefly to Virginia a month earlier, moved to Florida and then to New Mexico. "The last he knew, they were living somewhere in New Mexico, but he also represented that he did not know where in New Mexico Nancy Miner or her husband could be found," the prosecutors said in the motion to dismiss the charges.

Midwife Charged in Death of Newborn Baby

Nancy Miner insisted on giving birth to her first child in the rustic Middleburg cottage where she lived, even though the building had no electricity and she would be assisted only by her husband, a friend and an unlicensed midwife.

Twenty minutes before delivery, though, on a cold January evening in 1995, something went terribly wrong. The baby girl's umbilical cord became compressed, cutting off blood flow and slowing her heartbeat.

But it wasn't until after the unconscious baby was born -- more than 20 minutes after the first sign of trouble -- that someone in the house called for outside medical help, according to court records and those familiar with the case.

The baby died the next day, and now Loudoun County prosecutors have charged the midwife, Martha Hughes, with manslaughter. Their unusual step has kindled a debate among health officials and midwives about just how far a state should go in regulating medical care during childbirth.

Prosecutors contend that Hughes, 35, of Flint Hill, Va., had a "callous disregard for human life" because she was unlicensed and failed to summon paramedics promptly. But Nancy Miner and her husband, Harrison, who have refused to cooperate with prosecutors, and Hughes's attorney said they believe Hughes is a skilled woman who did everything she could in a harrowing situation.

"This case is all about the rights of parents to make decisions about the welfare of their children," said Erin E. Fulham, a Silver Spring nurse and a member of Maryland Friends of Midwives. "Should parents have the choice about the health care of their newborn?"

Health officials estimate that there are 1,400 to 1,800 lay midwives such as Hughes nationwide. Lay midwives, unlike the nurse-midwives who work in hospitals, are not certified and typically help women who want to give birth at home. Lay midwives handled 14,190 of the more than 4.4 million documented childbirths in 1992, the most recent year for which such statistics are available, according to the American College of Nurse Midwives.

Hospital births with a doctor cost $5,000 on average, and a lay midwife charges less than 25 percent of that, experts said.

Lay midwives, who are not required to have formal training, are allowed to practice in 30 states and the District, according to the college. They are prohibited from working in Maryland and Virginia, with the exception of a few women who have been exempted because of a "grandmother" clause.

Hughes would not discuss the case, but her attorney, David S. Bracken, said she has participated in several training courses for midwives and is a certified emergency medical technician. She is not a nurse and is not exempted by the clause and therefore could not be certified as a midwife by the Virginia Board of Health Professions.

After being tipped off by a physician, the board began an investigation of the case last year that led to a grand jury indictment last month.

Nancy Miner, a 40-year-old photographer who was uninsured and who recently moved out of the Washington area, said she sought out Hughes because she did not want to give birth in a hospital.

"Everyone was born at home a generation ago," she said. "Now they act like it's outrageous."

She said Hughes, who has assisted at 179 deliveries, visited her regularly before the birth for medical examinations. On the night of the birth, Hughes tended to Miner in a candle-lit bedroom. About 20 minutes before the delivery, it became clear that the baby was in a breech position -- being born feet first -- and that the umbilical cord had become compressed, Harrison Miner said. Despite the complications, he said, the couple decided to go through with the birth at home and made their wishes clear to Hughes.

Obstetrics specialists said that although there's no guarantee that the child would have survived had Miner gone to a hospital at the first sign of trouble, the odds would have been much better. Most babies in the breech position are delivered through Caesarean section, the specialists said.

"The chances would have been infinitely better had they been in a hospital setting," said John T. Queenan, the chairman of the obstetrics and gynecology department at Georgetown University. "It's certainly poor judgment not to have a hospital delivery with an obstetrician with a breech baby."

Bracken said Hughes should not be held liable for the tragedy because she was simply respecting the parents' wishes. Hughes "was just trying to do what they wanted," Bracken said. "They wanted to have a child in their own home."

Commonwealth's Attorney Robert D. Anderson would not say why prosecutors waited until almost 16 months after the death to file charges, and he refused to comment further on the case.

If convicted, Hughes could face up to 10 years in prison.

The Miners said they knew the risks of having the baby at home. "Sometimes babies die in birth," Nancy Miner said. "They don't always make it through."