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this is the future, if we choose not to learn from the past

Safer Midwifery for Michigan is the group that inspired me to start Safer Midwifery Utah. The founder of SMM lost their child during a breech birth by a home birth midwife. They won a settlement but the midwife filed for bankruptcy so she would not have to pay. The same midwife is still practicing (Audra Post), and she is still willing to attend a breech birth. Safer Midwifery for Michigan says that she has attended at least 2 deaths, and on Audra’s web page she claims to have attended “over 300” births. Lets round it up to 400, to be charitable, and then she has a notably high death rate of 1 per 200 births. That is shameful, absolutely shameful. Direct entry midwives are like walking cases of dunning-krueger effect, their incompetence is what feeds their sense of confidence in their practices. 

This is the future for our state if something is not done soon. I have no doubt that our state has one or several Audra Posts in our midst, but its impossible to hold anyone accountable in a system like ours or find out who they are until its too late. The victims of home birth midwives can be made silent in many ways. It takes remarkable strength and dedication to go through a lawsuit when the plantiff knows the judgment will likely go unpaid, and their child will never be brought back by a judgment. To rehash every detail in front of a judge, to your lawyer… the pain of it makes many loss parents turn away from fighting. It is completely understandable. Some might believe the convenient lies that their midwives cook up to cover up what happened. Without very strict record keeping requirements there is no way to determine exactly how many babies died preventable home birth deaths in Utah, though if Oregon’s numbers are any indication its far too many (these numbers were collected when Oregon had the same legal requirements for midwives that Utah currently does). 

Please click on the action guide on the left side of the page to contact your legislators about preventing the next home birth tragedy. 

Utah Midwive’s Association statement on the Vickie Sorensen trial

Here is the Utah Midwives Associations official statement:


We, the Utah Midwives Organization, are aware of the reported charges against Vickie Sorensen, a midwife in Cedar City, UT. The charges are very serious. We are always concerned when there has been loss of life or potential misconduct of a midwife. 

Midwifery care is meant for normal pregnancies proceeding in a normal manner, and there are definitely times when pregnancy is outside the scope of midwifery practice. We cannot comment on this case specifically as it must work its way through the legal process. 

We offer our condolences to the family who has suffered the loss of their child.

 
This statement reminds me a lot of when MANA’s death rate came out. They said that midwifery care is for low risk pregnancies (as to excuse the astronomical rates of death for twins, vbac, and breech births), but did not make any practice recommendations. The Utah Midwives Association has done the same thing- they have said midwifery care is only appropriate for certain pregnancies, but does not have plans to actually change anything legislatively to ensure that midwifery care is only dispensed to women with low risk pregnancies. 
 
It also reminds me of the Valerie El Halta fiasco. When that happened Utah midwives also acted as though this was some kind of isolated incident or a deviation from the normal, but I happen to know that two of the midwifery schools in Utah teach breech, vbac, and twin births to students. I know that the trade magazine for home birth midwifery calls all these conditions “a variation of normal”. I’ve read Ina May Gaskin books that say the exact same thing. 
 
The standard you walk past is the standard you accept, and unless UMA lobbies for common sense policies to ensure the safety of moms and babies I will be forced to assume that they find the legislative situation of utah midwives acceptable. 

The mention of the family is appreciated. I wonder if their condolences extend to plans to make sure no other family ever has to endure such a tragedy again?

The reason the #notburiedtwice campaign exists

The most disturbing thing about the radio show is that the pro-vickie camp essentially blames the family. They say that families who are grieving look for someone to blame for the tragedy, as if the family, ambulance, hospital, cops etc would join in on a lie for no apparent reason. MANA’s own statistics on home birth midwifery show that these are largely preventable tragedies caused by a inadequacy in the training of direct entry midwives.

Ex Natural Childbirth Advocates

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…

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Vickie Sorensen and Camille Wilcox learned nothing from the death they presided over

The title of this post is a bold statement to make,  I know. How could someone preside over a preventable death and not change their practices? I can’t pretend to know the mental gymnastics needed to justify the practices at Pathway to Wellness birth suites. I have very good evidence that Vickie Sorensen and Camille Wilcox learned nothing from taking on a twin birth with additional risk factors, because they took on another twin birth with additional risk factors after that poor baby lost its life at the path to wellness birth suite (its called a birth suite because legally its not a birth center).

This birth story is told enthusiastically by the mother as a ‘success’, when to just about anyone else its clear that the midwives agreeing to take this case on nearly cost a baby their life. Its pretty horrifying. Here is the way the mom found Pathway To Wellness:

 I contact the midwives at the Pathway to Wellness Center. I sent them an email and asked if they would be willing to deliver twins. I also asked them if I could be supported with gestational diabetes and at the age of 41. I was so happy the day that I heard back from Camille, one of the midwives at the center, when she said “YES”- they could deliver twins, and that they don’t consider my age or the diabetes a risk because older women usually take better care of their health and I didn’t need medication to regulate the diabetes.

Wrong, wrong wrong.

Risks of pre-existing diabetes in pregnancy are numerous and requires a lot of monitoring– monitoring direct entry midwives are not able to provide.

Risks of advanced maternal age (meaning over 35) are quite similar to the risks for pre-existing diabetes, so it would not be unreasonable to think that each risk factors could exasperate the other.

If a mother is actually informed of the risks of such a pregnancy and decides to do it out of hospital anyway, then I support her right to choose out of hospital birth. But this case illustrates the problem with home birth and informed consent quite vividly- the midwives don’t believe that there is any significant risk, so they by definition cannot inform the patient of the risk. The only condition I have seen midwives reject uniformly is complete placenta previa, where the placenta grows over the cervix. Literally everything else has been fair game for them.

I don’t mean to imply the view that this was a good idea for an out of hospital birth is rare among Utah midwives, its actually quite common for direct entry midwives nationally. Trade magazines such as Midwifery Today declare that twins are just a variation of normal, along with a lot of stories of midwives delivering twins at home intended to support the view that this is entirely safe.

Anyway, one of the twins in the may 2014 delivery was very close to dying:

Mr. Alexander took us all by surprise by being born first. No wonder the midwives had had a hard time finding his heart beat during labor. He was moving down, down, down to be the first born! He was so sweet and innocent that I just laugh every time I think about holding him that first time, thinking it was Megan- but so obvious that he was not Megan.

Losing heart tones on a twin is an emergency, not a funny story. They did not know which twin was coming out first either, another total failure on their part when it comes to monitoring. Things get even worse when:

Again, another surprise! Giselle said, “I have a foot!” Megan’s feet were down and coming through the birth canal. The little girl must have turned around right after Alex was born! Giselle continued to help Megan with a now breech delivery… one foot, two feet…I reached behind me and felt little baby feet kicking in the water… legs, chest, one arm, then two arms were out. John could see that Megan stopped kicking and that her body was floating in the water with no movement.

There are a few breech presentations, feet first  is called a footling breech. It is the most dangerous breech presentation. I have an emergency childbirth guide for military OBGYNs that explains how and why footling breech births are the absolute worst presentation with a ‘significant’ increase in risk for complications and death.

Unbelievably, it gets even worse:

 When Megan was completely out of the water, she wasn’t able to breathe. The midwives held her white, limp body and started calling her name. She was given a breath through mouth-to-mouth resuscitation and they tried to stimulate her with pats and calling her name. Megan took one gasp and then stopped breathing again. They checked her heart and it was still beating. The cord was cut and the team rushed Megan into the other room and onto the crib so they could continue the resuscitation work.

John and the midwives continued to stimulate her, give her mouth-to-mouth breaths and also used some cayenne solution on her chest to get her respiratory system jump started. After about 4 minutes, Megan was breathing successfully on her own.

We found out later that the two placentas were fused together. When Alex was born, the placentas detached. By the time Megan was born, just 14 minutes after Alex, Megan’s placenta had completely shut down.

No one called 911 at any point during this, but they did pour pepper on a baby to try and get it to breathe. They are lucky that their child did not die, but there may have been some damage done by the lack of oxygen. The mother continues:

 We think Megan missed out on about a minute of oxygen from being delivered to her via the placenta. (fyi- newborns that miss around 20 minutes of oxygen may start to experience brain damage.)

Not sure why they think she only missed one minute of oxygen. They do not use electronic fetal monitoring so everyone has to guess about how long the baby went without oxygen.I don’t know who told her a baby can hold its breath for 20 minutes without brain damage (probably her clueless midwives), but they were lying to her. Every source I could find said 5 minutes before hypoxia sets in, even Ina May Gaskin  says so and she is the big name in home birth midwives. All the other indicators of hypoxic brain injury require hospital equipment to detect, and a lot of the time these brain injuries do not become apparent until years after the birth. There is no way of knowing if that tiny baby came out of this unscathed without following up in several years.

The mom is happy because she thinks she received great care. Her babies weren’t dead, although they came much closer to death than they ever needed to, and were attended by incompetent practitioners who think that sprinkling pepper on a baby is a better idea than calling 911 when they aren’t breathing.

I realize the birth story I linked to may soon disappear once it reflects poorly on the midwifery community (a story about a near dead breech birth was removed after I reported on it before), so I have saved this one in its entirety on my computer just in case. I hope the prosecution for the VIckie Sorensen case is paying attention- this additional birth shows a craven disregard for the life of newborns and mothers on Vickie Sorensen’s part. Delivering one dead twin wasn’t enough to discourage her from taking on twins again. Most people try to learn from their mistakes, especially when they are costly to others, but this mother-daughter midwife team seems to think that its normal or acceptable to ignore what they have been responsible for (when the outcome is bad, anyway). Regular people would be tormented by even possibly having played a role in a newborn death, these midwives are so unconcerned about it that they decided to risk it again.

 

Reasons I believe the Vickie Sorensen Allegations

I’ve seen a lot of attempts to whitewash the tragic death of a newborn during a birth that Vickie Sorensen attended at her free-standing birth center in Utah. The child was a twin that was born premature, two risk factors that should have excluded the patient from an out of hospital birth. The arguments the pro-vickie, pro-home birth camp put forward are pretty pathetic. It is the same garbage I hear every time a midwife is arrested. The first response is that no one is allowed to have an opinion on the validity of the charges until the verdict comes through (interestingly enough, every single case I’ve followed ended in a conviction).

Courts rightly presume innocence until guilt is proven, but regular people are under no such obligation when forming their opinions.

The first argument is “we don’t have all the facts yet”! But we do have the fact that the attorney general felt that there was enough evidence to base a manslaughter charge on. We have the fact that the Salt Lake Tribune felt comfortable enough with the findings of police and interviewing witnesses to run the story.

Another important thing to remember is that if ANY of these allegations are true then it was an appalling way to behave. I have a hard time believing that *none* of the allegations are true, and they do not all need to be true for this incident to serve as a wake up call to Utahans and our legislators.

There are other factors that lead me to believe that these charges are based on fact.

The sheer number of witnesses which would have to conspire against Vickie Sorensen (for no known reason) is pretty astronomical. I could accept one or perhaps maybe two witnesses testifying for some known reason against Vickie, but if you read the allegations it becomes clear that the minimum number of witnesses far exceeds reasonable doubt:

baby’s mother

baby’s father

baby’s grandmother

first EMT

second EMT

at least one doctor

at least one nurse

 

That is, at a minimum, seven people who witnessed the case at hand. I would imagine that if the testimonies were mixed there would be no case- the district attorney generally tries to avoid wasting time on cases that are not able to be prosecuted successfully. I find it much more likely that the accounts of 7 (or more) people corroborate the manslaughter charges.

Even if there was some attempt to persecute Vickie Sorensen for a reason not apparent at this time, there is the problem of the medical records. All the workers involved would have to falsify their records while the events were taking place or shortly after. I find this highly unlikely.

The other possibility I have been able to come up with is that police officers would have to tamper with the evidence, risking their career (again for no known reason). Since most of the evidence would probably be witness accounts and medical records it would be pretty difficult to fake, and would be found out rather quickly at trial. I find it unlikely.

The other major reason I find the allegations plausible is that this is exactly the same as every other home birth disaster. Anyone who follows them knows there is a theme. There are three phases to many home birth disasters:

First, the midwife makes a mistake.

Second, it becomes apparent that she doesn’t know what she is doing and real medical professionals are called.

Third, the midwife lies about her involvement in the delivery, or opts to lie to the hospital about her mistake.

Here is a collection of stories that fit the pattern:

Magnuss’s death (midwives told the mother breech birth was safe, the baby got stuck and brain damaged from oxygen deprivation, the midwife told EMTs they weren’t aware it was a breech birth until the delivery)

Shepphard’s injury (midwives told mother it was normal to labor for days, kept finding reasons not to show up to help the mother, baby was injured by days and days of labor and had to have extensive hospital stay to recover, midwives denied that any of this happened and threatened a lawsuit if the mother told anyone what happened)

A mother’s injuries (midwives told her to push and that she was crowning, when she was not fully dialated and had a blood clot coming out due to pelvic organ prolapse, midwife refused to give hospital any information about the birth, mother has injuries to her pelvic organs that are only fixable by surgery, baby was in distress but saved by c-section)

Sam’s death and mothers near death (midwife ignored signs of placental abruption, transported too late, baby had severe oxygen deprivation injuries and mother almost died from post partum bleeding. Midwife lied about her involvement to the board and blamed the physicians for her mistake. Sam died at 3 years old due to his brain injury.)

Mary Beth’s death (midwife didn’t show up for the birth on time, so EMTs were called. the midwife said everything was fine even though there were signs of respiratory distress. The baby died later that day, and the midwife falsified medical records to avoid arrest, as well as trying to convince Mary Beth’s mother that the death was not preventable)

Newborn baby birth injured, mother gets sepsis (breech baby had a brain bleed, mother had a fever after home birth delivery. Midwife told her not to go to the hospital, but things kept getting worse. The midwife asked the mother to sign a form that said the midwife did not attend the birth and begged her not to tell because she was concerned about her own license)

Aquila’s death (another placental abruption, mother begging for transfer that was denied, midwife put that patient refused transport on medical documents to try and avoid consequences, baby dies)

Lia’s death (midwife said twin birth after cesarean is safe, one twin is born not breathing and isn’t resuscitated, midwife denies that the baby could have been saved in hospital)

Gavin Michael’s death (a midwife lied to their patient about the safety of going past 43 weeks or pregnancy with a measurement of zero amniotic fluid, the baby died in utero from slow suffocation, the midwife lied about attending the birth in public and then in private blames the mother because they would have “hated” her if she had decided to be harsh about the emergency)

It is worth noting that in the last story, the midwife decided to ask other midwives what to do publicly on facebook instead of admitting that she really had no clue what she was doing. A parade of other clueless midwives, including Jan Tritten (editor of Midwifery Today, the trade magazine for direct entry midwives) all suggested that they either wait longer or take worthless remedies like stevia. None of them have taken any responsibility in the death despite being questioned about it relentlessly via facebook and email.

I decided to take 10 minutes to find these stories, there are many more out there. There are unknown stories, where the patient believed the midwive’s lies and decided not to seek disciplinary action as a result. This is normal for midwives.

As I have pointed out before, midwives have a handy guide to avoiding responsibility for deaths (called From Calling to Courtroom) which advocates Lying to hospitals, to patients, to police. I have also pointed out that the Utah Midwive’s Associations peer review guidelines encourage lying to conceal illegal behavior.

It is so predictable, it would be boring if it weren’t so tragic. The point of this is not to say that you can always believe a midwife is guitly, it is to demonstrate that this is by any standard a completely ordinary event. Ordinary events do not require extraordinary evidence in order to be believed by regular people. If I am wrong I will make as many retractions as needed, but I’m not holding my breath.