Dana Albillo, a registered nurse, began training in midwifery in 2000, apprenticing in several Midwestern states and working as an intern at birth centers in Miami and El Paso. By 2005 she had logged more than 1,500 hours of training and attended about 200 births. Though she'd planned to open a practice in Colorado, when she became pregnant with her third child she moved back to Missouri to be near family.

Still unsure of whether she'd be able to practice here, Albillo went to Kansas City in February to take a written test. She'd already traveled to Wisconsin, where a certified professional midwife administered a clinical exam that involved performing two checkups, one on a pregnant woman and another on a woman with a newborn. Albillo likens the process, which is administered by the North American Registry of Midwives, to clinical training for nurses, during which supervisors sign off on trainees' work. "It's based on the CPMs before you," she says. "It's kind of an honor system."

Gordon Goldman, the St. Luke's obstetrician, scoffs at the process. "Theoretically, you don't have to graduate high school, and you could become a CPM," he says.

But Daniele Pasatieri, a St. Charles mom in search of a midwife to help deliver her third child, says she's glad to see the trade move aboveground. "There aren't many to choose from," Pasatieri says. "I'm glad there's going to be a professional route."

Albillo says the first thing she'll tell clients is that she can't afford malpractice insurance. "Most people who are going to be litigious for litigiousness' sake, they're not going to come to a home-birth midwife because they know we're not the gravy train."

In the meantime, Albillo works nights in Barnes-Jewish Hospital's intensive-care unit, where she's grateful that the contentious topic of home birth does not come up in conversation. "I think we're better off finding common ground," she says, "than fighting each other."

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