Category Archives: direct entry midwives

Midwife kills mother and baby: has moved overseas and is still practising

I found a report of a out-of-hospital death in New Zealand. A mother with multiple risk factors was attempting a water birth when she collapsed. The baby and the mother both died as a result. The coroner has pointed out that the deaths could have been prevented at multiple points in the care being given, but that the midwife’s training and experience was inadequate for her to even recognize what happened.

The typical building blocks of a charlatan are present:

When giving evidence for the coroner’s inquest, the [midwife] came across as “confident, capable, intelligent and articulate”, the findings said. “If she had a fault it was an overweening confidence in her own ability.”

The court heard she was “very well regarded” and had worked hard to re-establish her professional reputation.

The midwife who was lead maternity carer has moved overseas and is still practising.

Is this your midwife? You’ll never know. There is a permanent supression order that bars the press from mentioning her name. Having killed a few people doesn’t seem to have dampened her enthusiasm for delivering babies. After all, she is a confident person.

The other midwives in New Zealand are not using the coroner’s recommendations about midwifery education to prevent the next tragedy, instead they are digging themselves in deeper by dismissing his criticisms altogether.

[The coroners]’ comments came after his provisional findings were sent to the Midwifery Council of New Zealand and the New Zealand College of Midwives.

[The coroner] slammed remarks made by Karen Guilliland from the New Zealand College of Midwives who accused the court of relying on ill-informed medical opinion.

Similarly, [the coroner] said although the Midwifery Council of New Zealand criticised his findings, they did not provide an alternative explanation for the “errors of judgement and failures to follow proper midwifery practice that occurred in this case”.

It is the same story I have seen all over, midwives have a craven disregard for the deaths of people at home births. They cannot accept responsibility or a change in their natural child birth dogma, so they simply reject any information that could be used to help future cases. This is the opposite of a profession.

No, OBs are not accountable

I was reading this post from the skeptical OB today

as you may or may not know, I was banned from the skeptical OB for calling Dr Amy out on being a fence sitter on the issue of date rape. Remember that any time she complains about being “silenced” by home birth bloggers for asking uncomfortable questions. She does the same thing to people who think there isn’t a neutral zone when it comes to rape.

IN this specific post Dr Amy says a survivor of sexual abuse who had several cuts to her perineum done to her body against her will during labor, by an OBGYN isn’t experiencing violence. She doesn’t even condemn the behavior of the OB at any point. She laments a series of home birth deaths in australia, one of the summaries she quotes points out that the mom chose home birth because she had been treated so poorly in the hospital. The only violence in birth is when the baby is injured? Here is as close as she gets to saying anything condemning that horrible physician:

Don’t get me wrong. I’m not claiming that hospital care is perfect. Although there is rarely any violence, there is a great deal of poor and disrespectful treatment.

Beforehand she literally says that the baby being inside the woman fundamentally changes the interaction. She talks as though women are simply vessels for children, and that being such a vessel fundamentally changes the way that a woman would experience having her gentials repeatedly cut against her will. The lack of empathy is very telling. The woman who was cut against her will, over and over, well before crowning, should be comfortable going back to the hospital because Dr Amy is apparently the ultimate authority on what constitutes violence or not. Its laughable, especially from a woman who insists that one must be an expert on a topic in order to have an opinion. Dr Amy goes on and on about the inability of midwives to call out their fellow midwives for negligence and damage done to patients, but here Dr Amy does the same thing and ignores deplorable conduct on the part of a gynecologist.  She goes on to say:

However, the chief victims aren’t Western, white, well off women; the chief victims are the elderly, people of color and those of lower socio-economic status.

For a skeptic she sure has an aversion to actually linking to evidence. Being white and college educated are one axis of privilege, but it doesn’t erase being female. It doesn’t erase the fact that women, regardless of any of their other characteristics, are targets for sexual abuse and violence by virtue of being female. Why anyone would believe that this problem vanishes in the hospital is beyond me. One kind of oppression does not erase the other. Dr Amy’s total ignorance of contemporary feminism and social justice movements is showing once again.

ANYWAY, I wish i could comment so I could let everyone know that NO, you don’t have many avenues for redress if your OBGYN decides to do all kinds of shit to you without your consent. You need a ton of money (enough to pay a lawyer for a lengthy and probably fruitless lawsuit). Medical boards don’t give a damn about this, and the doctor and hospitals have better lawyers than 99% of the population.

Women have many legit reasons for choosing home birth, and this is one of them. A lot of the people in the comments section of the Skeptical OB, who claim there are Very Serious Consequences for physicians who do things against your will, are living in a dream world. In the real world, your word doesn’t matter at all. I know from first hand experience. The issue at hand here is that midwives and home birth do not solve the problem. Horrible attitudes from other people about abuses of women during hospital childbirth (including disbelieving the women, rebranding their experiences as “disrespect” instead of abuse or violence, insisting that they will be compensated despite all evidence, etc) makes a vulnerable population easy pickings for midwives. I know that seeing unauthorized procedures done to patients during my time working in hospitals was instrumental in my decision to have an out of hospital birth. I knew that these doctors were not accountable because they did it all the time. There isn’t anything that holds them accountable for these issues. A suit for battery is unlikely to succeed and is hard to pull off. Ignoring the problems won’t make them go away, and will in fact drive more women to seek care from midwives, who at least pay lip service to how damaging abuse during childbirth can be to patients.

the deaths we don’t hear about

I’ve tried very hard to track home birth deaths (mostly via the internet and news papers), and it is a very difficult task. I know that many women who lost their babies to home birth do not believe the deaths were preventable, and don’t wish to sully the reputation of home birth by sharing their stories in public. There are others who understandably want to keep their grief private for reasons unrelated to choosing a home birth. I’ve had to ignore a lot of the home birth deaths I’ve found because a state and year were not available to properly catalog them on the home birth fatality map

However, there are statistics available to give the public an idea of how many of babies die as a result of home births and natural child birth ideology. 

 MANA (Midwives Alliance of North America) released the results of a non-random survey recently. They call it a “study” when it is nothing of the sort. It is a voluntary survey with less than half of participants staying with the project until its completion. Data was voluntarily reported on 16,000 births. The results of the MANA stats project under-represents the number of home birth related deaths, but I will still use these numbers to give home birth midwives the best chance to prove that their practices are safe.

According to an independent statistician, the results of MANA’s project are as follows:

So, for a comparable group of infants born in the hospital, with congenital abnormalities excluded, the combined neonatal and intrapartum death rate is at most 0.7 per thousand. The combined neonatal and intrapartum death rate for the MANA STATS group, with congenital abnormalities excluded, was 2.06 per thousand, which is significantly higher. (p<.0001, highly statistically significant.)

In other words, the expected number of deaths from causes other than congenital anomalies was at most 12, and the actual number of deaths was 35 (44 with anomalies included). It is clear that home birth substantially increases the risk of neonatal death and of intrapartum death.

According to the CDC the rate of out of hospital birth was 1.36% nationally as of 2012.

According to the CDC 3,952,841 births were registered in the U.S. in 2012.

1.36% of 3,952,841 is 53,759 births. 

If you use MANA’s overly optimistic numbers, 110 babies died at home births in 2102. The rate of death for the same number of babies in the hospital is 38. 110 minus 38 equals 72.

That means at least 72 babies died because they were born at home that year. It is likely more. Midwives who have multiple adverse outcomes likely chose to keep their data to themselves. 

I also know that there is no real tracking of the deaths that are caused by Unassisted Child Birth (also called “free birth”), and that freebirthers are encouraged to lie to authorities if their baby dies. They say they just couldn’t get to the hospital in time. I know that a midwife can make a birth more or less dangerous by being there- sometimes a UC mom will go to the hospital when a midwife would have discouraged doing so, or vice versa. There is no doubt that these deaths are overwhelmingly the result of natural child birth philosophy.

There is not any information on how many midwives failed to attend a birth that ended in death as a result, despite knowing that this can and does happen to mothers. Dreah Louis and Vylette’s mother both lost a baby this way. It does not seem possible for midwives to report on a birth that they weren’t even there for. 

The skeptical OB, who is very good at finding and posting about home birth deaths, only found 23 in 2012. Less than half of the minimum that could be expected.

Some people may be thinking that it is hard to use statistics for a five year period on any given year, but home birth midwifery doesn’t really change. Like all pseudoscience it has no advances, and practitioners believe things are fine the way they are.  

I am sure other people are saying that 72 deaths is too small a number to be concerned about. 34 children died of heat stroke from being left in cars in 2012, and the outrage over the deaths is considerable. The issue with deaths from home birth or being left in cars isn’t the number, its that they were completely preventable, and that parents have a duty to protect their children from preventable deaths. This is just an estimate of a single year, these tragedies are repeated each and every year.

Reading a number doesn’t really do justice to what these deaths mean. I am going to try and represent them visually, by posting 72 pairs of baby shoes. Each pair represents the unfulfilled hopes of parents for their children’s first step, first word, first everything.

baby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoes

 

name changes for negligent midwives

The skeptical OB has an article up about negligent midwives changing their names as to deceive their customers.

It happened to me, too. Ester Werbach now goes by “Nueve Lunas Maternity” on the internet. The Utah Midwive’s Association is well aware of it, and my complaints of sexual misconduct, and continue to support my abuser. They don’t care.

These types of actions also make it impossible for women to research their care provider. If you have a health care provider that has killed negligently, had their license suspended, or otherwise been reprimanded their patients have a right to know. Midwives rob women of the opportunity to know what they are getting into.

Gloria Lemay: pre-eclampsia is the mother’s fault

If you are unaware of Gloria Lemay, she was an illegal midwife in Canada who defied court injunctions that deemed her a danger to the public. She was involved in an infant death and subsequently sentenced to serve time in prison for her actions.

She still has quite a following in the world of Natural Child Birth, despite having no real qualifications and a ton of documented fuck ups to her name.

The most recent piece of idiocy can be seen on her facebook page. Here is the initial post:

gloria lemay 1

Gloria Lemay remarks that she would “love to see every baby in N America wearing this little message!” The message is “My mommy refused to induce me”. 

Some people rightly pointed out that there legitimate reasons to induce someone, such as pre-eclampsia, which can have serious health consequences (including death) if improperly managed. Here is Gloria’s reply:

gloria lemay 2“When a baby is at risk with “Pre-e” (pregnancy induced hypertension), what has been done to prevent the situation? Over and over, it has been shown that diet plays a key role.

 

The insistence that diet controls pre-eclampsia has absolutely no evidence behind it. A lot of women at the Pre Eclampsia foundation have a lot of anecdotal accounts of following the brewer diet religiously, and then ended up with the condition anyway. Some of them say they got pregnant again because they were confident they could beat pre eclampsia with diet, and in one case the mother almost died as a result. The idea that pre eclampsia is always a case of eating the “wrong” diet caused a lot of the moms on the forum to feel guilty. Lemay continues:

 

Then, if the situation is really out of control with high liver enzymes, is it a good plan to torture the woman/baby with an induction when you already have two ill patients? How is adding synthetic hormones to the situation going to help anything?

 

If you tell women that they are torturing their babies by inducing, you better have some damn good evidence. But there isn’t any. 

As for women being tortured by induction… that doesn’t seem to be what women actually say if you ask them about it.

 

 

There is a very high risk that the induction will end in c/s anyway. I would advise anyone in my own family to go straight to c/s in this situation, avoiding all the drugs, iv’s, of the induction.

 

C-sections include plenty of drugs and IV lines. I have no idea why she thinks she knows better than a physician about induction vs c/s for a case of pre-eclampsia. It is a complicated condition and the mode of delivery is chosen based on a number of different factors. Lemay talks about how horrible c-sections are all the time- perhaps she thinks a woman “deserves” a c-section for eating poorly? Its hard to know. There does seem to be a certain level of vitriol in her answer to a simple question.

 

Inductions are dangerous. Cesareans are dangerous. Ignoring sound dietary practice in pregnancy is dangerous.

 

Saying “x is dangerous” doesn’t really tell me anything about the danger. How dangerous is it? Are all three of those things equally dangerous? 

Lemay is again suggesting that mothers are to blame for eating poorly. I usually try to find a decent amount of evidence before blaming someone for a negative medical outcome. 

 

Birth is as safe as life gets. Medicine is for medical problems but it should be reserved for states of illness, not normal healthy women who have carried a baby to full term. “

 

“Birth is as safe as life gets” is bullshit. It can be pretty dangerous depending on what resources and technology you have available to you. Women still die all the time from complications of child birth, and women like Lemay are only able to ignore that because she is privileged enough to live in a place where obstetric care is very advanced and widely available. It is the same reason she can ignore the effectiveness of vaccination. 

Someone talked about how guilty this discussion made her feel, because she had been induced.

Here is Gloria Lemay’s response:

gloria lemay 3 After telling women they tortured their babies by inducing, which they obviously caused by poor diet or ignorance anyway, she decides to wash her hands of the obvious consequences of making these (extremely judgmental) statements. I don’t know how women are supposed to feel okay about torturing their babies, if they believe what Gloria Lemay has to say about it. In fact it seems pretty unethical of her to excuse people for baby torture, if she genuinely believes induction is an equivalent. 

The guilt heaped on mothers, regardless of the choices they make, is a symptom of a misogynistic society. It isn’t fair to women to add to that. 

 

my perspective on informed consent or refusal

I worked clinical labs, and patient care, for many years. I did phlebotomy (venous blood draws), specimen processing, some testing, and some problem resolution with Doctors and Nurses. I worked in both clinics and hospitals. You can pick up a lot of information from these experiences if you make a point to do so (and I did). I also took an ethics course that was instrumental in my approach to patient care.

There were times that I had to draw blood on a patient that refused, either because it was a trauma/code, or because the person had a condition that made them unable to make their own care decisions. Some of these patients would protest during the blood draw.

I cannot express the level of guilt that went along with these draws. I was always very cautious to only draw patients on their own terms, whenever possible. It felt so incredibly wrong to be drawing blood from someone who was asking for it to end. I don’t even hug people without asking first. I had no paternal leanings that caused me to make decisions on behalf the patient “for their own good”. To do so would be dehumanizing.

Sometimes patients, who were competent to decide their own care, would ask for the draw to end before all the tubes were filled. I asked if they were sure, and if they were sure then the draw would end. They are human beings, after all. What right do I have to tell them that I should keep drawing their blood when they do not want me to? 

This is how I was trained, and how all phlebotomists are trained to limit liability. There are different kinds of consent depending on procedure, but people can easily revoke their consent if it was implied or verbal. It works a lot like sexual consent in that sense. Lawsuits can, and do, result from blood draws being done without patient consent. Its considered a civil case of battery if a phlebotomist, for instance, decided to draw blood from someone who was asleep. Here is a synopsis from findlaw:

Medical battery is the intentional violation of a patient’s right to direct their own medical treatments. Doctors must obtain a patient’s informed consent when rendering non-emergency treatment. If medical treatment is performed without the patient’s consent or against their will, the patient may have a claim for medical battery, even if the doctor did not intend to cause any harm.

In a medical battery claim, there is generally no need to prove injury or negligence. However, as in all battery cases, it is necessary to prove that the medical personnel engaged in unauthorized touching, contact or handling of the victim.   

It is hard to retain an attorney for these cases because the damages are often lower than their fees, but some wealthy people make a point of suing because of how disgusted they are with the violation of their person. I wish this option was open to everyone, because I have a feeling that these violations are more commonly enacted on marginalized people to begin with. Many people aren’t even aware that they are allowed to refuse if they want to.

I sincerely wish that it were easier to sue or reprimand health care workers who violate their patients rights, but it is very hard. I am convinced that the hospital whose attorney approved a forced c-section did so because the cost of a battery suit was likely less than the cost of a malpractice suit if the newborn was injured by refusal of a c-section. Something needs to be done to remedy this flaw in the system. 

I am continually in awe of midwives who seem to think that sticking your hand in someones vagina should require less etiquette and respect than I gave to patients during a blood draw. I cannot imagine continuing a pelvic exam on someone begging for it to stop. I would feel like a rapist. I think most decent people would. No one is entitled to another persons body, ever. 

What is wrong with these women, that allows them to think its acceptable to do this to people? I’ve written before that midwives who advocate natural child birth often seem to become hardened to seeing women in unbearable pain. Perhaps the midwifery attitude of “I know best” goes with the same territory. That was certainly the opinion of a woman who lost her baby to valerie el halta’s methods:

But rather than the “natural” childbirth she expected, Rose said El Halta subjected her to unwanted interventions. Without warning, she “stripped the membranes” — a procedure to separate the amniotic sac from the wall of the uterus and stimulate labor, Rose said.

“It was rough and painful, and she brings her bloody glove back out. ‘I figured I’d just help you along,’ she said. That was her attitude: Auntie Val knows best.”

….

“It was the single most painful thing Val did during my birth,” Rose said. “She had both of her hands inside me. I was yelling at her to get them out, but she refused because she was helping. If someone has two hands in you, and you’re telling them no, and they don’t stop — that’s why I call it a rape.”

This will continue to happen as long as other midwives accept it and do nothing to keep it from happening. 

The uneasy relationship between pro-life and anti-home birth rhetoric

There is an umbrella term for issues of abortion, birth control, and maternity care. “Reproductive rights”. Lumping these three topics together can make it very hard to have a meaningful conversation about the ethics of any specific obstetric or gynecological practice.

The way that home birth communities superficially appeal to feminism is something that contributed to my choosing an out of hospital birth provider. Con artists are skilled at  figuring out what selling point will work on any particular mark.

There were a lot of things that turned me off about anti-home birth web pages when I was doing initial research on maternity care. Certain phrases or arguments served as a  dog whistle to pro-choice feminists like myself. An abortion and a home birth are very different situations, but its hard not to have a knee jerk reaction to phrases like “The baby didn’t get to choose.”

An abortion is usually performed at 8 weeks (medicinally induced abortions can be initiated earlier). A fetus that was aborted was either not wanted or could not be adequately cared for if carried to term.

A home birth baby is very much wanted.

These are obvious differences that everyone knows. It is very difficult to let go of the dehumanization that women face when confronted with anti-choice rhetoric. The message is clear, over and over again: the woman matters less than the contents of her uterus. Its unfair, extremely unfair, especially in the case of elective abortion. Anything that even sounds like that makes me cringe, and that tendency caused a blind spot for me while researching home birth.

The mothers of home birth babies generally want them to arrive safely. They are overwhelmingly white, middle to upper class, and college educated. Outside of domestic violence and other outliers it would be hard to say that home birth mothers are forced into their pregnancies.

Talking about the rights of the baby to arrive safely means talking about what their mother is choosing as well.  There are some women who seem to think that having a home birth is more important than having a live baby, and it is a disturbing reminder of how disparate these issues are from abortion rights.  Virtually no one could condone the conduct of women who loved their home birth experience when their baby didn’t make it.

I am absolutely not arguing for revoking a pregnant woman’s right to refuse treatment or tests. That is a human right that everyone has.  That is not usually what is at stake in home births. Most home birthers are convinced that it is inherently better to have a natural birth at home, or that it is actually as safe (perhaps safer) than having a baby at a hospital. Most women choose home birth because they want a positive outcome, and have been lead to believe that home birth is the best way to accomplish it. Speaking about the babies that pay the price for misinformation is not at all at odds with what most pregnant women desire from birth. These women are being lied to. Just as crisis pregnancy centers twist facts about abortion to try to convince women of taking one specific path, midwives will twist information to make a home birth seem safer. By pushing for legislation to reign in home birth midwifery we are protecting a vulnerable population from predators.