As jurors prepare to weigh manslaughter charges against a midwife who attended an unsuccessful birth, there are those who believe much more is at stake than the fate of one woman.
Yvonne Cryns is accused of not doing enough to save the life of a baby born dead in his parents’ Round Lake Beach home. But her trial in a Waukegan courtroom has attracted the attention of proponents of lay midwifery. Day after day, they have jammed the courtroom seats behind Cryns.
“If Yvonne is convicted, midwives everywhere will stop practicing or else go underground to avoid prosecution and litigation,” said Kathleen Adams, a Genoa City, Wis., woman who delivered her two youngest children at home with the aid of lay midwives.
As the trial resumes Tuesday against the Richmond midwife, the twelve jurors soon must decide guilt or innocence in an atmosphere clouded by lofty arguments about rights and choices.
For months, Heather Verzi and her husband, Louis, have insisted that Cryns, 50, is not responsible for the death of their son, Spencer, who was stillborn in August after being delivered on the Verzis’ bedroom floor in a highly risky feet-first breech position.
Cryns, meanwhile, has sought to distance herself from the choices that apparently led to Spencer’s death.
The trial highlights the debate about the proper role of lay midwives. The debate essentially comes down to whether parents should have the right to choose a lay midwife, even for risky births, and whether Illinois should recognize and license lay midwives, to offer some protection to parents who make that choice.
Supporters of direct-entry midwives, or lay midwives such as Cryns, acknowledge that high-profile cases such as this can serve to push the movement backward because of the negative publicity they generate.
Direct-entry midwives receive their education through apprenticeships and private schools and generally attend home births. The term “direct-entry” refers to their out-of-hospital training and in-home apprenticeships.
For at least two decades, lay midwife advocates have argued that they should be recognized by the state as legitimate caregivers, but physicians groups have opposed them.
So far, attempts to pass legislation to license lay midwives have found few followers in Springfield. The state recognizes certified nurse-midwives, or nurses who receive a master’s degree in obstetrics and gynecology. Most nurse-midwives deliver babies in hospitals.
Fewer than 1 percent of pregnant women choose a home birth.
Jurors see videotape
Early in the trial, jurors watched a videotape of the birth taken by a family friend that documented in graphic detail the birth and death of Spencer Verzi. It’s a textbook example of what can go wrong during a home birth, prosecution experts said.
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On the tape, Spencer’s tiny foot is seen dangling for more than 20 minutes from his mother, who is kneeling in a child’s wading pool filled with warm water. Heather Verzi pleads with Cryns for help as her labor drags on for another 25 minutes, and Cryns responds that Verzi needs to do the work herself.
A distraught Louis Verzi is heard praying for his newborn son as Cryns works furiously to revive him after he emerges.
An autopsy found that Spencer died of asphyxia.
Cryns’ manslaughter trial has highlighted the crux of the disagreement over who should be considered more responsible for events that transpire during a birth: the medical community or the parents.
Some parents who opt for a midwife do so out of the belief that it is a more natural form of childbirth and gives them more control than they would have in a traditional hospital setting.
Heather Verzi testified last week that she wanted someone who “would do what I want to do” and not “force decisions on me” during her home birth.
Midwife defends role
Lucky Tomaszek, a home birth advocate from Milwaukee, said, “Becoming a parent for the first or 17th time is a pivotal moment in a woman’s life. Would you rather be in control and have the love and support of family around you? Or would you rather be a body, acted upon, in a hospital? “
Proponents of lay midwifery say Cryns’ trial shows why Illinois should license direct-entry midwives. Licensing would give consumers more information about individual midwives’ education and competence as well as establish standards for care, they say.
For example, legislation could stipulate that when a birth becomes more risky, such as if the baby moves into a breech position or if twins are detected, a lay midwife must refer the case to a doctor, midwife advocates say.
“My job is to create a safe environment in which the birth should take place,” said Valerie Runes, an Arlington Heights lay midwife who is leading the movement to recognize lay midwives in Illinois. She said she does not hesitate to refer a patient to a hospital when the situation becomes too risky.
“I think this is a good example of where licensing is necessary,” Runes said. “We have to have standards to practice safely.”
Marsden Wagner, a Washington, D.C.-based doctor who is retired from the World Health Organization and is an outspoken advocate for midwives, said the most important job for a midwife is to determine when the normal birth becomes abnormal. He said some midwives will help deliver breech births, but the majority would refer those women to doctors and hospitals.
“The people of Illinois are not being protected,” Wagner said. “I would hope very much that what would come out of this trial is the realization that there is no way for the people of Illinois to determine who is or isn’t a good midwife.”
Delivery complications
Doctors say Spencer Verzi’s death is just the latest example of what can go wrong when women have their babies at home without the back-up of medical technology and personnel.
Dr. John J. Barton, chairman of obstetrics and gynecology at Advocate Illinois Masonic Hospital, said he does not believe lay midwives receive proper training to deal with the many things that can go wrong during birth.
Barton said he would have performed a Caesarean section on a first-time mother who was delivering a baby in the foot-first breech position because of the great chance that the head would get stuck in the uterus.
Barton said he does not believe that legislation to recognize lay midwives would ensure that the midwives had proper expertise in emergency situations.
Indeed, Cryns has testified that because she isn’t a licensed professional, she can’t purchase pure oxygen, start an intravenous line or prescribe prescription drugs.
“Again, what I’m for is the safest environment for that mother and baby,” Barton said. “And I need a blood bank, and I need an operating room. I need all the support I can get.”