Without License

By: Alysia Yi, Graduate of Wake Forest University School of Law

Alysia Yi is featured in our Author Spotlight section. You can read her interview about this piece here.

Photo by John Hammond

Part I. The Way It Was

1958, Seoul, South Korea

A woman lay on her bed, silently staring at the ceiling of a tiny master bedroom. She’s wearing a dress, her legs open and stretched out, immobile. Blood stains the old white sheets from the waist down. She looks at least ten years older than her young age of twenty-five, a kind of hard aging that has befallen those who’ve lived through war. The kind of aging that did not draw attention in a country thoroughly afflicted with grief. A single tear falls down her face as she stares blankly into space, her stoicism gratefully masking her sorrow of yet another loved one lost. There was no war to blame for this one though.

“I’m so sorry,” squeaks the ten-year-old girl at the foot of her bed, disrupting the heavy silence. The young woman glances at the child by her feet, whose bright eyes were brimming with tears. An elderly woman, who was carefully wrapping the baby in a clean white cloth, pinches the little girl’s shoulder hard, giving her a stern look. The little girl turns away, wipes her tears quickly, and focuses on cleaning the tools in front of her. The young woman resumes staring at the ceiling without a word.

Standing at the corner of the room, the elderly woman inaudibly sighs as she peers into the little face of the baby she has in her arms. It was a baby girl. The elderly woman had been the go-to midwife of every town she’s lived in for over fifty years. Her husband, at his older age, still made wooden furniture. She was the store keeper, the store behind where her whole extended family resided. Whenever someone rushed to her door saying that a woman was giving birth, she would yell to one of her children or grandchildren to watch the store before running out the door with a purse full of supplies. This time, she’d brought her eldest granddaughter with her, with the mind to train her and keep the sacred knowledge of midwifery alive. She had delivered a thousand babies in her lifetime, but this kind of tragedy never got easier.

The elderly woman took one last look at the baby’s beautiful face before covering it gently with the end length of the cloth.

‘This is a tragedy indeed,’ thought the older woman. The young woman who gave birth to this stillborn, Ji-hae, was someone she knew personally, someone everyone knew personally.

Ji-hae was the town pharmacist, but the aftermath of the war had instilled in her the moral obligation to be more. Most people in her town didn’t have access to doctors when they or their loved ones were ill. Having graduated from the top university in Korea, people saw her as an honorary doctor.  In return, she dedicated all of her waking hours to helping everyone that walked though her door. So much so that even the men in town had to respect her.

As was the case for many, the Korean War had torn Ji-hae from her family. By the time it was becoming clear to everyone in the chaos of war that the country was being split into two, there was a mad rush of citizens trying to make it south of the border. Making it south was nothing short of a miracle, and it was just too late for many.

None of Ji-hae’s family members had made it. Maybe they were killed before they could even try—she wasn’t sure. Her family’s hometown, Kaesong, was just north of the newly created border. Ji-hae just happened to be studying pharmacology south of the border in Seoul when the war broke out. So, she had no choice but to persevere alone for some time, until she met and married a police officer dedicated to bringing back peace to the streets.

The elderly lady approached Ji-hae’s bedside.

“It’s going to be okay, Ji-hae. I’m going to bury her for you, okay? And I’ll make you seaweed soup and bring it to you in about an hour. Rest up. I’ll make sure nobody bothers you.”

Ji-hae nodded, grateful. Ji-hae was pretty much an orphan, and this elderly woman felt like a second mother to her, at least in this moment when she needed a mother the most. Ji-hae closed her eyes, as the elderly woman gently cleaned her bloodstained lower half with a warm towel.

After she heard the elderly woman and her granddaughter close the door behind them, Ji-hae started crying in earnest.

“Yeo-bo, Yeo-bo,” she murmured, a term of endearment for one’s husband. This was their first child, and her husband wasn’t there. In fact, he wasn’t even in the country. He was an entire ocean away in the United States, where he would stay for another three weeks. His top score on the national police examination had earned him a prestigious training trip to the United States, where he would join much more highly ranked government officials on a journey that would open his eyes to how a developed country kept its citizens safe.

Ji-hae did not blame her husband’s absence for the stillborn child, even though the lack of his presence probably did instill a fear in her so deep that made delivery  much more difficult. She had felt so alone. In this moment, no words could express how much she regretted not going to the hospital. There was one, not too terribly far, and she could’ve asked anyone for help in getting there, especially with her and her husband’s reputation. This was a country in which your daughter was my daughter and your mother reminded me of mine, especially after the war had devastated the lives of so many families. There were always hands ready and willing to help.

“Besides,” she thought, “this was my own fault. My own stubbornness led me to think that I could do this on my own. I am a pharmacist. I have a progressive attitude about medicine. Sure, a lot of people still birthed their babies at home, but those people are less educated or can’t afford to go to hospitals. Plenty of people these days have babies in hospitals. And it’s supposed to be safer in case anything goes wrong. Sure, it’s expensive, but we would’ve come out okay. While our jobs don’t make us rich, we save everything and we do okay compared to a lot of folks. This was my child’s life I put at stake, and for the sake of what?” She couldn’t bear to imagine the look on her husband’s face when he would come back home from his very first trip abroad to learn what had happened. She buried her face in her hands.

“Dear God,” she prayed, “Forgive me for failing my child and my husband. If you ever decide to bless me again with more children, I promise to be a responsible mother and have them in the hospital.”

Part II. Stuck

Chapter 1. The Power of Rhetoric

2023, Asheville, North Carolina

“Aw, geez, not this,” muttered my husband, his words waking me from what had been a most comfortable sleep, a kind of sleep that was impossible to come by lately. I opened my crescent-shaped eyes just a sliver and turned to see him propped up on the bed, watching the news on mute with subtitles.

“Just can’t let the pregnant lady sleep, huh?” I joked, rubbing my eyes. I squinted at the clock. It was a little past ten o’clock in the evening. I looked back at Christopher, his eyes still glued to the television. “What are you watching?” I asked, hoisting myself up and reaching for my glasses on the nightstand.

“Well, you’re not going to like this, Rosie,” he said. It was the news. We both fell quiet as I read the words on the screen.

The President had tweeted yet another provocative statement: “Midwifery has murdered THOUSANDS of newborns. These American babies would be ALIVE had they been in the care of qualified doctors and nurses!”

I sighed and touched my husband’s arm.

“Keep watching,” said Christopher.

Right then, a second Twitter screen capture appeared: “Midwifery should be illegal NATIONWIDE. Blame state legislators and judges who aren’t taking action! Unconscionable!”

This presidential hostility was a reaction to a peaceful Midwives’ March that took place just the day before in Washington, D.C. This march was inspired by women responding to the administration’s reaction to a recent U.S. Supreme Court decision. A couple of weeks ago, the U.S. Supreme Court upheld Roe v. Wade in the newest abortion case, and one of the President’s trusted advisors had appeared on television the very next day. She repeated on various networks, “The President is disappointed in the U.S. Supreme Court decision, but we will continue the fight. This isn’t about women’s rights—it’s about human rights, protecting the most vulnerable and helpless population there is. Why shouldn’t the Constitution protect them? And this isn’t just about abortion. It’s about the sanctity of life. As a matter of fact, there was a huge uproar in North Carolina a few years ago, where a baby literally DROWNED in her mother’s womb because midwives are now attending and mishandling births rather than qualified doctors and nurses. I mean, what is going on here? Where is the media coverage on that? Let’s focus on what’s really important here, protecting the lives of our little ones.”

These few sentences, a mere thirty seconds of footage, unleashed a huge debate on midwifery laws across the United States and led to the Midwives’ March. However, because midwifery has traditionally been a state matter, no one expected the recent rhetoric from the administration to change anything. Apparently, there is a national midwifery certification process but no national licensing process, which is left to the states. In order to be nationally certified, a person must meet the certification standards set by the North American Registry of Midwives, which consists of a general education component in midwifery, a clinical component, and passing a written examination.

The real issue is, in almost all states, a Certified Professional Midwife (CPM) can only practice with a license provided by the state in which they intend to practice. It’s up to states to create these midwifery licensing laws as well a state midwifery board, but so far, only twenty-eight states have, though many have an active CPM bill in session. In almost all of the states that lack a licensing process, it’s  illegal by default for anyone other than qualified doctors and sometimes specialized nurses to deliver babies.

“These are just words, right?” I asked, turning away from the television screen to look at my husband. The anchorwoman was now discussing the propriety of the tweets with a correspondent. “This won’t affect anything, will it?” I asked again. “I mean, I guess it really makes no difference for us the way things are in North Carolina and Asheville.”

“Words do make a difference, Rosie. It’ll be okay, though,” he assured me. I could tell that he was seething inside.

My husband, Christopher, is Mexican American, and it was actually his idea for us to have a home birth with a midwife, instead of having a traditional hospital birth. He comes from a culture and family tradition where midwifery isn’t necessarily seen as “lesser” than a hospital birth experience. His great aunt was a Certified Professional Midwife and she had delivered him and his younger sister in California, a state where it is possible  to be licensed as a direct entry midwife and practice midwifery lawfully. Christopher was raised to believe that a home birth in the presence of a caring and supportive midwife was one of the most sacred ways to bring forth a new life into this world. I agreed.

I am Korean American, also from sunny Southern California. Like most people, I grew up with the notion that babies were born in hospitals. My mother, sister, and I were all born in hospitals. My grandmother, Ji-hae, was born at home, only because that was the way things were done back in the day. Even so, when my husband suggested this idea even before we got pregnant, it just felt right, even though I didn’t know much about the practice.

As responsible parents, we discussed the matter with our obstetrician during my first prenatal examination. I didn’t realize how naïve we had been. I remember walking hand in hand with my husband into the clinic. We looked at each other as we waited, both a little nervous, but excited. This was our first child after all! So when our doctor completely dismissed our birthing plan even before I could get out a full sentence, we were both taken aback. He curtly informed us that midwifery is banned in North Carolina.

“And nevertheless,” I remember the doctor saying, “you are going to be thirty-five years old when you give birth to this baby. This is a higher risk case; you should really be in a hospital for your birth.”

We hadn’t thought to consider the legality of the birthing process we chose. It was kind of hilarious in a way, because we were both lawyers, but I mean, who would’ve thought midwifery was illegal? Haven’t people delivered babies this way forever? Wasn’t this a personal decision? Why didn’t I have the right to choose? After some research, I found out that what the doctor had said about the law was mostly true. North Carolina doesn’t offer midwifery licensing, so direct entry midwifery is illegal. While there are some specialized nurses who are allowed to practice midwifery, the few of them that do exist all practice in hospital settings under the supervision of doctors.

We were both in poor spirits when we got home from the prenatal examination. I rested my heavy body on the bed for a while, staring blankly at the ceiling. Christopher phoned his mother. I must have fallen asleep, because the next thing I remembered was Christopher waking me up.

“Hey Rosie, sorry to wake you, but I just talked to my mom and great-aunt on the phone, and they had some suggestions we could consider.”

“Uh, okay,” I said, thinking of how to tell him in the nicest way that there was no way we were moving back to California. I loved my career here too much.

“My great aunt said that there are underground markets for in states where it’s illegal for them to practice,” he stated. “She could ask around for us. It won’t be too hard to find someone in a New Agey city like Asheville. And it’s relatively low risk. Law enforcement in our state doesn’t actively ferret out midwives. What do you think?” he asked.

Oh. I wasn’t sure what to think at first. Would it be worth taking legal risks so I could get the birth experience that I want? Is that selfish? And what if something goes wrong?

After a few weeks of hashing it out, Christopher and I did decide that it was worth it. We contacted a midwife to help us bring our baby into the world. Our midwife, Esperanza, was recommended to us by a friend of a friend of Christopher’s great aunt.

We immediately took to Esperanza, who was also of Mexican descent. Her kindness and depth of knowledge made me feel at peace with my decision and the pregnancy. She came from a long line of midwives —her mother, grandmother, great-grandmother, and great-great grandmother had had all been midwives. She witnessed her first birth at the tender age of seven, and for as long as she could remember, she had been by her grandmother and mother’s side helping with births in their community. Esperanza had moved from Mexico, where she was born, to Asheville about ten years ago, due to her husband’s business. She had become nationally certified as a Certified Professional Midwife; however, that did not allow her to become legally authorized to practice in North Carolina.

“Midwifery is my calling,” she had told us on our first meeting, when I asked her why she risks practicing midwifery illegally.

It has now been five months since that first meeting with Esperanza, which took place in our home, as every meeting with her did. Now, this latest string of tweets from the President had upset our perfectly peaceful evening.

Exhausted, I removed my glasses and pulled the comforter up to my shoulders to resume sleeping. But I opened my crescent shaped eyes just once more to look into my husband’s warm gaze.

“It’ll be okay,” I said, repeating my husband’s words, moving my body closer to his, as he continued to intently watch the news.

Chapter 2. The Law of the State

A few months later, 2023, Asheville North Carolina

“Asheville Police Department,” I answered on the telephone.

“Yes, I’d like to report that Esperanza Velasquez, a forty-eight-year-old woman of Mexican descent, is illegally delivering babies in Asheville and North Carolina as a so-called midwife. She is killing thousands of babies.”

“When and where did this killing happen?” I asked.

“That’s your job to find out,” he replied.

“I’m sorry, may I have your name?” I asked.

“No, this is an anonymous report. Now, you heard what the President had to say about midwifery. It’s YOUR responsibility to keep our babies safe. Midwifery is illegal in North Carolina. You have a duty to investigate and if you don’t, people will find out that you all weren’t doing your jobs,” he said.

“Okay, thank you for your report, and have a nice day.” I hung up the phone, exasperated. I had already received ten phone calls alone that morning about Esperanza Velasquez. Before these calls had started coming in about a week ago, I had never heard of her before. But I wasn’t surprised that there would be midwives practicing illegally in Asheville. This was the kind of place that embraced holistic health and alternative medicine. Unless someone can tell me that there has been an actual death involving this lady, I and the rest of the department have better things to do with our time than to track her down. I logged the reports in to my computer, planning to take no further action. I suspected Esperanza’s name was probably leaked to a small group of pro-life supporters, who were now hounding us to make her arrest.

As I stood to take a bathroom break, the Chief Police approached me.

“Bennett,” he said, “we have a situation. Remember all the calls we’ve been receiving about Esperanza Velasquez? Well, we’re getting pressured from the city and higher ups of the state to arrest her. I know that we’ve usually turned a blind eye to these kinds of things as long as there was no harm done, given the culture of our community. However, the attitude of the current administration as well as the recent media coverage of our handling of that infamous North Carolina midwife a few years back seems to have reinvigorated our state’s crackdown on midwives. You have to take care of this.”

“Yes, sir,” I replied. Damn it. “Sir, has there been a report of a death of a newborn associated with Esperanza Velasquez?”

“Not that I know of,” he responded, “But there doesn’t have to be a death. The practice itself is banned in this state, as we don’t offer any licensing of Certified Professional Midwives. We also know that she isn’t a doctor or specialized nurse.”

“Understood, sir,” .

“Good. Gather the evidence, and make the arrest. I’m counting on you.”

***

    I watched the beautiful, beige, Tudor-style house from the driver’s seat of my unmarked police car, struggling not to fidget in my seat. I knew what I had to do, but as a woman, I wasn’t sure if I would be able to sleep tonight after I did it.

Esperanza’s cell phone number wasn’t too hard to find. She seemed to do a pretty good job of changing the number regularly, but when I went on a local pregnancy messaging board pretending to be a pregnant woman seeking midwifery services, it didn’t take long before I received a couple of phone numbers. No names, just phone numbers. When I called these numbers, sure enough, one of them belonged to her.

“Esperanza Velasquez?” I asked when a lady picked up the phone. There was silence.

“Why are you calling her?” the woman suddenly demanded.

“I heard that you provide midwifery services, and I need a midwife,” I said, a little too easily for my comfort.

“She doesn’t do that,” she snapped and hung up the phone.

Esperanza didn’t answer any of my phone calls after that, nor did she return any of my voice messages. So, I tracked down her home, which was a little hard to find even with my GPS. As I drove my unmarked car down the small dirt road embraced by trees and other little homes, I saw only a quiet and peaceful neighborhood. One of the little houses stood out, painted light yellow with multiple wind chimes of various shapes hanging above the porch. This was her home. A car was parked next to it, so I waited at a safe distance.

A few hours later, Esperanza rushed out, carrying two small duffel bags. I followed her as she drove away, and twenty minutes later, here I was, in a different neighborhood a bit closer to downtown. There, the houses were bigger, the roads were nicely paved, and the kids rode their bicycles. I parked across the street from the beautiful, beige house that Esperanza entered. She was greeted by a man with a warm face, and she shooed him away when he tried to take the bags from her. A very pregnant lady with a porcelain white face and crescent-shaped eyes poked her head out the door. Her hair was pulled up in a sweaty bun and her right hand clutched a glass of sweet tea. She was only half dressed. They talked and laughed as they guided Esperanza in.

I fidgeted, resuming my internal struggle. Should I knock on the door and demand to know what’s going on? It’s obvious that the woman is in labor. They’re going to be there a while. I can probably wait an hour or two, no? If I arrest Esperanza Velasquez right now, I would be forcing the parents to fend for themselves or go to the hospital. Perhaps I should call the ambulance first before I arrest her?

And what will happen to Esperanza Velasquez? She’s definitely going to be hit with a Class 1 misdemeanor for the unauthorized practice of midwifery, but the state may also pursue a felony charge for an obstruction of justice or more. That would teach all the other midwives a lesson. Is that what the state wants? What choice do I have, anyway? I have a job to do.

***

    A few hours had gone by as Officer Bennett gathered her will to follow her orders. She made a move to step out of her car when the siren of an ambulance grew louder and louder until it parked right in the driveway of the beige, Tudor style house.

Officer Bennett rushed out of her car at the same time the EMT’s rushed out of the ambulance. One brought out a resuscitator from the back.

“What’s going on?” demanded Officer Bennett, flashing her badge.

“Newborn’s not breathing,” he said.

Officer Bennett rushed into the house with the EMT’s. The home was in a bit of disarray. There was an inflatable tub in the living room, full of murky water. Rosie was sitting on a chair wrapped in blankets, holding her baby to her chest, with Christopher by her side. Esperanza was on the other side, working a baby-sized resuscitator to try to breathe life into the baby. The EMT that had retrieved the adult-sized resuscitator from the ambulance put the device to the side.

“How long has the baby not been breathing?” the EMT asked.

“Six minutes,” replied Esperanza, looking at her watch.

“We need to get this baby to the hospital NOW,” he said.

Just at that moment, Esperanza heard a tiny gurgle. She removed the resuscitator from the baby, rubbing the baby’s little sides. With a slight jerk, the baby started crying, followed by a cry of joy from everyone in the room, including Officer Bennett.

While the EMT’s hauled their stretchers and tools back to the ambulance and the new parents fawned over their newborn, Esperanza quietly motioned Officer Bennett to the kitchen.

“Follow me,” she said softly but with an unmistakable aura of authority that took Officer Bennett by surprise. Wasn’t she, the officer, supposed to be in charge here?

“I know you’re here for me,” she said. “I know that lately some people have been out to get folks like me. I’ve been providing women this much needed service for a very long time. I take every precaution. It’s a shame this state still makes it impossible for us to practice, unlike three of our bordering states. We have to get that Certified Professional Midwife bill passed in our state. Women deserve choices.”

“That baby could’ve died,” said Officer Bennett.

“That baby could’ve died in the hospital too,” said Esperanza. “We can’t control everything.”

“Ms. Velasquez,” said Officer Bennett, choosing to no longer engage in this difficult conversation. “I entered the premises on emergency grounds and witnessed you practicing midwifery, which is unlawful in the State of North Carolina without a license. I see that the duffel bags you brought in to the house with you are filled with midwifery tools. I’m sorry, Ms. Velasquez, but I have to arrest you.”

There was only the slightest pause.

“Okay, just give me twenty minutes to finish my job, will you?” she said. There was no pleading in her voice—only a request for time to complete her duties. Officer Bennett understood this sense of duty well.

“Okay,” replied Officer Bennett. “You have exactly twenty minutes.”

Officer Bennett sat on the kitchen table quietly, away from view, as she didn’t think that the parents had noticed her continued presence. Esperanza approached the joyful parents with a beaming smile and a tear in her eye. Esperanza took the baby lovingly in her arms for a minute, rocking her slowly, before placing her gently in a special baby weighing cloth. She pulled the baby up by the end lengths of the cloth for brief moment before announcing, “A healthy seven-pound girl!”