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.

“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.

 

The reason the #notburiedtwice campaign exists

The reason the #notburiedtwice campaign exists

I came across a link for a radio show called Progressive Parenting, which decided to discuss the Vickie Sorensen manslaughter case. They had someone from the human rights in childbirth campaign and Katie McCall of Our Sisters in Chains. These women are trying to bury the memory of the baby that died a preventable death in Utah, they are trying to make sure people do nothing in response to the deaths.

The focus of the show was how prosecution of midwives for attending preventable deaths would affect the community. There are a few major claims in the show that are questionable:

Claim #1 is that Doctors are never charged with manslaughter for killing a patient.

It took me one google to debunk that, there are many cases of physicians being charged with manslaughter when they have done something incredibly negligent. The reason that doctors or midwives are charged with manslaughter is that their negligence was so egregious that it could be considered criminal. I think it is safe to say home birth midwives are more likely to do something outrageously negligent because of their dogmatic belief system about the nature of birth combined with paranoia about being persecuted. The women on the show complain that physicians only have to worry about being sued, but are not in favor of mandatory insurance for midwives so that they too could “just” be sued in the case of a death. If midwives want to be sued instead of charged they should carry insurance. The ones with risky practices cannot secure insurance because insurance companies know the risk involved would make for a very high rate for services, and midwives cannot charge prices high enough to justify the insurance cost. Its common sense that if you do a risky job then you open yourself up to these problems, but midwives and natural childbirth advocates believe that they should be exempt from the rules that the rest of us have to play by. They want all the glory of being a physician without any of the responsibility, which leads me to the next claim.

Claim #2 is that home birth midwives are experts in vaginal birth and should be regarded as such by the medical community.

The women on the show praise Utah’s midwifery laws, despite the fact that you need no training or experience to become a home birth midwife in the state. They later refer to Utah as a ‘haven’ for midwives because the law is so lax. I don’t know how they can claim that our laws are great because they require nothing of people who want to practice home birth midwifery, but then demand that untrained or undertrained midwives be regarded as experts in childbirth. Physicians are sick and tired of cleaning up after the mistakes made by lay people and have a negative view of home birth midwives for a reason. I’ve noted before how a non-nurse midwife’s complete ignorance of electronic fetal monitoring makes them unable to detect distress patterns outside of brachycardia, and likely explains the wealth of intrapartum deaths that home birth midwives preside over that are completely unheard of in a hospital setting (the long labor, heart rate was fine, then suddenly the baby is dead story you’ve seen so many times before). The human rights in childbirth rep says that collegiality needs to be in place so that the midwife and hospital can trade info, but if you’ve read From Calling to Courtroom (the guide for home birth midwives to avoid liability) you know the standard advice to avoid liability is to make a chart in your own special code that only you understand.

Do not chart emergency medical procedures. Use a “made up” code that only YOU understand. Don’t ever think it can’t happen to you. I believe I was careful BEFORE I was prosecuted. I am even more careful now.

 

-Chapter 1 of From Calling to Courtroom

It is absolutely impossible to take information from someone in this profession seriously because there have been so many cases where home birth midwives lied to the hospital, EMTs, police, etc.

Claim #3 Anyone working with birth is bound to see a ‘bad outcome’.

Lets assume that by bad outcome they mean a newborn death, since that is the case being discussed on the show. Vickie Sorensen was a midwife for over 30 years, and has delivered ‘over 1000 babies” (according to her fundraiser page). Contrast that with an OBGYN, which would take about six years to get that number of births (delivering 140-180 or so babies a year). OBGYNs still manage to lose significantly fewer babies in the hospital despite taking on cases where newborn death can be expected.  It seems to me that if most OBGYNs were working at the same pace as home birth midwives, and could be as selective in choosing their patients, that they would be extremely unlikely to see an unexpected perinatal death. The culture of home birth has a creepy way of trying to normalize preventable newborn deaths as being unpreventable, but the numbers say something different. The vast majority of home birth deaths can be prevented.

Claim #4 There is an anti-home birth agenda that causes unmerited arrests of midwives and causes the media to falsely report information.

I’ve never actually seen a midwife be exonerated after being accused of manslaughter or homicide, so unless the agenda extends to juries its a bit hard to take seriously. A lot of evidence would need to be produced to support this claim, which is essentially a conspiracy theory to try and excuse the allegations against midwives. I’ve seen no evidence of it anywhere. It seems as though this would be a pretty low priority target, considering the minority of births are taking place out of hospitals. I’ve pointed out why I believe in the charges against VIckie Sorensen, and I talk specifics exactly because I know that these natural child birth advocates won’t. Its a manipulation tactic to keep things vague.

Claim # 5 The right of midwives to practice is about the right of women to choose when and how they give birth.

I find this incredibly dishonest and appropriative of legitimate feminist issues. This is and always has been about letting midwives do whatever they please without accountability. People who are actual feminists think that women deserve to have skilled birth attendants who can actually adequately explain risk vs benefit to them, not a bunch of anti-vaccine nutjobs who idealize the history of human child birth, despite its high mortality rate. Letting midwives get away with being unaccountable and untrained means that we are letting women fall into the trap of charlatans, and many of them are choosing home birth because of fear of hospitals or a lack of finances.

Claim# 6- if midwives have restrictions placed on them, women will have to choose between c-sections and unassisted birth.

Of course this is a false dichotomy, there is a lot of space between those two things. Many hospitals have tried to incorporate as many features of home birth as they can into birth centers attached to hospitals. You could have a vaginal unmedicated birth in a hospital.  Illegal home births attended by midwives happen all the time.

The claim here supposes that going unassisted is much worse than having a midwife, a claim that is false in many cases. Midwives have a mantra of ‘trust birth’, and it means that they are more likely to say that everything is fine when there is a real risk or a real problem happening. There have been many times where home birth midwives prevented transport or insisted it wasn’t needed while the patient knew that they needed urgent help. Midwives have a history of making things much worse than they needed to be.

math is an intervention

math is an intervention

…or at least home birth midwives must think it is, because they seem to have such difficulty with it.

MANA (midwives association of north america) had a voluntary survey to collect outcome data. They found a death rate for HBAC (home birth after cesarean)  of 5/1000, which is much much higher than comparable hospital birth. MANA did not understand that this is equivalent to 1/200, and denied it when it was pointed out to them. Here is what MANA had to say on their facebook page:

…[I]t does show a combined 5 deaths of 1000 (which is not the same as 1 in 200, since 1000 subjects were necessary to find those 5 deaths).

They deleted the post instead of correcting their error. Typical.

how midwives manage a retained placenta

When a woman retains the placenta long after the birth of a baby, the risk of serious bleeding increases. Blood products obviously are not on hand at a home birth, so it can be a very dangerous situation. Hospitals and nurse midwives usually manage this problem with drugs, and in some cases manual removal of the placenta.  Jan Tritten crowd sourced a solution for this issue, even after her last crowd sourcing adventure killed someone.

What would a direct entry midwife do in such a situation?

She could pour pepper on you.

If that doesn’t work, she could feed you some chocolate.

If that doesn’t work, she might talk to the placenta and acknowledge its “intelligence”

If that doesn’t work, she might advise you to gag on your own hair or to compliment you until your placenta comes out

The vast majority said “just wait it out”, and literally only one person talked about this matter with any medical terminology or advice at all. Only one.

These women are quacks and have no idea what the hell they are doing. I can’t illustrate it better than by posting their own words.