The Philadelphia Inquirer on Monday examined the debate over lay midwifery -- usually defined as midwives trained through apprenticeship -- in Pennsylvania. According to the Inquirer, only people who have nursing degrees can be licensed to practice midwifery in the state, but Pennsylvania law does not prohibit the practice of lay midwifery. Some advocates say that safe home births in the state -- which has a large Amish population that largely does not have health insurance and relies on the comparatively low cost of lay midwifery -- would decrease without lay midwives. According to the Inquirer, lay midwives attended almost 50% of the 3,481 out-of-hospital births in the state in 2004. Daniel King, a spokesperson for the Lancaster County Amish community, estimated that about 75% of community residents have home births with lay midwives. Pennsylvania Department of State spokesperson Catherine Ennis said the state code defines the word midwife as a "person licensed by the Board to practice midwifery," which means midwives who are not licensed nurses are prohibited from legally delivering infants. "There's no exception in the statute or case law that allows a lay midwife to fall outside the boundaries of licensure," she added. According to the Inquirer, the American College of Obstetricians and Gynecologists last year released a statement in opposition to lay midwifery. Sarah Kilpatrick, vice chair of the obstetrics practice committee at ACOG and head of the ob-gyn department at the University of Illinois, said that although she is "a big fan" of nursemidwifery, it is dangerous to allow lay midwives to deliver infants (Buchman, Philadelphia Inquirer, 2/5).

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