unlicensed midwives and their dangerous practices

Here is a look at how one unlicensed midwife chose to operate (likely due to the lack of accountability for her actions). This part is telling:

She practices near one of the largest Amish communities in the US in a state where lay midwives operate in a “gray area” legally. She likes it that way because the Amish women don’t question her, trust her implicitly, and will not pursue litigation or repercussions of any kind. They call her for any kind of medical questions they have, even outside of women’s health, and she freely dispenses medical advice over the phone without seeing the patient in question. Sometimes her advice even contradicts a doctor’s advice. . .guess whose opinion carries the most weight?

If you think that Utah midwives are operating any differently…you are in for a surprise.

practicing medicine I have already covered some midwives practicing medicine in my posts titled “seriously?” and “seriously? part 2“, but above is a post from the vickie sorensen support page talking about the same behavior from a midwife who was recently charged with manslaughter in connection with a baby’s death. They are using the words of people who openly discuss vickie sorensen acting outside her scope of practice, and they think that proves that she is a wonderful person instead of an irresponsible person. This seems to absolutely be the norm for midwives, although when they lobby for legislation to keep unlicensed midwifery legal, they claim that midwifery is different from medicine. They have to claim that. If they told the truth then it would logically follow that they need to obtain a license and insurance to practice.

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midwives respond to the newest preventable death

There are many anonymous donors on  Vickie Sorensen’s gofundme page, but there are some midwives that aren’t afraid to lend their name to the ’cause’ of supporting a midwife who allegedly lied to EMTs about her patients condition as she almost died from blood loss, and they are:

Darby Partner

Jessica Weed*

Melissa Valet

Susan DiNatale

Katharine McCall*

Juanita Michelle Gober

Marcene Rebeck*

*The names with asterisks are midwives who have been prosecuted in different states for negligence of various sorts. I’ve linked to the cases on their names, you can click to see for yourself that none of them were exonerated.

Most of the other donors are former patients, other birth workers (like birth photographers, doulas, etc), and anonymous donors.  They have managed to post Vickie Sorensen’s bail, and so they raised the gofundme goal to 80,000 (likely for her legal fees).

So far I haven’t seen any midwives condemn the laws that allowed this to happen. I’ve only seen them try to put a good face on this and pretend that most midwives follow a reasonable standard of practice, when I’ve pointed out before that most do not.  The norm is midwives making up their own rules and their patients remain blissfully unaware of it unless a problem arises. Most Utah midwives, including midwifery school owners, are against vaccinations and are far outside their scope of practice by discouraging vaccination in their patients.

The salt lake tribune is the biggest news outlet reporting on the charges against Vickie Sorensen, and their comments section has a few midwives willing to put their name on the line to pretend that legislation would solve nothing in these situations. Tara Workman Tulley, political candidate for city council in Springville, Utah, was among the most vocal in support of keeping things exactly the same as they are now.

tara tulley most midwives would not

First she starts with a statement that “most” midwives would transfer this case, and that this is not considered “normal practice” for midwifery care. In reality there is no standard for midwifery care, so this statement is entirely based on her personal opinion of what other midwives would do, rather than any actual data.  I get the feeling that Tara will say anything so long as it helps the “cause” of keeping midwives unlegislated.

What is particularly alarming is that she only thinks “most” midwives would transfer, rather than “virtually everyone” or “all competent midwives”. This should be alarming to the general public- Tara Tulley runs a midwifery school and trains other midwives.  Tara is vice president of the Utah Midwives Association. She started a political committee to respond to the last death caused by negligence, and she clearly felt that it was persecution. Her acceptance of this conduct is deplorable in light of that fact.

tara tulley against licensing

In subsequent posts, Tara Tulley pretends that Vickie Sorensen is worse off as an unlicensed midwife, and therefore not licensing midwives is the rational thing to do. It would be a good argument except for the fact that Vickie Sorensen and other Utah midwives only feel comfortable taking high risk pregnancies like twins, premature, vbac, etc because they have legally done so before, or because they know there is no legal consequence for taking these cases in and of themselves. The legal consequences only emerge when there is clear negligence, like in this case (refusing to call an ambulance, interfering when they did show up, etc). Taking on births that should never reasonably be attended at home is not a legal problem in the state of utah unless the midwife does something else to merit an arrest. It doesn’t matter if the baby lives or dies. Licensing of midwives would prevent this, it would punish them for taking on cases they should not *regardless* of outcome, and insuring of midwives would make sure that even negligent midwives who break the rules would be able to pay for the damages that they have caused. Tara Tulley is against any legislation of midwives.

tara tulley voluntary standards

At this point Tara Tulley acknowledged that the standards that are available in direct entry midwifery are entirely voluntary. People can follow them, or not. Throughout the comments on the salt lake tribune she pretends that this is the norm in other medical professions. She conflates other medical professionals breaking the rules as a case for foregoing standards, when in fact it evidences the opposite case. Punishment for deviation from protocols should be swift and harsh as to discourage such behavior. She has stated before that she prefers a mentorship style program to actual legislation aimed at protecting people from clearly negligent midwives.

tara supports dangerous midwives cropped

This is her (ridiculous) solution to the problem- mentorship. She calls it ‘responsible inclusion’, but what I call it is using pregnant women as guinea pigs, and then being unable to pay when you damage them. If you don’t know what you are doing, you shouldn’t practice midwifery. Period. No matter how skilled you are you need insurance in case you hurt someone on accident. Its become clear to me that virtually none of the midwives in Utah know what they are doing, and that is probably because there is no central body governing evidence based practices. There desperately needs to be a change in the situation of direct entry midwifery in utah.

I’ve contacted the utah midwive’s association for an official statement on the Vickie Sorensen situation. I will update this post if and when they respond (or fail to).

 

Vickie Sorensen’s victims should not be buried twice

Dr Amy Tutuer of the Skeptical OB has a very apt saying about home birth deaths- the babies get buried twice. First in the ground by their parents, and then by the home birth midwives who wish to bury the memory of what happened. It does not have to be that way- take action, call your legislators and let them know that you don’t find it acceptable that its harder to legally drive a car than it is to legally deliver a baby in our state.

It may seem like common sense that the law changes after this, that legislators will wake up to the problems with voluntary licensing and voluntary insurance for midwives, but that did not happen last time a horrific home birth death happened in Utah (at the hands of serially negligent midwife Valerie El Halta). The reason nothing changed is that Utah midwives stand up for each other regardless of how heinous their actions might have been. Right now, instead of asking themselves how this could have been allowed to happen or how to prevent it the next time, they are raising funds for Vickie Sorensen’s defense. They are denying reality by trying to say that this is persecution or that there is no merit to any of the charges (we will have to wait and see, but I have yet to see a midwife charged in a case like this that is let free- there are simply too many witnesses in home birth deaths).

They also have a leg up because legislators like Holly Richardson support home birth, even after the bill she passed cost a life (now we know its cost many more than that). I brought this to her attention and she ignored me and my concerns. She is running for house district 57 in pleasant grove, and will no doubt push the home birth agenda if she is elected. She is a major reason this state of affairs exists in the first place, but she has washed her hands of all responsibility. You will see that she more or less blames parents for not being diligent enough in checking references, but in both Utah home birth deaths the midwives in question have glowing reviews from a large number of people and professional achievement (El Halta wrote for Midwifery Today, Vickie Sorensen was integral to the original Utah Midwives Association). The Utah Midwives Association (now the Utah Midwives Organization) had a meeting about how to best cover this up and prevent any laws from being passed. The El Halta death happened very shortly before the legislative session opened so no one else was organized enough to change the law.  It seems that the lack of action from that death has unfortunately allowed other deadly midwives to operate legally.

These babies need you and me to contact everyone we can to try and prevent the next death. Midwives refuse to police themselves and prefer to have a total lack of supervision or guidelines for their practices. There is actually an official guide for home birth midwives to avoid accountability for deaths they attend, it is called From Calling to Courtroom. You can read it here. You will notice that a lot of what Vickie Sorensen is accused of doing- lying on medical records, interfering with EMTs, etc is encouraged in this book. This is standard operating procedure for home birth midwives.  You and I are the only thing standing between negligent midwives and the next preventable death- please help, it will only take a few minutes of your time.

You can sign a petition demanding licenses and insurance for midwives here. 

Utah midwives make a mockery of peer review

Peer review is a process that exists in many disciplines, usually ones with high stakes decision making like medicine or science. The purpose of peer review is to verify the truth, and sometimes to recommend a disciplinary action (if the peer review arose out of an incident that ended poorly).  Peer review can be very scary for those who are going through it, since the idea is to be critical of a person’s actions or ideas. No matter how scary peer review is for the person being reviewed, it is absolutely essential to everyone else that it be done. Drugs cannot be put on the market because the researcher’s feelings might be hurt if someone points out a flaw in their study of its safety. Doctors cannot be allowed to keep practicing in a negligent manner because the peer review board thinks doctors should stick together. Everyone recognizes that patients and the public in general are the reason for peer review.

 

…everyone except direct entry midwives of course.

 

I found the utah midwive’s association’s peer review protocols, and they are an absolute joke. You aren’t allowed to question why a midwife performed a certain action. You will be asked to leave if you ask why someone chose the course of action that they did- this means even if someone died or was disabled because of the action, other midwives aren’t allowed to be critical of it.  You are only allowed to ask if they considered a different course of action. You aren’t allowed to hurt another midwife’s feelings, that seems to be the main concern throughout the document. They do peer review for “educational” reasons, although I don’t know how much education can be gleaned from a discussion where critical thought (which generally involves asking hard questions) is not allowed.

Interestingly enough, you also aren’t allowed to be honest about your case if it involved anything illegal. Here is what the practice guidelines say:

  • Please do not present cases in which there has been or may have been illegal conduct, such as an unlicensed midwife administering medications or a licensed midwife acting outside her scope (delivering twins, for example). We want the review to be a safe place where we can learn from each other. Announcing that you have engaged in illegal or questionably legal activities as a midwife puts you and each participant in an emotionally, ethically and legally perilous situation. Just don’t do it!

 

How are the midwives who are doing illegal things supposed to learn about the dangers of it if they aren’t allowed to discuss it in peer review? The utah midwive’s organizaton has lobbied to make it so that unlicensed midwives can take on any client they feel comfortable with, regardless of the risk level involved, and now they refuse to even let these women learn the error of their ways through a peer review instead of by personally maiming or killing someone. Its deplorable. It is worth noting that the majority of midwives in utah do not decide to become licensed, likely so they can practice outside the state’s guidelines. The Midwive’s College of Utah and Community School of Midwifery both teach skills for homebirths that fall outside the license midwife’s standard of practice (such as twins and breech births at home). These practices are encouraged in the name of “trusting birth”, and bragging rights of course. I’m sure its wonderful to be the breech expert in town like Melody Pendleton claims to be.

 

You can contrast their joke of a peer review process with an actual hospital peer review protocol. 

When the findings of the assessment process are relevant to an individual’s performance, the medical
staff is responsible for determining their use in peer review and/or the periodic evaluations of a
licensed independent practitioner’s competence, or in connection with any corrective action, in
accordance with the procedures and standards set forth in the Medical Staff Bylaws, Credentialing
Procedures Manual and Corrective Action and Fair Hearing Plan.

….

Peer review is the review of the clinical activities of members of the Medical Staff by other qualified
practitioners with comparable training and experience who can render an unbiased opinion on the quality of
care

 

Peer review is supposed to be about improving the care provided. Advising participants to lie about their activities or to avoid hurting anyone’s feelings is just another piece of evidence that direct entry midwives aren’t professionals, they just pretend to be to deceive more Utah families into hiring them.

If your baby dies or is injured in a home birth, if your midwife fails to show up or lies to you about the safety of your pregnancy, if your midwife does ANYTHING she isn’t supposed to, these are the people you are supposed to be able to turn to. But they will do nothing to help you, they turn their backs on anyone who does not aid them in the goal of hiding the deaths and injuries caused by home birth midwives in our state.

Holly Richardson responds

Holly Richardson left some comments on my last piece about her. Lets get the easy stuff out of the way, by disproving this bit that Holly said:

And ps: I have not hosted a “midwifery meeting” in almost 10 years. Your “facts” are, in fact, wrong.

holly gave presentationwhoops July 2013 was last year, not ten years ago.  I have my own copy of the audio from the meeting from before UMO made their page private, I will upload it soon. Now that thats out of the way, we can move onto the comments with some meat to them:

While I’m flattered you want to highlight my campaign, your anti-midwife agenda will get you nowhere in this state.

I am not anti-midwife, I am anti-unaccountable medical practitioners. I am sure that the majority of people in utah are.

And really, you have no idea what you are talking about when it comes to Utah law, the process we went through, or the mood on the Hill.

Holly does not cite the portion of the law that would prove me wrong or tell me exactly where I made an error, I am very interested in knowing where I made a mistake. I will correct it if it is demonstrated to me.

Sadly, you’re not even brave enough to use your real name to attack political candidates.

I don’t use my real name because I blog about my abuse history, and it is humiliating to me to have anyone googling my name find out that it happened to me. Newspapers use this same standard in their reporting, and it is reasonable.

 I am proud of my work on behalf of midwives in this state. We have a long history of safe midwifery care.

I linked to several stories of extremely dangerous breech, vbac, and twin births being presided over by utah midwives. Holly is already aware of how unsafe Valerie El Halta’s practices were, because they killed someone who did not have to die.

Dr Amy Tueter has a saying about home birth babies that die- they are buried twice. Once in the ground, and again by midwives and their advocates who don’t want the public to know about them. This is a prime example of being buried twice, pretending that there is a long history of ‘safe midwifery care’ when there was at least one high profile case of extreme negligence in the past two years. I am joining the skeptical OB in using the #notburiedtwice hashtag on twitter to make sure that these babies did not die in vain.

For those who practice outside their scope, there already are safeguards in place.

Oh really? Where were those safegaurds when I was pregnant, and my midwife lied to me about her qualifications and practices? Because I’ve tried, unsuccessfully, for over a year to get something done about the midwife I had that acted outside of her scope and abused me during my labor. If there is some resource I am missing I am very interested in hearing about it, but so far I’ve tried the owner of the birth center where the midwife worked (who blamed me for what happened), DOPL (can’t do anything about unlicensed people), the police (do not know what to charge someone with who pretends to be licensed but isn’t, do not have enough evidence to go to the DA with my other claims), Utah Midwives Organization (who I had to pester to get a response and ultimately rallied behind the midwife that abused me),  and the Midwives College of Utah (who are putting a note in that birth center’s file for later- no idea what that actually accomplishes). Nothing was done. Valerie El Halta made the ultimate mistake, one that killed someone, and she got probation and a ban from attending other births in the state. She will probably just move again to another state where midwives can get away with being unlicensed.

We are a right-to-work state and we are predominately Republican, which means we believe in limited government and in people’s right to make decisions for themselves and their families – and those include healthcare decisions.

I am pretty sure that republicans also believe that little babies should not be killed because of their parents choices, right? Or are republicans pro-choice now? Because what I see is a lot of babies being sacrificed to letting parents decide to birth out of hospital, and in fact the states with the most restrictions on home birth are predominantly republican.

Although you refuse to use your real name, I am quite certain that you were never a part of the discussions to legalize midwifery in Utah, nor have you ever been involved in lobbying. It’s evident that it is difficult for you to read and understand the Utah code but I assure you, there are consequences for those midwives who practice outside their scope.

Once again, the consequences are not named and law isn’t cited, and I have first hand experience in trying to get something done about this and there isn’t any real consequence for midwives. There just isn’t. I am eager to learn of any new avenue for getting my situation resolved.

Believe it or not, midwifery is not my primary interest in running for office. It’s education and the economy.

It should be your primary interest because the state of midwifery in Utah is appalling and you had a hand in it. Take some responsibility and pledge to fix the law. I’m not going to stop my exposure of the deplorable practices of utah midwives in response to negligence.

You all are just one more tragedy away from this whole thing blowing up again. I can wait, but I wish I didn’t have to, I wish that someone with the power to change things before they get out of hand would do so.

Holly Richardson and the “rogue” midwife

I was able to get in contact with Holly Richardson (of Holly on the Hill), who is running for house district 57 in Utah right now regarding the problems with the midwifery bill in Utah. She was instrumental in passing the bill, so I was interested in what she would want to do about the gaps that allow dangerous women like Valerie El Halta to come to Utah and practice legally. Here is the first exchange, which she deleted from her facebook page:

holly richardsonI said “What do you plan to do about negligent midwives? Your bill is what enabled killer midwife Valerie El Halta to deliver babies in utah without a license. What do you want to change about the bill to prevent another tragedy in the future?

Holly “You obviously have NO IDEA what you are talking about but thanks for your input.”

I tried to reply but she had deleted the thread already. I am not sure what she meant here, I did know what I was talking about. El Halta had her NARM certification revoked before coming to Utah, she came here because she could practice midwifery without having to obtain a license. If there had been mandatory licensing in our state she would not have come here, and would not have worked as a midwife, and would not have been given permission by the state to kill another newborn. A life might have been saved by that legislation and we now have an opportunity to maybe save someone else in the future, but Holly isn’t interested. She isn’t interested in being responsible for the legislation she pushed through in Utah and its deadly results.

I would be more willing to be charitable towards Holly Richardson if she took some responsibility for what happened, but she doesn’t. I went back to her facebook page to talk to her more because I think the public deserves answers.

holly richardson 3I ask again about what she plans to do about the bill that enabled the death of this child. She replies “Which is why I spoke to the press about the rogue midwife practicing far ouside her scope of practice”.

I point out that unlicensed midwives aren’t subject to the scope of practice standards in the direct entry midwifery act. Holly claims there are standards, “including criminal”, but I could only find two actual standards for unlicensed midwives. They can’t claim to be licensed, and they can’t carry certain drugs. The law says that doing those things is “a misdomenor”, but when I reported the midwife I used (who claimed to be licensed but was not) nothing happened. Valerie El Halta was not charged for using prescription drugs w/her patient either, so the law is not being enforced nor is it clear what misdomenor police are supposed to charge unlicensed midwives with when they violate these (weak) standards.

Unlicensed midwives can attend any kind of birth they want to, and that is the important issue that is cause for concern in utah. They can attend a footling breech birth after 4 c-sections with triplets if they want to. Nothing in law prohibits dangerous practices from midwives who aren’t licensed. Holly knows that, because her personal reaction to the newborn death was to host a meeting instructing midwives on how to lobby to keep the laws exactly the same. A baby died and her reaction was to help everyone keep things the same so that this can happen again.

I want to take a moment to address Holly Richardson’s claim that Valerie is a “rogue” midwife, because I know that isn’t true either. Holly is an administrator of the Utah Midwives Organization. When they were getting together for an annual conference a few years back they had a poll asking who should be the keynote speaker.  Check out the names suggested here: UMA keynote speaker valerie el haltaLooks like you can choose Ina May Gaskin, Valerie El Halta, or “other”. Valerie came to utah after a long history of dangerous practices and dead children, so it wasn’t some sort of secret that she behaved this way. If she was a rogue then she was one that the community completely supported and accepted (meaning, she wasn’t a rogue at all). Only when the press came asking questions did anyone pretend like this death was surprising. Holly also pretended that it was unusual for midwives to practice far outside of the scope outlined in the direct entry midwifery act, but its not. I know for a fact it is not.

Do you have a baby that is in breech position after 36 weeks gestation (which licensed midwives aren’t supposed to attend)? Don’t worry, there are unlicensed midwives willing to help you out, and your licensed midwife will pick up the phone and call her if things get dangerous and give you tips on how to avoid going to the hospital. Here is a ‘breech expert’ even (whatever that means), who delivered an almost dead baby in 2011 because midwives helped the mom avoid transfer.  It was a VBAC too. That is a combination of risk factors that no midwife should find acceptable, but more than one of them did.  There are other breech stories floating around, and that the Midwife Alliance of North America (MANA) has demonstrated that breech births have horrendously bad outcomes when attended by CPMS in out of hospital settings. There is no excuse for why this continues in our state, knowing what we do now.

UPDATE 2/24- the story I linked to above has been removed. Luckily its been screen capped and can be found here. 

Oh no, but what if you have twins or gestational diabetes? What if you have those problems and a prior c-section? Don’t worry about that either, here is a woman who will take you on as a patient even though she isn’t qualified to manage those conditions.

Here is a story about an overdue set of twins being attended to in utah by a midwife (who was likely unlicensed).

Here is another unlicensed  Utah midwife advertising her willingness to attend vbacs, twins, and breech births.

The question I have for Holly Richardson, and anyone else who thinks the midwifery act in utah is so great, is this:

Do you think that the public will stand for deaths to happen again and again? How long do you really think this will last? Wouldn’t it be better to prevent a death instead of trying to cover up the practices that led to it?

A preventable home birth death- Possibly in Utah

 

UPDATE : Jan Tritten had this to say after deleting the thread on facebook:

“The
questions on this page are messaged privately to me and put up
anonymously. They are not my cases. This is to help mothers, midwives,
doulas and physicians in their work. it is to get opinions from many
different practitioners and parents.”

I found a link today to the facebook page for an editor of Midwifery Today (Jan Tritten), a trade magazine for direct entry midwives. She makes a habit of posting questions on behalf of other midwives. I assume she does this because midwives may not want their names known when asking about dangerous practices OR because Jan has more friends and will therefore get more responses to questions. It seems that she was posting about her own client this time.

I found a ton of these types of posts on her timeline. In this specific instance, a woman who was over 42 weeks pregnant and had no amniotic fluid visible in her ultrasound, and the patient’s midwife decided to crowdsource advice via facebook instead of immediately transferring care. Here are the screencaps

midwifery today editor crowdsource midwifery today editor crowdsource 2

Note the part on the first post that says “We’re in a state with full autonomy for midwives and no transfer of care regulations past 42 weeks”.  What does ‘full autonomy’ mean? Its midwife speak for “no rules to protect patients from negligence”. Utah is a state that lacks these protections for mothers and babies. This could be a death here or in Oregon- it is not possible to know, however Oregon does have more restrictions on unlicensed midwives than Utah does. 

In Utah, a midwife can do whatever she wants to unless she voluntarily decides to get licensed. The law is very misleading to the public- if you look up the law about midwifery in utah it looks as though there are strict practice guidelines, but they only apply to women who volunteer to abide by them. If those women lose that license they can still practice afterwards, with fewer restrictions.  They cannot call themselves licensed midwives, and they are not supposed to carry drugs, but when I tried to report an unlicensed midwife claiming to be licensed there were not any consequences. Utah midwives (licensed or not) don’t carry insurance so if they injure or kill someone the grieving families are unlikely to be able to sue, and if they can sue they are unlikely to collect any money.  What reason is there for the midwife to act differently? There is no negative consequence for depraved indifference and a lot of praise for delivering high risk clients to ‘prove’ that birth is inherently safe.  You can see from the comments that virtually every other midwife seems to act like this was an unforeseen tragedy that could not have been helped. There were multiple, glaring indications for transfer and the midwife did nothing. Other midwives in the comments talk about the importance of midwives setting their own standards of practice, when in fact that is exactly what caused the death. Jan Tritten is the editor of the trade magazine for midwives, and she engages in behavior which enables dangerous practices like this to happen. Why is she not ashamed?

Something similar happened in Utah awhile back. It was another case of depraved indifference to the wellbeing of a mom and baby, and it ended in a death. What consequences were there for that midwife?

The harshest consequence I’ve seen for a midwife in Utah was to be charged with negligent homicide, and then be sentenced to probation and banned from attending births. That’s it. Probation. She wasn’t even shunned by the community in the aftermath, they embraced her and probably still do (while the public isn’t watching).

One of the main reasons Utah’s state laws are set up this way is because of legislator Holly RIchardson (republican, of Holly on the Hill fame). She was instrumental in getting the original direct midwifery act passed as legislation, and has yet to take any responsibility for the outcome of such an outrageously negligent policy.  Even if this death was not in Utah, there is absolutely nothing that would have prevented this level of negligence from happening here. There is absolutely nothing in place to punish or discourage this level of negligence by unlicensed midwives, and that’s the way Holly Richardson and her friends at the Utah Midwives Organization prefer things to be. Without new legislation we are literally waiting around for this to happen again. How many dead newborns will it take for people to demand change?

Holly is running for House District 57 in Utah this election. Let Holly know how disgusted you are at her for enabling dangerous quacks to operate without any accountability. Her contact form is here.

Edited to add- there are actually multiple states with lax licensing on midwives. Read the comments for additional information. In the end it turned out that this tragedy happened in Nevada.