In the 1970's Tosi Marceline was a high school teacher. She taught math, English, science and history to pregnant adolescents. She soon began to hear the horror stories of their birth experiences – girls told of being dropped off at the hospital to have their babies and left there alone for days. So, Tosi turned their science class into childbirth preparation for school credit. And she volunteered to go to their births with them.
This was back in the day when very few women had anyone at all accompanying them to their labors. But Tosi figured as a public school teacher she would seem non-threatening. She came to understand that hospital staff treated the girls poorly because they represented the threat teen pregnancy held for their own children. But to Tosi, they were just pregnant women, and she simply rubbed their backs, held their hands, whispered comforting words.
By the time she was pregnant with her first, Tosi had begun taking classes at the Holistic Childbirth Institute in San Francisco, taught by people like Suzanne Arms and Nancy Mills, and doctors who were attending home births themselves. Many homebirth activists believed that direct entry midwifery would soon be legal.
When Tosi took those classes, she did not want to become a midwife. She merely wanted to be a better support for the teens, so that they did not run to the hospital with their first contraction. Their mothers, often very young women themselves, were too scared to provide this support.
Tosi’s first child, Miles, was born at home in 1980 and her second, Molly, was born at home in 1984. Tosi strongly believes that her first birth would not have gone well had it taken place in the hospital. It was a very long labor, and her son was born in the caul, with the thinnest little cord that anyone had ever seen. The cord broke as he was born and it only had two vessels. Tosi believes that, had she been in the hospital, her labor would have been hurried, her membranes probably ruptured, and it may have caused distress for her son.
Tosi was thrilled with her homebirth. She and her midwife, Jan McNabb, had become good friends. Their babies were born 4 months apart, and when illness caused Jan’s milk supply to dwindle, Tosi would stop by and nurse her infant. Jan knew Tosi had experience with birth and with being on call. She began asking Tosi to attend births with her.
But Tosi refused. She did not want to be a midwife. She replied that she would need to be an old lady first, with her children grown so her husband wouldn’t care if she were out all night. Plus Sacramento was a center for high-risk obstetrics, a tough place to be a midwife.
Then, when Jan needed help with the birth of a dear friend, Tosi agreed to attend, just that once. Although she had been to hundreds of births by then, this was the first homebirth besides her own that she had ever seen. She was amazed at the difference. She says that: “In the hospital women had to ask permission to do anything – it always felt like they were on someone else’s territory. At home, we had to ask her permission before we could do anything.”
The experience was awesome, and she was hooked. She never said “no” again.
Tosi trained under and eventually partnered with Jan. In 1988 Tosi become one of the first CAM certified midwives, and when her senior midwife retired, she took over the practice.
Tosi first became involved in midwifery politics because she lived near Sacramento. She would join rallies and lobbying days. She became increasingly active after she was CAM certified. After that first certification ceremony, Janice Kalman sat everyone down asked who was going to volunteer for what. Tosi volunteered to be treasurer for the certification process.
They planned to present the certification process to the legislature as a model for licensure. Tosi volunteered to interact with politicians because “I wasn’t afraid to wear hose and put on lipstick.” She also had the benefit of a political science degree from UC Davis.
It was during this time period that Tosi was arrested. She was charged with practicing midwifery without a license. She remembers waking up in the middle of the night having dreamt that the police were coming. She had been doing billing that evening and she got up to put away her records. She figured she would still need to be a midwife, if a more secretive one, and she did not want to have all her charts taken away.
The local police actually called her before they arrived, which gave her an opportunity to hide the rest of her things. She recalls that there was one box of supplies her husband and friends did not manage to get out of the house. Although it was August, she told the police it was a box of Christmas presents for her children, and they never looked inside.
Tosi says that she was lucky because the Medical Board never became involved with her case. It remained entirely local, and she recalls the police and DA being mostly kind to her. The police never woke her children when they were in her house; they never searched her housemates’ rooms. This was in sharp contrast to the experience of a midwife friend of hers in nearby Sacramento who was arrested around the same time. The police held Sally Wright and her children at gunpoint while they ransacked her home.
Tosi continued to do births. She also had a great deal of support within her community, and people donated money to cover her legal expenses. In the end, she pled no contest to 2 of the 4 charges and her record was expunged after a few years.
While the case lingered, Tosi recalls being quite paranoid, looking for police cars as she drove to births. Many midwives encouraged her to take a break from practicing. But she said she had to listen to her heart. There were not enough midwives in her area at the time, and she figured she just had to keep at it. She stayed focused on her job and the women she served.
When it was all over, though, Tosi had learned that a license was worth having. By then, Faith Gibson (who was also arrested in the same time period) had won her court case, largely by doing her own legal research and proving that midwifery was never explicitly illegal in California. The DA in Faith’s case appeared in front of the Medical Board and stated that he would not prosecute midwives unless there was a law.
As a result, the CMA approached Senator Killea, who had carried a failed midwifery licensing bill for CAM. CMA agreed not to oppose her bill, thus assuring its passage, as long as physician supervision was included in the language. This left the midwives, who had been lobbying so long for passage, with a “crisis of conscience.” Ultimately, they conceded that this bill was a stepping-stone and agreed to work on getting rid of supervision later. Of course, we have been fighting it ever since.
Tosi became part of the team that lobbied to get this bill passed. After its passage, she was involved in getting it implemented. This was a very difficult and time consuming process, involving “endless hours” of meetings with the Medical Board. They had never regulated anything like midwifery before and did not know how; the midwives knew what they wanted but did not know how to communicate it to the Board. Tosi says they held out as long as they could for as much as they could.
Tosi has trained a number of apprentices who have gone on to become licensed and even to partner with her. She now works in a practice of three midwives. They have designed a system in which they each receive salaries and share the workload according to people’s abilities and needs. It is a work in progress as they continue to refine a call schedule while honoring the needs and wishes of partners and clients.
Tosi is incredibly grateful to her husband, Phil, a nursery man. He has always worked from home and been willing and able to take care of the kids at a moment’s notice. She says she never could have been a midwife without him.
She says she owes a real debt of gratitude to all the women who came before her. Without their help she believes she never would have been able to give birth vaginally to her first child. Afterwards, she wanted to make sure someone would be around to do the same for her daughter. So each birth she attends is just one way of paying back her debt of gratitude. She says she doesn’t know if her work is really something she needed an award for – she just did what she had to do.
Tosi believes that in this state of technology in birth, we cannot afford another collapse of the homebirth system. There was too much knowledge lost the last time homebirth nearly disappeared, and there is so much less trust in birth now. Tosi has seen a lot of changes in hospitals over the years, and little for the better. The cesarean surgery rate is six times higher now than it was when she first began going to births. It is more important than ever for us to keep holding the candle for the women who need us.
Tosi believes that physician supervision is the center around which all of our other issues revolve. Most states in this nation understand that midwifery is a distinct profession. Physician supervision is an onerous burden that is not good for midwives, physicians, or the public. Having been involved in several attempts over the years to get rid of it, she keeps the faith that we will succeed some day.
Tosi argues that our fate in the supervision issue is tied to that of the CNMs, for we have an identical scope of practice and equivalent education and testing. We need to garner their support, and to give our support to them. This can only be done on a local, grassroots basis. We should all be reaching out to the CNMs in our own communities, going out of our way to form alliances. Our time will come.
Tosi says that we must look at the big picture. The answer to all the big questions in health care in the US today is universal coverage. And midwives must be included in this universal system. We need to train as many midwives as possible and befriend them all, regardless of where or how they trained. There is strength in numbers, and our numbers remain small.
Tosi says that she really appreciates the faith people have shown in her. She has been attending births for over 30 years now, and she can’t see an end to it yet. Just this past week she attended 4 births in 5 days. She just keeps “plugging away.’ She believes she must, for “if we don’t keep the light shining, it will go out.”
CAM celebrates the hard work and dedication of the awardee in midwifery activism. In no way should this award be construed as a determination of the midwife's skill nor as a recommendation to use her services.