Category Archives: incompetence

Following In Dr. Biter’s footsteps

A North Carolina physician is being investigated after having presided over 3 home birth fatalities.

In a statement issued through his attorney Friday, Dr. John David Hayes also said families of the babies have continued to support him.

Of course they do, most people choose birth providers specifically because they trust them. It is terrifying to think that someone you trusted hurt you unnecessarily. The article actually notes that the information came from an unnamed source and that details of the deaths will never be released. Someone saw a pattern and spoke up out of concern for other people, and I commend them for doing so. The fear of repercussion or being ignored is very daunting when deciding to report other people for misconduct.

Dr Hayes expects to be cleared of wrongdoing. I do not expect that for him. Most obstetricians lose one full term baby that was otherwise expected to live in their entire careers, and he has lost 3 in 10 years. At least that is if you believe that he was only taking low-risk patients, which seems to be the only possible way for him to excuse taking a patient for home birth to begin with. His arguments are nonsensical in some portions of the article:

“I expect that after a thorough and impartial investigation, all of my home birth practices will be found to be within the standard of care for an obstetrician in North Carolina,” he said.

Home birth is not the standard of care for any obstetrician. The standard of care for obstetrics involves having ready access to blood transfusions and an operating room, something no home birth can offer without an unacceptably long transfer period. That is why ACOG and virtually every obstetrician discourages out of hospital birth for patients. Most pediatricians discourage home birth as well, on the basis of having treated so many brain damaged patients who were hurt by their parent’s decision to home birth.

However, as Dr Hayes and a few notable exceptions prove (Dr. Biter, and non-OBGYNs Aviva Romm, Dr Sears, and the late Marsden Wagner) an adequate education is not always enough to protect doctors from believing in quackery.

For those who are unaware, Dr Biter is another male OB who was dead set on home birth and insisted on its safety. Unlike dr Hayes, Dr Biters patients did complain in the form of a lawsuit. Dr Biter ultimately surrendered his medical license in light of the fact that he botched a home birth and killed someone’s child. He later decided to open a birth center as a non-physician, until social media pressure caused it to close. Dr Biter has also been the subject of sexual complaints, having taken advantage of the dr-patient relationship in order to obtain sexual favors from his patients. He is very scummy.

Many people who are aware of the debate about malpractice reform know that a minority of doctors are usually responsible for the majority of malpractice claims. When your doctor swims against the current in their speciality it is very difficult to know if it is because they are ahead of their time or because they are quacks. This I know for sure- there are far more doctors who succumbed to quackery than those who were ahead of their time. Be careful.

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

 

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. 

My original blog is back up

It has the story of my experience at a birth center with lay midwives. There was a CNM at one of the checks and she was professional.

There is also a lot of information about how little the natural child birth community did in response to my complaints. I literally complained of sexual misconduct and no one who could do something about this felt the need to do anything. They want to sweep my story under the rug instead of dealing with it. They don’t want people to know what they will tolerate from other midwives. I thought that what I went through was the worst thing, but then I began to read about how women who lost their babies to negligence go through the same thing. Midwives support each other so much more than the people who get hurt by their natural childbirth ideology.

The blog was down because of an attempt at mediation with better birth of utah, but it looks like its not going to happen. 

What happened to me has made me stronger. It has made me an advocate for change. I know for a fact that my shame on better birth blog and my safer midwifery utah blog are making midwives fear that their scam will be exposed to the public. I have emboldened public officials to take a stand against unlicensed midwifery, and for that I will likely be taken to court for defamation. I’m willing to fight in order to tell my story.

Thank you to everyone who has shown me support.

UK midwives insult a father whose son died from negligence

I point out the difference in training between nurse midwives and lay midwives often, and there is a difference in that nurse midwives have more training and more accountability. I would say that on average there is a big difference in practices and attitude as well, but of course there are horror stories about CNMs just like any other profession. The common thread seems to be Natural Child Birth (NCB) advocacy.

Here is one such story from the UK, where there have been many problems because of midwives pushing vaginal birth no matter what, and otherwise discouraging any intervention during births. The father who lost his son to negligence is treated like an inconvenience, as an unimportant voice, in the natural birth debate. We should be listening to those who paid the price for ideology based decisions. That is the only way to learn from the past.

“do nothing”- the official slogan of home birth

With a few exceptions (namely placenta previa) the home birth midwife’s theory of practice is to not do anything. Their strategy of not doing anything (often euphemistically called “trusting birth”) is what patients shell out thousands of dollars for. Home birth midwives seem to believe that active management of risk factors causes deaths, when there are plenty of statistics that evidence the safety of hospital birth when compared to home births. Here are the numbers from Oregon. The midwives have a theory, that doing nothing is better than doing something nearly all of the time, but they ignore all the available data to check and see if their theory is correct. They put peoples lives on the line and do not check ahead of time to see if their idea is true.

The way that midwives come to believe such nonsense is that the majority of the time no one dies when they decide to do nothing. The issue with doing nothing isn’t usually death, its usually brain injury caused by oxygen deprivation. There is not any accountability or tracking of brain injuries in babies by home birth midwives, but a paper by perinatal specialists found an 18 x higher rate of them. Sometimes it takes years before the effects show up.

I began thinking about this matter because of an article on the Thinking Midwife’s page about how nuchal cords (cords wrapped around baby’s neck) are a “scapegoat” for interventions. Heres her advice:

  • During birth DO NOTHING.
  • IF the cord is preventing the baby descending once the head is born (extremely rare) use the ‘somersault technique’ (Schorn & Blanco 1991) – see below.
  • Once the baby is born, unwrap the cord (the mother/family can do this).
  • If the baby is compromised at birth encourage the parents to talk to their baby whilst the placental circulation re-establishes the normal blood volume and oxygen for the baby. if the baby requires further resuscitation do it with the cord intact.

She emphasizes over and over again how rare it is to have to use the somersault technique, but to me that says that american home birth midwives specifically will be unlikely to actually learn this technique during a birth. Would you want to be the first patient a midwife has used this technique on? Would she even know if she were making a mistake? States that actually regulate direct entry midwives require that they fulfill educational criteria that is woefully inadequate, You can take the NARM exam and get certified after attending only 20 births- most non OBGYNs deliver more babies in med school than that.

The thinking midwife’s theory is that compressed cords are providing compromised, but not completely absent, blood and oxygen to the baby. That may or may not be true in any specific case, but there isn’t any electronic fetal monitoring to detect distress at her home births, so midwives are forced to form an opinion based on intermittent Doppler readings.

I sometimes wish I could get midwives together with malpractice attorneys sometime to talk birth injuries. Midwives who do home births attend to far fewer births than physicians, midwives get to pick their patients with more freedom than physicians, and lay midwives are less likely to actually recognize their mistakes. Home birth midwives are less likely to see the impact of their practice choices in any representative way, which probably makes it easy for them to pass around useless advice over and over. Malpractice attorneys deal exclusively in cases where someone died or was injured because critical decisions were made (or not made). They tend to have a much more common sense explanation of the problems caused by nuchal cords because they actually have to see the parents of the injured babies, and file the documents in court, and see the costs associated with the injuries, interview medical experts who explain what went wrong, etc. Malpractice attorneys have to face what these midwives would rather forget or blame on the parents. You will notice that it says in some cases the only way to treat is emergency c-section, and the only way to make sure its not an unduly delayed c-section is to use fetal monitoring. Home births have neither of these things at their disposal, so they have to push the lie that doing nothing is better than doing something that can only be done in a hospital. Admitting that it is more dangerous would lead them to having to obtain actual informed consent, and very few people would be willing to sign on for the risks of homebirth if they were honestly represented ahead of time.