Asa Joy Cruz, who was delivered via cesarean section May 4, died during an attempted home birth in Georgia. [Photo provided by Ashlyn Cruz] ▲

Ashlyn and Gabriel Cruz picked a name for their daughter a few months before she was born.

They would call her Asa, Hebrew for "healer." It's a name from the first Book of Kings in the Old Testament. Her middle name would be Joy.

But after some 60 hours of labor at home in May, when Ashlyn Cruz finally got to hold Asa Joy in her arms, it was too late. Her daughter had died in utero at least 10 hours earlier.

Had the Dearing, Georgia, mother planned to deliver her baby in a hospital, Asa would have lived. Instead, the family trusted an unlicensed midwife to guide them through the process, Ashlyn Cruz told GateHouse Media.

"This shouldn't have happened," the 28-year-old mother said on the phone, as her almost 3-year-old son called for her in the background. "She was perfect. Asa was healthy."

The Georgia Board of Nursing opened an investigation Thursday into the midwife, Cindy Morrow, and her unlicensed practice. The case since has been referred to investigators in the Secretary of State's Office, according to its press secretary, Tess Hammock.

The family also retained an attorney and is pursuing a lawsuit.

Morrow declined to comment on the details of Cruz's case, saying in an email to GateHouse Media that privacy laws prevent her from doing so. But she said she disputes the family's narrative.

"I was devastated and traumatized by the outcome of this birth, and I have complete empathy and compassion toward baby Asa's grieving parents in their loss," Morrow wrote. "However, I believe that I provided the best care and support that I was able to provide to this family, in the context of their choices and the marginalized, vulnerable status of home birth midwives in the state of Georgia."

Only nurse midwives can legally practice in Georgia, according to state rules. But many non-nurse midwives practice openly in the state, seemingly without consequence.

Morrow is one of them. Although she is certified as a professional midwife — or CPM — by the North American Registry of Midwives, Morrow is not licensed by the state of Georgia and is not authorized to practice there.

Non-nurse midwives have lobbied state lawmakers for years to license and regulate them. Some recently pointed to Asa's death as evidence the state needs to act.

"We are confident that licensure similar to the other 33 states that license CPMs will help GA families in identifying adequately trained and licensed providers for community birth. It will also provide an avenue of recourse by families," the Georgia State Chapter of the National Association of Certified Professional Midwives posted Tuesday on Facebook.

When Cruz hired Morrow for her May delivery, she said she didn't know the midwife lacked a state license or the legal authority to oversee her birth.

Morrow told GateHouse Media that all of her clients sign an informed consent document acknowledging her status as an unlicensed midwife in Georgia. But the document Cruz received, which she shared with GateHouse Media, had no such disclosure.

Cruz, who owns a business selling children's shoes made by Nicaraguan artisans, had delivered Asa's older brother, Michayah, via C-section. She wanted to have what she considered a more natural birth with Asa.

After serving as missionaries in Nicaragua for a year, the Cruz family moved back to the United States, settling in Georgia in October 2018.

When Cruz found out she was pregnant, she sought a provider who would let her have a vaginal birth after cesarean section — or VBAC, which carries a roughly 1 percent risk of uterine rupture, and can be fatal to both mother and baby if not treated immediately.

That's when she found Morrow, who was willing to oversee the high-risk delivery.

"I viewed it as she was willing to take on a mother who wanted what was best for her body and her baby," Cruz said.

In addition to receiving prenatal care from Morrow, Cruz said she also twice visited Atlanta-based OB-GYN Brad Bootstaylor on the recommendation of her midwife. Known for championing natural birth, Bootstaylor performed two sonograms, Cruz said.

He also assured Cruz she was a good candidate for home birth and in good hands with Morrow.

"He was promoting the fact that she would be qualified to do a job," Cruz said. "That's why I felt so secure in Cindy. How would an obstetrician be backing up an illegal midwife, and saying that what this lady is doing is okay?"

GateHouse Media made multiple attempts to reach Bootstaylor, including leaving a message at his practice, but was unsuccessful.

Cruz said Bootstaylor also agreed to serve as her backup doctor in case she needed a C-section and that he prescribed her Ambien upon the midwife's request.

Morrow, who is not a licensed medical professional, told the mother she could donate the prescription drugs if she did not use them.

"I will request a prescription for Ambien be called in for you in preparation for labor ... ," Morrow wrote Cruz in a March 25th email that was shared with GateHouse Media. "If you end up not using it, I am happy to have donations to have on hand for those Moms who do not have a back up doctor/rx."

Cruz was 39 weeks and 3 days along when contractions began. In the nearly three days that she labored at home, the mother was without midwifery care for hours after Morrow left the residence three times — twice to go to a hotel and once to get breakfast.

"She lied to me," Cruz said. "She said she would be at the home and be there the entire time."

Cruz estimates that Morrow checked her four or fives times while she was in labor. Each time, she said, Morrow assured the mom all was well.

But it wasn't until a day and a half after Cruz's water broke with meconium — the baby's first stool and can be a sign of distress — that Morrow told the family it might be time to go to the hospital, Cruz said.

Morrow's labor notes, a copy of which the family provided GateHouse Media, showed the baby's heart rate, though hard to locate, was between 120 and 128 an hour before hospital transfer.

But when they arrived, hospital staff could not find Asa's heartbeat.

They detected only the mother's heart rate, Cruz said. The heart rate Morrow had found was hers, not her baby's, Cruz explained through tears.

Doctors rushed Cruz into surgery and performed an emergency C-section to get Asa out.

Asa had died an estimated 10-24 hours before doctors delivered her via emergency cesarean section, the family said. It was so long that she had begun to deteriorate in utero — her skin peeled off at the touch.

When Cruz awoke, she cried for Asa, and asked where she was.

Her husband broke the news to her, and the couple held their daughter close. She had a full head of hair that was curly just like her dad's, and a nose just like her mom's.

"I'm just so angry," Cruz said.

Cruz wrote about her tragic experience on her blog, the Humble Soles, and blamed Morrow for her loss. The Sept. 17 post had received nearly 1 million views more than a week after it was posted. At least one additional mother has come forward since then, saying she had a similar experience with Morrow.

Whitney Welch, a Georgia mother of four who attempted to deliver her youngest in a home VBAC earlier this year, said she also was neglected by Morrow. Welch's son was delivered in April by emergency C-section 10 days after her water broke. The doctor told Welch that if she had waited any longer, her baby wouldn't have survived, the mother wrote in a blog post.

"I wish I would've spoken up before," Welch told GateHouse Media. "Had I spoken up, maybe Ashlyn would've known better."

Cruz said she hopes Georgia will adopt regulations for non-nurse midwives like Morrow so it can regulate them and hold them accountable.

"There has to be better outlets for moms to know who is what and who can do what," Cruz said. "I did my research, and everything looked perfect to me."