The delivery room in Mary Saldano's home looks like a children's hospital suite that a piñata threw up on. Bright pinks, yellows, blues and reds radiate from the chaotic, pack-rat collage of dozens of dolls, stuffed animals, Virgin Marys, little dresses, diapers, blankets and other baby stuff covering the bed, walls and ceiling. Yet despite its Technicolor, cartoonish quality, the room is cozy and clean.
A third-generation midwife, Saldano has been delivering babies here for 39 years. She claims to be the longest-practicing midwife in southeast Texas. Virtually all of her patients are Mexican nationals.
These days, she says, business sucks. In part, she blames the passport issue.
"When a patient comes in to talk to me about a possible delivery," she says, "the first thing they ask is if they'll be able to get their baby a passport. This is their No. 1 concern and they're afraid."
The people who come knocking on Saldano's door are no longer pregnant mothers ready to burst. Instead, they're Hispanic Americans in their forties, fifties and sixties following a trail of bread crumbs. More than 100 people have contacted Saldano in the last two years looking either for documents or for information about their midwife.
Twenty-five years ago, Saldano was delivering 35 babies a month. She remembers 11 once came in a single night. Now, she's lucky if she gets ten patients a year.
The decline in midwife births along the border, Saldano says, also has to do with America's medical insurance policies. Midwives used to be less expensive than a hospital, but now cost upwards of $1,500. Work the system right, and a hospital delivery can be essentially free.
"Mothers say, 'I don't have any money,' so they go to the emergency room," says Saldano. "They wait until the last minute, until they're in labor, and they go to the ER and then don't pay. Medicaid pays, which means we all are paying. It's killing the midwife tradition that they're allowing people from Mexico to go for free who don't have Medicaid."
Midwives hundreds of miles north, however, say they're doing better than ever.
"The passport issue is not affecting business at all," says Jackie Griggs, a Houston midwife for the past 18 years and president of the Association of Texas Midwives. "It has to do with the fact that we're so far from the border and people don't think you have to be a total weirdo to have your baby at home now."
Griggs, who recently opened a birth center, says she delivers six to eight babies a month. Still, the issue has midwives concerned.
"I'm nervous," says Elizabeth Overton, a midwife in Corpus Christi. "I'm licensed and recognized by the state, and I just think it's insane that the U.S. government would question a birth certificate simply because a midwife signed it. I mean, either we're able to do this or we're not."
Says Griggs, "We're saying it's not an issue in Houston, but we're not happy about it. We don't like the bad press, because it may affect business. And it's unfounded and unfair."
Fraud is a delicate subject with midwives.
"I know it did happen," says Griggs, "but it never was widespread and it's certainly not going on now."
In addition to regulation and licensure requirements, midwives are all patched into the state's Vital Statistics department computer and file birth certificates directly online. This reduces the chances of someone duping or bribing a county clerk in person.
Yet, Griggs concedes, while she believes fraud is rare, it is possible.
"Theoretically," she says, "I could make up the whole thing and type it in, but I'd be risking my license. I don't think it's a big problem at all."
Along the border, Saldano is one of a dying breed.
"There used to be 40 midwives in the southeast valley in the 1970s before regulation," she says. "There were a lot of older people working who did not know how to read or write, so most of them stopped working when regulation began and you had to take classes to renew your license."
According to the Texas Midwifery Board, a state survey estimated that at least 4,000 midwives were practicing in Texas in 1924. The Midwifery Board's modern statistics start in 1985, when 473 midwives were identified as working. As of October, there are 191 licensed midwives.
"It makes me very sad," says Saldano. "This is the end."
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