This text is part of The Vaccine Dividea data-driven investigation into the United States’ potential loss of its measles-free status as the deadly virus resurges with a vengeance and childhood vaccine defenses continue to crack and crumble.
When Roberta Devers, a midwife in Lancaster County, Pennsylvania, performed a prenatal checkup on an expectant mother this week, the woman—a member of the Amish community and in her third trimester of pregnancy—had been sick with measles.
Devers said she has cared for dozens of pregnant women infected with the virus since measles began spreading rapidly in the county in April. Lancaster County is largely rural, with extensive family farms.
“Every day,” she said, “someone calls to ask what they should do. They are pregnant and have been infected, or their babies have been infected.”
Devers, 63, estimates that she has delivered nearly 2,000 babies over her 38-year career. She has a degree in maternal-fetal health, but works as an unlicensed traditional midwife in Pennsylvania, independent of hospital systems and without the supervision of a doctor. State law prohibits traditional midwives from practicing medicine.
Devers noted that as a young mother, she was hesitant about vaccines and never vaccinated her child.
“There was so much information against vaccines as in favor of its effectiveness,” he noted. “It was difficult to know who to trust and who to believe.”
His experiences during the outbreak in Lancaster County have changed his way of thinking.
“Numbers and files became people,” he declared. “The situation was humanized when I saw what was happening to the mothers I was caring for.”
In mid-October, the Pennsylvania Department of Health alerted doctors about an increase in measles cases among pregnant women and newborns. As of Wednesday, state health authorities had confirmed cases of measles in 97 pregnant women. However, there is no data on how many miscarriages have occurred due to measles.
Devers said one of her young mothers went into labor at 17 weeks and lost her baby. “I had no doubt it was measles.”he commented. “Two weeks earlier, she had contracted measles and then had a miscarriage.”
Midwives like Devers are the closest contact many pregnant women in the community have with conventional medicine. It’s not always easy to access medical or vaccination clinics in rural areas, especially for Amish families who rely on horses and buggies for transportation.
Families often rely a lot on health advice from midwives because they work with generations of women from the same families. Devers even offers a discount to her long-time clients: after having delivered nine babies, the tenth is free.
“We are part of the most intimate experience of their lives. We are in their bedrooms. We have long conversations at the kitchen table about health,” Devers said. “We are your trusted professionals.”
Devers may advise isolation to minimize the spread of the highly contagious virus. It may explain the risks of measles infections during pregnancy, such as premature birth and miscarriage. But it can’t do what experts say is critical to curbing the outbreak: administering measles vaccines.
“People ask me: ‘Do you have that vaccine in the car?’” he said.
Many of the inquiries come from unvaccinated husbands, she said, worried about exposing themselves to measles at work and then bringing the virus home to their wives and children. “I have to say no. We midwives asked the Department of Health directly to be allowed to take this vaccine, and they told us no.”
The Pennsylvania Department of Health stated in a statement that it “does not have the authority under current state law to allow traditional birth attendants to administer vaccines, nor does the DOH regulate the practice of medicine in the State.” Any changes would have to come from the Legislature.
(New York records first death from measles in more than 30 years)
There are opportunities for people to get vaccinated against measles in Pennsylvania, and those vaccines can be administered by certified and licensed nurse-midwives, according to state law. The Department of Health said it has administered nearly 11,000 measles, mumps and rubella vaccines this year.
A survey of Amish families in Lancaster County found that nearly half had home births in 2022. These families have increasingly rejected routine childhood vaccines. Less than a third – 30% – said they will have vaccinated their children in 2022, compared to 52% in 2014.
New data research by NBC News and Stanford University reveals the extent to which measles vaccination rates have plummeted, not only among the Amish, but also nationally.
At the start of the 2025-26 school year, 75% of U.S. counties and jurisdictions with measles, mumps, and rubella vaccination data were below the threshold needed to achieve measles herd immunity, up from 67% in 2024-25.
Lancaster County is a prime example. Before the pandemic, the county’s measles, mumps and rubella (MMR) vaccination rate was 95.5%, the level needed to prevent an outbreak. Last school year, only 87.6% of children in kindergarten of the county had received the measles vaccine, according to NBC News data.
Some parents stopped routinely vaccinating their children in the 1990s and early 2000s, when misinformation about vaccine safety began to spread. Those children are now old enough to be parents themselves, like Hannah Garman, 27, of Lancaster County. She will give birth to her third baby in early December.
“When I was young, they didn’t take us to the doctor, so I never actually got them,” Garman said, referring to the vaccines. She’s taking modest precautions to stay away from sick people, but she’s relying primarily on good nutrition and her Christian faith to protect her from contracting measles during this outbreak.
As of Wednesday, 1,505 cases had been reported in Pennsylvania. More than a third are located in Lancaster County.
“Babies struggling to breathe”
Pregnant women cannot receive the measles vaccine because the shot contains a live, attenuated version of the virus.
Devers noted that the disease is affecting his clients in different ways. “Some are still standing, doing their chores and working. Others are completely prostrated by the disease.”
(Pennsylvania records its first measles deaths in 35 years amid outbreak)
Most children who get measles will recover without problems. However, some develop complications and must be hospitalized.
“Babies struggling to breathe, children needing oxygen and respiratory assistance, patients on ventilators. We see babies and children coming in with infections in organs in the abdomen, like the liver, dehydration, and babies not being able to drink from a bottle,” said Dr. Evan Shirey, a pediatric infectious disease physician at Penn State Health Golisano Children’s Hospital in Hershey. “The truth is that it has been horrible to see.”
Shirey has a three-month-old son who is too young to receive the measles vaccine. “I am experiencing this outbreak as a doctor, but also as a father, and I still cannot protect my baby with a vaccine,” he said. “It’s scary.”
Some children are developing brain inflammation called encephalitis, which can take months to go away or be irreversible in some cases, Shirey said. Others are born with congenital measles. At least two babies have died in the state.
How midwives could mitigate the spread
Almost all states have similar laws that prohibit traditional birth attendants from administering vaccines without a doctor’s support. New York recently declared a disaster emergency in response to its growing measles outbreak, allowing unlicensed health professionals with a certain level of training or licensing, including some midwives, to administer vaccines.
It’s a measure Katherine Wells, public health director for Lubbock, Texas, said she wishes she had taken during last year’s outbreak among Mennonite communities in Gaines County. Leveraging personal relationships between midwives and families would have been a good way to mitigate the spread, she said.
“During an emergency, it’s not the time to go around handing out your business card. You have to know these people,” Wells stated. It is essential in rural communities, he noted, “especially those that are more religious and even more suspicious of the government, to find people within that community who can speak from the perspective of how things are done there.”
Wells mentioned that he was able to train the Department of Public Health’s front office staff to administer vaccines during the outbreak. “In theory, that order could have been directed at midwives”.
In Wisconsin, where a baby died from measles, Korina Bauer, a certified midwife in Shawano County, said she is working with colleagues at the county Department of Public Health to organize a measles vaccination clinic for her clients, many of whom are Amish. The state has reported 551 cases of measles as of Wednesday.
Bauer is counseling two pregnant Amish women whose husbands were exposed to measles. “They are worried and want to know more about the symptoms,” she said. “There is a lot of curiosity.”
Devers said the Pennsylvania Department of Health recently invited her, along with other midwives, to an upcoming measles educational webinar.
“There are many midwives who do home births in the state of Pennsylvania, and if they were given the opportunity to vaccinate, it would be another way to quickly vaccinate people,” she said.
There are early signs that the spread may be slowing in Pennsylvania, with just 73 new cases reported last week.
That doesn’t mean the outbreak is over. November marks the start of the traditional wedding season for many Amish families, celebrated after the fall harvest. Weddings are usually quite large, easily exceeding 300 or 400 people.
The pregnant Amish mom Devers visited this week said she has recovered from her measles infection and is feeling well enough to attend a wedding scheduled for Thursday. It appears that the event will take place even though, according to Devers, the bride has measles.
