He Was Born at Home in D.C. Now His Parents Have to Prove He’s Theirs.

The Washington Post / Ellie Silverman

13:16 JST, February 19, 2024

For nearly two years, Teresa and Jeff Williams have lived in a state of suspension, unable to plan for their family’s future and unable to fully enjoy their young children.

​​​​They would love to travel abroad but cannot get a passport for their youngest child. They worry their family’s SNAP benefits will be revoked. They lament they’ve lost about $5,000 in unclaimed tax credits. And they fear they are one hospital visit away from losing their little boy, JJ.

JJ, born in an inflatable tub in his Southwest Washington living room in August 2022 without any medical assistance, does not exist on paper. Despite their many attempts at certifying his existence, JJ has not been granted a birth certificate, social security number or a single official government document bearing his name.

“It’s almost as if we’re battling just to keep our family whole,” Jeff said.

While home births have been on the rise in the United States in recent years, a midwife or doula often helps with the baby’s arrival as well as with the ensuing paperwork. But Teresa and Jeff decided to do it all on their own and now have to prove that JJ is theirs.

​​Across the region, rules vary about proving parentage for a home birth. In Maryland and Virginia, a parent typically needs one piece of evidence for categories such as proof of pregnancy and live birth. But D.C. typically requires two pieces of evidence per category. In cases where there is a Fire and EMS report related to the birth, D.C. Health said it accepts this single document as sufficient proof that the baby was born in the District.

Teresa and Jeff applied in November 2022 for a birth certificate for JJ – Jeff Niklaus would be his “official” name if he had documents – submitting reams of proof that Teresa had birthed him at home. But the D.C. Health Department has denied the application, citing “insufficient documentation.”

D.C. Health said it can’t comment on specific applications and doesn’t track how many people were denied birth certificates. But the agency emphasized that its “extensive process” follows national guidelines and views births outside a medical facility with the same scrutiny as delayed requests for birth certificates because of concerns about fraud. Delayed registration “can be used to circumvent legal adoption and register individuals not born in the District,” the agency said.

The ordeal has wracked the Williams family with anxiety and fear at what should have been a celebratory time. Instead of watching JJ bond with his sister, Tamar, and experiencing life anew as a family of four, they’re plagued by the feeling that they are letting down their baby boy.

Sam Sewell, a licensed and certified professional midwife who has served clients across the D.C. region, said the Williamses’ predicament is unsurprising. When her clients give birth in Maryland or Virginia, she said, the process is straightforward and easier.

D.C. Health argued that the agency has more flexible guidelines than surrounding jurisdictions, but Sewell called the District’s system “absurd,” with a higher burden of proof and more paperwork for parents.

“Postpartum is hard enough,” Sewell said. “Do we really need to be throwing this on top of everything else when we know that other states right next to D.C. are doing it right?”

For Teresa and Jeff, who are both Black, home birth was an easy choice. As the couple navigated the health system during her pregnancy with Tamar, they felt judged and unheard.

For years, too, they had heard horror stories from friends about medical bills that can average nearly $19,000. They had read news reports of births gone wrong. They had their personal histories, too, with their parents telling them about their own difficult entries into the world.

And then there were the alarming figures about Black women: The maternal mortality rate for Black women is 2.6 times the rate for White women, research shows. They are more likely to die from pregnancy-related complications and are more likely to report being mistreated while receiving maternity care. Research also shows physicians are more likely to doubt what Black patients say about how they’re feeling and their symptoms.

In the District, pregnant Black people represent about half of all births but 90 percent of all pregnancy-related deaths.

Teresa didn’t want to become a statistic. And she didn’t feel like the physician she saw while pregnant with her first child was listening to what she wanted for her childbirth experience. Giving birth at home, she thought, would be safer than at a hospital.

And so she joined a growing number of women opting for home births. While the number is still tiny, with just 1.4 percent of the 3.6 million babies born in 2021 delivered at home, according to the Centers for Disease Control and Prevention, the number of Black women opting for home births increased 21 percent from 2020 to 2021.

In the District, there are fewer than 100 home births per year – less than 1 percent of all births, according to D.C. Health.

To prepare, Teresa and Jeff thought through worst-case scenarios – if the labor was prolonged, if Teresa had excessive bleeding – and they trusted their plan. If needed, they were prepared to call 911 and rush to a hospital.

For Tamar’s birth in March 2020, Teresa and Jeff had a midwife, birth assistant, doula and friend to support them.

“It was day and night. The midwives actually asked me what I wanted my birth experience to be like versus telling me what it would be like,” Teresa said. “I was actually being heard, and I was actually in control of how the environment was for my child to be born.”

Even though the family has health insurance through Jeff’s job as an assistant group sales manager at the Kennedy Center, Teresa estimated home birth cost them about $3,000. They had additional income from Teresa’s DoorDash food delivery gig and the couple’s direct sales business for health, beauty and home care products. Still, they’ve struggled to pay rent.

When Teresa was pregnant again in 2021, they were confident they could do this themselves – without an expensive team.

On Aug. 9, 2022, they barely had time to fill the inflatable tub in their living room with water before Teresa needed to push. At 6:45 p.m., they had a son and named him after his father.

Jeff jotted his weight and height onto a newborn exam sheet.

7 pounds. 19.5 inches.

JJ cried and latched, his nails looked good. By all measures, as Jeff filled out the form, they had a healthy baby.

Three months later, the family went to the Health Department building and paid $23 for a birth certificate. It was their first time doing so; a home birth company handled the paperwork for Tamar.

While there, Teresa was directed to call the D.C. Vital Records Division. She said she spoke with the records management assistant processing home births and learned they needed to prove JJ was their son.

Two pieces of evidence showing Teresa had been pregnant. Two pieces of evidence that the baby was born alive. Two pieces of evidence that Teresa had been in D.C. when she gave birth.

Among the list of acceptable documents, Teresa could submit a receipt for utility payments at the home where she gave birth and public transportation receipts from the District within 24 hours of the birth. She could submit medical records if she was transported to a hospital and a report of the baby’s pediatrician visit within five days of birth.

Teresa spent weeks tracking down proof of her pregnancy test. She requested documentation of her ultrasound, a receipt showing online purchases to be delivered to their home address and an Xfinity bill.

Then it got tricky.

Teresa didn’t have a midwife or doula. She didn’t go to a hospital or call EMS. JJ saw a pediatrician on Aug. 22, within two weeks, not five days, of his birth.

She tried to explain this to the records official in a series of emails.

“We didn’t go to a hospital at all,” she wrote Dec. 23, 2022, in an email, which was provided to The Washington Post. “Our son was examined by his pediatrician on August 22nd. It was the earliest we could get on her schedule so I have attached the notes from that day.”

On April 3, 2023, the Health Department denied her application for JJ’s birth certificate, stating the documents the couple provided didn’t sufficiently prove his live birth and her presence in the District at that time.

The office said she could submit additional information, such as a signed statement from the health-care provider or medical institution that examined the baby at birth, a labor and delivery report, or credit or debit card transactions or public transportation receipts within 24 hours of the birth.

But Teresa had her baby at home – then stayed home. So those documents didn’t exist.

The family turned to Melody Webb, the executive director of the Mother’s Outreach Network, a racial justice and anti-poverty organization, for help. Lower-income families often face extra barriers when trying to accomplish routine tasks, she said.

“They’re obviously loving parents,” Webb said. “They deserve the understanding of this agency to try to help them.”

This entire process, the couple said, seems like it has been going wrong.

“It feels like I am an absentee father even though I am here,” Jeff said. “I can’t physically show that my son belongs to me because I have no document. And I might now have to go to court to prove my fathership to my child. And I have been here since day one. I haven’t left.”

D.C. Health said it “does not wish to penalize” parents or a child. While families cannot appeal a denial from the Vital Records Division, they can either correct their initial application or file a court petition.

So Teresa and Jeff are still trying to navigate forms. With the help of their attorney, Webb, they filed a petition in D.C. Superior Court this month requesting that a judge order the Vital Records Division to issue a birth certificate.

They have a hearing scheduled for next month.