Elizabeth Catlin is facing felony charges for her birth-attendant practice in upstate New York. (Photo: Mike Bradley for Yahoo Lifestyle)

It was just a few nights before Christmas, in 2018, when Elizabeth Catlin — a trained midwife who had attended the births of several hundred local Mennonite babies over the years — was arrested at her Penn Yan, N.Y. home and handcuffed in front of her 8-year-old daughter for practicing midwifery without a state license.

After waiting an excruciating year, Catlin, whose midwifery certification is recognized in 34 states but not New York, was finally indicted on Dec. 17, 2019. The district attorney handed down a surprisingly multitudinous 95 felony counts. But it was one count, the most serious, that most blindsided Catlin: that of criminally negligent homicide, tied to the death of an infant.

“That’s the most devastating,” she says.

On Tuesday morning, facing those charges during an arraignment in Yates County Court and greeted by a crowd of her supporters, Catlin entered a blanket not-guilty plea, setting into motion what’s sure to be a complex and closely watched jury trial — and continuing an episodic narrative that’s not only upended the lives of Catlin and her family, which includes 14 children and 20 grandchildren, but of the hundreds of Mennonites who relied upon the beloved birth attendant in what midwifery advocates call the “maternity-care desert” of rural upstate New York.

“These women need resources, they need help,” Melissa Carman tells Yahoo Lifestyle. As president of the nonprofit NY-CPM, Carman has been ramping up efforts, along with other advocates and state officials, including NY Assembly Member Richard Gottfried, to change the New York law in a way that could allow Certified Professional Midwives (CPMs) like Catlin to become licensed. That pre-bill effort, being called the Unified Midwifery Practice Act (UMPA), will hopefully have a hand in bringing women in rural, underserved communities what they are “desperate for,” says Carman — “quality care from providers who respect their cultural history and their way of life.”

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That’s precisely what Catlin, 54, was providing, say those in her corner. But, with the loss of her services in the area, says Carman, “the heart of midwifery — the compassionate care that was given, the relationships built and the trust in a provider — is gone.”

Catlin received a flood of supportive cards and notes from those in her corner. (Photo: Mike Bradley for Yahoo Lifestyle)

Now, Catlin’s lawyer David Morabito — a criminal defense attorney more accustomed to defending “serial killers and hitmen,” he says — stands ready for trial.

“I feel in a good position to vigorously defend her rights,” he tells Yahoo Lifestyle about the charges levied against Catlin, which include the unauthorized practice of the profession of midwifery and a slew of identity theft and criminal possession of a forged instrument charges, related to allegations that she used a physician’s identity to perform lab tests for pregnant clients.

The many counts, when added together, would carry a maximum prison sentence of 473 years, and constitute the “most charges ever in the history of midwifery in the United States,” according to Carman.

But Yates County District Attorney Todd Casella contends they are merely a “representative sample of what we had evidence of,” telling Yahoo Lifestyle, “There could’ve been over a thousand,” and noting that the charges result from a coordinated investigation by the New York State Police, New York Education Department and the District Attorney’s Office.

Advocates from across the country, meanwhile, find the breadth of charges “egregious” and “over the top,” with the charge of criminally negligent homicide, listed first on the 51-page indictment, most rattling.

Elizabeth Catlin, center, surrounded by her many family members. (Photo: GoFundMe)

“It’s devastating to me, and makes me very sad,” Catlin tells Yahoo Lifestyle of the charge, stemming from the October 2018 death of a baby boy who was born septic at a local hospital after Catlin transferred the laboring, in-distress mom there from her home; the infant died as he was being rushed to another hospital for emergency care.

Anger, meanwhile, is what many in the national midwifery network are feeling.

“What they’re trying to do, I guess, is make some kind of crazy example of this person — for what, I’m not exactly sure,” Vicki Hedley, president of the Midwives Alliance of North America (MANA), tells Yahoo Lifestyle. “The fact that she is being indicted for negligent homicide is way over the top, since the baby died six hours after being in her care.” Hedley is not yet sure about what the case could mean for midwifery, but surmises, “Maybe that they’re on a bigger witch hunt than they ever have been.”

Lead police investigator Mark Eifert tells Yahoo Lifestyle he can provide no further comment “until the trial.”

Catlin is certainly not the first midwife to face criminal charges, as it’s been a well-documented pattern since the early 1900s, when anti-midwife campaigns were headed by the medical establishment. But this, Hedley says, “might be the worst one that’s ever happened. Nobody has ever had 95 felonies against them … It’s outlandish.”

Mennonite women gathered to speak with Yahoo Lifestyle in 2019, following Catlin's arrest. (Photo: Mike Bradley for Yahoo Lifestyle)

Many see Catlin’s case as emblematic of how alternative-birth choices are viewed, for the most part, in America. “Criminalizing women for helping other women have babies tells us all that women still are not free to make our own health care decisions — even about something so extremely personal,” Cristen Pascucci, founder of the organization Birth Monopoly, previously told Yahoo Lifestyle following Catlin’s arrest.

It seems particularly true in New York, a complicated state as far as the country’s patchwork of midwifery laws go. The state offers a path to licensure for only two types of midwives: Certified Nurse Midwives (CNMs), the majority of whom work in hospitals alongside OB/GYNs and who are licensed in all states after earning a master’s degree, maintaining a registered nursing license and graduating from a CNM education program; and certified midwives (CMs), a relatively new class of provider, who must also earn a master’s degree, follow a specific educational preparation and then take a CNM-equivalency exam.

CPMs, meanwhile, become nationally accredited either through an apprenticeship or educational program (Catlin received much of her training through an Idaho-based midwifery program, combined with an apprenticeship under a licensed midwife), or a combination of the two; there are nearly 3,000 in the U.S., almost all of whom attend home births (which represent only about 1 percent of births). While CPMs are licensed to practice in 34 states, New York is not one of them — and while there was once a path for granting an exception, that changed in 2011, excluding midwives like Catlin because they don’t have a master’s degree.

The stance that higher education should be a foundation of quality midwifery care is one held by many — including the International Confederation of Midwives (ICM), a worldwide, non-governmental organization that works to “advance the profession of midwifery globally” and unify standards. And the official position on midwives of the American College of Obstetricians and Gynecologists (ACOG) is one that endorses ICM’s standards.

“Here in the US, midwifery groups have no agreed-upon definition of a midwife,” the position statement reads. “There are three separate midwifery credentials … with differing levels of education and training. CNMs and CMs meet and exceed ICM’s minimum education standards. However, possibly as many as two-thirds of CPMs do not meet the ICM standards. Our health care partners and state lawmakers must work with us to ensure that no woman in the U.S. receives midwifery care that wouldn’t meet the standards received by women in other, even less developed, nations. ACOG advocates for implementation of the ICM standards in every state to assure all women access to safe, qualified, highly skilled providers.”

Community fallout: “It’s been a hard and very upsetting year.”

Catlin’s arrest and indictment have had a domino effect throughout the community over the past year — beginning with her own family’s financial hardship, the result of legal fees coupled with the end of her practice, which has even forced her to recently sell her house. She has found work, though, at the University of Rochester, as a human research study coordinator focusing on Mennonites.

One of the many donations Catlin received from her supporters in the community. (Photo: Mike Bradley for Yahoo Lifestyle)

“I’m making ends meet, so that’s been a huge blessing,” says Catlin, whose husband Steve is a fence builder. She’s also received an outpouring of support, both emotional and financial, from many of the region’s 700 families of Mennonites — adherents to the Old Order culture who, like the Amish, do not believe in serving in the military or in politics, or in most modern conveniences, including computers, TV, radio and cars (although only some orders rely strictly on horse-drawn buggies).

They also eschew unnecessary medical interventions, particularly surrounding birth. And while the belief system values a quiet stoicism over loud activism, especially when it comes to Mennonite women, many have felt compelled to speak up in Catlin’s defense, turn out in force to support her at court dates and even donate financially to her cause.

“I’ve been blessed with piles of cards and letters with donations,” Catlin says, adding that many have donated to her GoFundMe page, currently at a sum of around $10,000. But as was noted in a letter sent to community members and posted on her fundraising page, “she is in immediate need of $75,000 to keep her case moving. The total amount needed is expected to be about $100,000…”

“It has been a hard and very upsetting year,” Brenda Zimmerman, a Mennonite woman with two children, ages 2 and 3, whose births were attended by Catlin, tells Yahoo Lifestyle in the days leading up to Catlin’s arraignment. “Some have accepted the change, some are like me, saying, ‘This is not fair.’ Liz didn’t call me to ask her if she could deliver my babies, I called her. We feel just as at fault.”

Elizabeth Catlin faces felony charges for her midwife practice in upstate New York. (Photo: Mike Bradley for Yahoo Lifestyle)

Zimmerman and others scoff at investigators’ claims that Catlin had been tricking Mennonite women for years, denying the idea in news accounts. “She was always upfront with us,” Rosalyn Sauder, a former Catlin client, told Yahoo Lifestyle for an initial story about Catlin’s arrest. “She was not fooling or exploiting us.”

Ivan Martin, a Mennonite elder and de facto community spokesperson, concurs “The prosecution of Liz’s case is just an outrageous overreach — 95 charges. I don’t think Jack the Ripper faced that many charges. It’s really insane,” he tells Yahoo Lifestyle. “The question goes back to, who’s behind all this? It’s being driven with such a vengeance … [I challenge you to] find any Mennonite lady who says she was a victim.”

Martin and others have long placed blame on the local hospital system, Thompson Health, as it was someone on the executive staff at the Canandaigua branch, F.F. Thompson Hospital, according to Eifert, who called in a complaint against Catlin after she transferred the laboring mom there.

Now, in what Martin sees as a slap, another local branch of that hospital system, in nearby Geneva, has announced it has added OB/GYN services — and had scheduled its ribbon cutting and open house on Tuesday evening, the very same day as Catlin’s arraignment. “It’s interesting to me that the same corporation from whence Liz’s problems and charges started is now advertising to pick up slack that they created by attacking Liz’s practice,” Martin says. “It looks like…they were looking to benefit financially, which Is what most of us thought from the start.”

Responding to that notion, Thompson Health spokesperson Anne Johnston tells Yahoo Lifestyle, “As mandated reporters, we were obligated to notify the state police of the baby’s death and they took the investigation from there. To suggest any relationship between Ms. Catlin’s case and our long-planned women’s health clinic in Geneva is simply false.”

Still, most Mennonites will not go to a hospital for prenatal care, leaving a still gaping void in the community — one that, according to several sources who wish to remain anonymous, is being quietly filled, now more than ever, by other renegade CPMs, along with lay midwives, who have no formal training. It’s just one more piece of evidence, say advocates, that such a punitive approach only makes home birth less safe, by driving some midwives underground.

“Most would prefer their sister to catch the baby than go to the hospital,” says Brigitte Rhody-Garrison, one of four licensed Certified Nurse Midwives (CNMs) who have come to Yates County from the Rochester area, renting out a tiny clinic space and attending home births in an attempt to help fill in the gaps of maternity service. When asked about CPMs continuing to attend births, she says, “I’m surprised that people who are practicing are being so brave … A lot are very religious, and say, ‘It’s God’s calling.’ But they could lose everything.”

Rhody-Garrison reports that she’s felt very welcome among her Mennonite clients — of which there’s been no shortage — despite complaints from some that the CNMs charge double what Catlin charged. That, she believes, is “comparing apples to oranges,” considering the CNMs’ costs of malpractice insurance, licensing fees and repayment of student loans. “We’re not out to make money, and we’re not making money,” she says, adding that she and the others have been working with a Christian healthcare ministry in an aim to work out coverage of their fees for Mennonites, most of whom are dairy farmers with low incomes.

If anything, Rhody-Garrison hopes the situation with Catlin “sheds some light on the global problem of lack of care in these maternity deserts … These country people have nowhere to go. It’s a crisis.” But regarding Catlin being arrested, she says, “That was going to happen eventually. It is not legal. And so, unfortunately, we have to figure out how to change the law or change the system. We need one route, no shortcuts. Let’s all be on the same page.”

Adds April Ward, one of the CNMs now working in the southern area of the county, “It’s a maternity desert [here]. Midwives are really it.” She laments the arrest of Catlin, understanding it’s the job of the state to keep clients safe, but noting, “There should be a better solution to all of this.” After all, Ward says, “I support CPMs. I support the right of families to decide where and how to give birth.”

This story was originally published on Jan. 29, 2020 at 1:21 p.m. ET and has been updated to clarify the details of Elizabeth Catlin’s education history.

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