Three years after that, Weber had a very different experience. She gave birth to her third child, Elijah, at home, beneath her brass headboard. She tried laboring in a squatting position on a birthing chair, but when her contractions stopped, her lay midwife, Diane Goslin, suggested she lie on her side. Goslin massaged her, chatted with her, and gave her time alone with her husband, who was coaching her.

Weber pushed Elijah out in 15 minutes.

"In the hospital, they're eager to give you a cesarean or drugs, and you don't need that. They're eager to do things that aren't necessarily best for the mother or the baby. Diane looks for the other options," Weber said last week as she watched Goslin weigh and measure Elijah during his six-week checkup.

Now Goslin's clients, including many Amish, are worried the state could stop Goslin and other lay midwives from practicing. Many Amish and other so-called plain people traditionally give birth at home with lay midwives. The fear of losing that tradition brought about 200 of them to rally in Harrisburg late last month.

In Pennsylvania, only midwives who have nursing degrees can be licensed. The state argues that the practice of lay midwifery - usually defined as midwives trained through apprenticeship - is illegal, and many doctors say it is dangerous. However, the Pennsylvania statute does not explicitly prohibit the practice of lay midwifery.

Goslin says she has 25 years' experience delivering more than 5,000 babies - but she does not have a nursing degree.

She came under scrutiny after an Amish baby she delivered in January 2005 died a day later, likely from pneumonia caused by bacteria transferred in utero, according to the Lancaster County coroner's report. The case led the state Board of Medicine to investigate and bring charges, accusing Goslin of practicing medicine and nurse-midwifery without a license.

Each of the two charges carries a maximum fine of $10,000. Goslin appeared before the medical board's hearing examiner last month. The examiner has six months to render a decision, which could be an order to cease and desist. If Goslin ignores the order, she could face criminal charges.

The American College of Obstetricians and Gynecologists recently came out against the practice of home births and against lay midwifery. Sarah Kilpatrick, head of ob-gyn at the University of Illinois and vice chair of the ACOG's obstetric practice committee, points out that complications can occur even in births that are anticipated to be low risk, and can be fatal.

Though Kilpatrick calls herself "a big fan" of nurse-midwifery, she says it's dangerous to allow non-nurse-midwives to deliver babies.

"Why don't we have direct-entry doctors who don't want to go to medical school? We wouldn't tolerate that for physician basic care. Our standards for care for women should be the same," she said.

A 2005 study of low-risk home births in the United States, published in the BMJ, found 1.7 infant deaths per 1,000 planned home births, similar to the risks in studies of low-risk hospital births. ACOG says the issue demands a lot more research.

Home-birth advocates say safe home births would be nearly impossible without lay midwives, who attended nearly half the 3,481 out-of-hospital births in Pennsylvania in 2004, the last year for which the state has statistics.

That's because nurse-midwives are required to have a collaborative agreement with a physician, and many doctors are unwilling to be a partner in home births.

"I don't think we should have to choose between birthing at home alone or birthing in a hospital," says Jody Ward, a Maryland mother of five who lives close to the Pennsylvania border. Goslin delivered Ward's three youngest children.

The Amish traditionally have large families and no health insurance, so many rely on the relatively low cost of lay midwifery, about $800 to $1,200 per birth. Daniel King, a spokesman for the Lancaster County community, estimates about 75 percent of his people have home births with lay midwives.

Fern Strickler, another of Goslin's clients, is a mother of 10 and a member of the Old Order River Brethren, a plain religion similar to Mennonite. As a registered nurse working in a hospital, she says she observed women, especially Amish women, coerced into unnecessary medical interventions.

"I wanted to be allowed to allow nature to take its course, to be in a setting where I could be completely relaxed, where I did not have to fit into somebody else's schedule," she says.

The Midwives Alliance of North America offers certification for lay midwives that is recognized in 20 states, including New Jersey. Goslin is certified by the organization.

New Jersey licenses both nurse and lay midwives and allows both to do home deliveries.

About half of all states regulate lay midwifery in some way, while 11 states prohibit the practice of lay midwifery completely.

Leonard Glantz, a professor of health law, bioethics and human rights at Boston University School of Public Health, calls the legal status of lay midwifery in Pennsylvania very murky.

"People have to be put on notice by the statutes that it's illegal," he said. "It's going to have to be clear then what it means to be a midwife."

In its code, Pennsylvania defines the word midwife as "A person licensed by the Board to practice midwifery." That, says Department of State spokeswoman Catherine Ennis, means non-nurse-midwives cannot practice legally in Pennsylvania.

"There's no exception in the statute or case law that allows a lay midwife to fall outside the boundaries of licensure," she said.

Because the medical board examines cases only after a complaint is made, Ennis says hearings like Goslin's are rare, but a similar case involving the death of a breech baby is currently in Allegheny County criminal court and set to come before the medical board.

Goslin and her supporters say a new attorney for the medical board is bent on ending lay midwifery and home births, something they say contrasts strongly with Gov. Rendell's recent alternative-focused health plan. Ennis says the state has no such agenda.

For her part, Goslin says she answers to a power higher than the state. "As a wife, mother, midwife and teacher, I believe God has given me a calling in the time-honored tradition of serving women in one of their greatest times of need," she says.

She's worried that prohibiting lay midwifery will force the Amish to turn to untrained birth attendants, such as family members.

"I think more people will go underground," she says. "I don't think we're going to see the plain people start flooding to the hospital."

If the medical board rules against her, Goslin says she will give up her practice to teach midwifery.