direct entry midwives: a public health menace

There is a curious overlap between anti-vaccination activists and midwives. It seems that it is hard to find a pro-vaccination midwife, despite the overwhelming scientific consensus that vaccines are a fantastic way to prevent illness. Midwives will outright tell patients anti-vax propaganda during their pregnancy- I should know, it happened to me. The midwife telling me reasons not to get a flu shot did not know that the flu is a virus instead of a bacteria, and she also believed that getting the flu shot causes the flu. I looked into the Midwives College of Utah and The Community School of Midwifery to see if midwives are actually being trained to reject vaccines or not. I could not find any vaccine specific information. But did I find an inadequate level of training for them to make any recommendations about vaccinations. The health courses that midwives take are very basic, and almost all related to birth, well woman visits, and newborns. Again, it is worth noting that when legislators ask midwives if they are practicing medicine, they vehemently claim that they are not in the business of practicing medicine. When their clients ask them questions that should be answered by a doctor, direct entry midwives claim to know what they are talking about and readily accept money for answering their questions.

Luckily I was informed enough to know that the flu shot is a good idea for a pregnant woman. What is more troubling to me is the fact that there is not any requirement for midwives, who work with a vulnerable population (newborns and pregnant women), are not required to be vaccinated against possibly fatal diseases. This is yet another gap in the Direct Entry Midwifery Act that should be bridged by new legislation.

Anti-vaccination midwives are totally at odds with the Utah Health Department’s vaccination initiative. Rates of vaccination are low in some parts of utah, and outbreaks of disease like measles and pertussis are increasing. This initiative is important and will save lives, but Utah midwives are purposely undermining this cause because of their own mistaken beliefs about vaccines. I do not think most parents who hire midwives know that they are not qualified to make a judgment for or against vaccination when they consult them. I certainly didn’t! I would not have asked if I did not think my midwife was knowledgeable about the process. This mom almost didn’t vaccinate because of the word of her midwife, so I was not the first or last person to make the mistake of asking the midwife about vaccines.

I found that the president of the Midwives College of Utah, Kristi Ridd-Young, discouraged the cancer-preventing Gardisil vaccine on her facebook page:

kristi ridd young is against vaccines

“Ughhhh! ank goodness I had a bad feeling about recommending this vaccine.” Someone (correctly) points out how there is a lot of information online about how the information Kristi linked to is not correct. Her response?

kristi ridd young is against vaccines 2

“Thanks Emily and Katy. As always, we should all be aware of all research. Sadly I now know two people personally who have experienced serious repercussions from the vaccine with no information prior to the vaccination that there was such a possibility.”

So her knowing some people with problems that she believes are caused by vaccines is enough reason for her to feel uncomfortable recommending it to people. That type of thinking privileges anecdotes over data, an obvious mistake when discussing matters of public health. Also, the nonsense about ‘no information that such a thing were possible” could be false as well. I have gotten vaccinated more than most people- I had my childhood vaccines twice because I could not obtain records and needed them to work in the medical field. The shot was cheaper than a blood test so I got everything again. I get a flu shot every year. When swine flu vaccine became available, I was the first one in line at the health department to get vaccinated. I have had gardisil and hepatitis b vaccines (three shots each). Every time I was either automatically given the CDC information sheet on vaccines or I was offered it. It is a requirement for informed consent. I am not saying that people behave perfectly or that the sheet is never forgotten, but it just seems much more likely to me that regular people likely skip reading detailed information about vaccines when they could be doing something else. It isn’t interesting to most people, and that is fine. This is also a story that cannot be verified because none of us have access to either of these people, the details can never be known.

She isn’t just against gardisil, she is against varicella (chicken pox) vaccines:

kristi ridd young is against vaccines 3

This is also a bit of nonsense that has been thoroughly debunked. There has not been a meaningful connection made between vaccination for chicken pox and shingles. There seems to be some other factor causing an increase in shingles infections that has not yet been identified.

If the president of the midwives college doesn’t know this, how can Utahans reasonably expect students to know? I would imagine that someone willing to publicly discourage vaccination would likely pass this message on to students, who in turn pass it on to their patients. The ripple effect of these damaging beliefs should not be underestimated.

I also found that the Utah Midwives Organization administrator is rabidly anti-vaccine. No one expressed disapproval of her ridiculous beliefs:

UMA admin against vaccines UMA admin against vaccines 3 UMA admin against vaccines 4 UMA admin against vaccines 5

She also seems to subscribe to the deadly belief that garlic is better than antibiotics. This belief has unfortunately cost at least one baby their life. Again, the idea that medicines and medical professionals are totally unnecessary passes without comment by the other midwives in the community

UMA admin garlic is better than antibiotics

People can believe whatever crazy thing they want to- I don’t take issue with that. What I do take issue with is midwives acting outside their expertise and scope of practice in order to spread beliefs. They have a position of authority over the clients that they serve (even if every effort is made to negate that authority, it still exists). People trust midwives to tell them reliable information about their health, and instead they are told rumors and falsehoods. Midwives are unlikely to regulate themselves, so I believe that the Utah senate should step in and do something. I will have a new page up soon about how to contact your representatives and possibly a form letter for concerned citizens.

remember, this meeting IS being recorded (part 2)

This part two of the review of the meeting by utah midwives that occurred in response to a preventable death caused by a serially negligent midwife (Valerie El Halta). Part one can be found here.  Keep in mind that these women are all keenly aware that these remarks are being recorded, so they believe that their reaction to a preventable death in their profession is normal and acceptable. Summaries of the meeting content are in bold, my commentary is in normal text.

A woman discusses the need for legal assistance for midwives. 

Another woman said that UMO needs a legislative agenda.

A  student midwife named Catherine  discusses possible legislation in California to make it easier for direct entry midwives to order labs, use medications, and attend births without any medical oversight. She shares how other midwives can help the effort to make life easier for direct entry midwives. Catherine wants to remove physician/nurse supervision of midwives and carrying of medications and oxygen. She notes that the problem is that physicians put their own malpractice insurance at risk by supervising these sorts of births and birth centers. 

Insurance companies are not caring corporations, they don’t take on policies or reject them on the basis of politics. They crunch numbers, do the math, and conclude if covering a practitioner it is an acceptable risk to insure. They have declined to insure these birth attendants, even with physician supervision. That should be a red flag for anyone paying attention. Midwives act as though there is a vast conspiracy instead of the simple fact that out of hospital birth increases the rate of perinatal death and injury, and this is especially true when non-nurse midwives are the attendant.

Around 37 minutes a midwife named Dyanna Gordon says “One of the big problems is that, we are on our way to mandatory licensure.You know, we haven’t played nice with each other for years.And if we don’t do something quickly, we are not going to have many options left available to us. 

We left things how they were, you know, and I believe that there are very few midwives in Utah who believe in mandatory licensure. I think most of us are very happy, with where things are, with licensure being optional. But that’s not where we are going to be in a year or two, if things don’t change. 

Those who are licensed are managed by DOPL. If there are problems in practiced, theres peer review required,all of that was established with saying ‘okay, the unlicensed midwives will govern themselves, they will work out their own issues,they will have their own peer review, and things will be taken care of accordingly.’ But the truth of it is that its not happening, and it is affecting everybody.”

DOPL stands for the Department of Professional Licensing. Diana Gordon understand the problem- there is no real oversight of unlicensed midwives, they can do whatever they want. It is obvious that a midwife could seriously injure or even kill someone by practicing dangerously. Diana is right that it is ‘affecting everybody’, but not in the way she means. She means it is affecting other midwives. I mean that it is affecting the parents who had to bury their child, other community members who were supporting them through that time, the investigator who had to go through the details of it, reporters, and everyone else who heard of the story and felt heart broken. How do I know Diana has no consideration for the community or the dead baby? Her solutions are all about keeping the situation the way it is instead of changing it to prevent the next tragedy.

There is discussion about how to organize, logistics, etc.

The details are boring and I am continually astounded at the lack of technical knowledge that the midwives display during the meeting, such as the constant echoing and the lack of editing for the first 6 minutes of murmurs. I was also surprised by their inability to actually make any progress in making a decision. They take two hours to decide if to have a meeting and when and what to call themselves. Yeesh.

Tara Tulley talks about legal fears because a member of the old organization’s computer was seized during a search warrant (Vickie Sorensen).

The professional organization’s computer was seized by police during a raid of some sort. Needless to say, this is not a problem that real medicial professionals are likely to have. The Utah Medical Association certainly doesn’t have this problem.

I cannot find any information on what happened to this computer, or why it was taken, except on the laughable “our sisters in chains” website, which claims it was all persecution (as you will note, basically ever midwife arrest is unfair in the owner of OSIC’s opinion). They want to raise money for criminally negligent midwives, which I have learned is the norm in this line of work. Comparing their story of what Jessica Weed of New Mexico did and the actual news accounts makes this website completely unreliable in my mind (scroll down to New Mexico or control+f for Jessica Weed). Who knows what Vickie Sorensen was accused of or why her computer was seized? If anyone finds any information about this raid please let me know in the comments.

Tara Tulley asks Suzanne Smith if there are legal concerns with continuing with the new organization. She says that she would rather move onto a new organization because there is no real hope of getting the seized computer back so they have to start again from scratch. She doesn’t feel that the activity of any member does not taint the organization so it would be okay to be the utah midwives association. 

Well, we were all aware that Suzanne Smith was okay with shady behavior from other midwives, due to her previous actions (ignoring complaints of forced vaginal exams and inappropriate sexual touching at her clinic, and subsequently recommending that same midwife to new patients), but now we have her saying it out loud. She doesn’t care if a midwife is under investigation for a death or anything else, it just matters that they are there to protect their collective income stream.

One of the midwives apologizes to Valerie [the midwife that killed a baby], saying “I’m sorry that you had to be the catalyst for this, but we have to move forward. What do we need to do today to move forward?”

Why are they sorry to valerie? Why aren’t they sorry to the parents who had to bury their child?  Direct entry midwives consistently display a depraved indifference to the well being of babies and mothers.

Another midwife says “I know there are hurt feelings over this or that, but the truth is we will be digging our own graves. I hate to be the negative nelly about that, but I think our main push needs to be legislative in nature, so we can keep the status quo.”

The status quo allowed a clearly dangerous woman with a pattern of negligence to legally practice midwifery in the state of Utah. The status quo allowed a baby to die for no real reason. How is no one at the meeting able to see how horrible this looks to normal people, who generally have a reaction of total devastation when they think they could have contributed to the death of another human being? These women directly contribute to whoever ends up dying or being damaged next, and they could not care less about it.

The same woman continues on about how important it is that ‘we can all practice midwifery in the way we believe.”

People can “believe” whatever they want to about birth, it does not merit an endorsement by the state by letting those practices continue legally.

It is also worth noting that this framing of midwifery practice from the meeting, where being a midwife is about practicing in whatever way you believe to be best… is very different than the way they presented midwifery to legislators when they originally passed the direct entry midwifery act. Previously, utah midwives made it seem that there was one responsible way to practice midwifery, the way where you only accept low risk women and transport at the first sign of trouble. They claimed it was an evidence based and safe practice. I doubt that law makers care at all about what midwives believe to be true about safety (especially when they believe clearly dangerous things, which I will demonstrate in a later post), they want facts. Midwives OWE the public evidence based practices because they have the potential to be a public health menace.

Suzanne smith says- what im sensing, from the way the conversation has gone, is that everyone is very concerned about how the Valerie situation, and possibly to some extent, the Vickie Sorensen situation, may affect us all legally. So it seems to me like the big motivating factor for everyone to suddenly be interested now, is the possibility of incoming legislation. I think that’s very reasonable (chuckles), I think that’s a very real possibility, that we will face hostile legislation as a result of this, and I just want to give a little reality check to the meeting.

She notes that they may have as little as 90 days to formulate a response because of legislative session deadlines.

Again, absolutely no concern about what to do to prevent the next death, just information on how to tell politicians that the legal situation of midwives is totally acceptable even though it quite literally cost a child their life.

Political strategy is discussed. 

Suzanne Smith- “there are a lot of people in government who do not understand why our licensure is voluntary. They just think that’s the weirdest thing ever, and don’t think its right. “

That’s because it isn’t right. The proof is in the tiny grave that none of these women bothered to think about when they realized they might make less money if the public got wise to what midwifery is really about.

Tara Tulley interjects to discuss how Oregon is currently fighting against legislation to make licensing voluntary, and that at the time of the recording Oregon and Utah were the only two voluntary licensing states. She notes that if midwives there lose voluntary licensure (which they ultimately did) then it puts Utah midwives in a position that is difficult to defend.

Of course Tara doesn’t mention WHY Oregon was changing its laws- it is because of a string of deaths caused by negligence, just like the one in Utah (and the future deaths that will no doubt occur if nothing changes). The bottom line is that this type of legislation has been tested in Oregon. It was tried, and it failed spectacularly. Do Utahans want to wait for more deaths before taking action? What possible reason is there that things would turn out differently here?

Tara tulley- “I don’t know if Holly Richardson can join the committee, but I know that she will be involved and will help us.

Tara notes that Holly has been consulting with her about this issue already.

Republican Holly Richardson, who was instrumental in getting the original direct entry midwifery act passed in Utah, is consulting with the midwives about what to do about their bad PR, now that the logical conclusion of the state’s policy has become apparent. She unfortunately couldn’t attend the meeting, so she was unable to demonstrate her cold indifference to the grieving family along with the other Utah midwives in attendance.

Around 1:30 into the meeting Tara Tulley says “… And Jennee Allan- and you’ve been working with Valerie, right? As well. Oh, I’m sorry, if you didn’t want that stated. *laughs*”

That is the opposite of funny. That is the opposite of acceptable response to a tragedy. It shows that these midwives either worked to help El Halta or they found it acceptable that someone in their ranks would help. Here is a brief reminder of what a monster El Halta is:

“Valerie … wasted, like, a whole hour,” Malloy said.”She played god. She had this ego: She was the guru of birth. Valerie knew there was a problem, and she withheld the information from us.” – A mother whose child died under the ‘care’ of el halta

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.” -the mother of the child who died under valerie el haltas care

El Halta arrived at the mother’s home Aug. 17 and inserted a vaginal pill that she said she received from her son, a pharmacist. El Halta had “boasted … that she used real ‘medicine,’ not herbal medicine.” Investigators later concluded the pill was Cytotec, a drug used to induce labor despite warnings that it can cause uterine rupture and other complications. The mother received three more doses.

The next evening, El Halta “seemed to have become anxious that the mother’s labor was not progressing.” She allegedly performed a painful vaginal exam on the mother, saying, “Let’s get this show on the road.” El Halta explained she was “breaking scar tissue” and “just moving things along.”

A few hours later, El Halta checked the baby’s heartbeat, which slowed and sped up again. As the mother began to vomit and have diarrhea, El Halta became “agitated and snapped at the mother and her husband.” The mother pushed for about an hour, but the baby slipped back into the birth canal. No heartbeat could be heard.”- the case report for the recent Utah death

THIS is the woman that these midwives are defending. All the talk about patient autonomy, about low risk women, about safe practices, it all disappears when they get in a room together and decide that their sisterhood is more important than…anything else really. Its even more important than other people’s lives and safety.

Tara  Tulley remarked “This feels good to me. I feel like we’ve accomplished a lot today. I’d like to thank Angie Blackett, Cathy O’Bryant, Erin Elberdean (sp?),  for all the work she has done. I think sometimes it takes a bit of a scare to get people motivated *chuckles*” 

A baby dying isn’t “a bit of a scare” to the parents, or anyone who isn’t a total sociopath.

Around 1:53 someone asked “What should we call this meeting?”  Tara replied “Call it the “oh crap” meeting!” 

You can there hear many midwives laughing. 

Laughing. About this. The death happened on August 17th. This meeting took place a little more than 4 weeks later.

Its worth noting that another prominent member of the community, Kristi Ridd Young, was also in attendance, but felt the need to say nothing. I find it deplorable that no one mentioned the baby or the family at ALL during the meeting. No one discussed what they could do to help that family or help prevent the next tragedy. The entire meeting was about protecting their own cause instead of what their cause had cost a family.

Kristi Ridd-Young spins a tale about a homebirth death

I took a doula training course from Kristi Ridd-Young, the president of the Midwives College of Utah. Part of the course was about bereavement and unexpected perinatal death. She told a story that I assumed was totally true at the time, but since reading this piece about electronic fetal monitoring  I am starting to think it wasn’t as she said it was. The story went something like this (I am paraphrasing, though I should note I have an impeccable memory when it comes to remembering what people said, and I do have notes from the class to jog my memory):

I was with a mother when she lost her baby at a home birth. I was acting as a doula, not a midwife. I might stop being a midwife someday, but I will never stop being a doula. It is too important to mothers.

The mother was a nurse at a labor and delivery floor at a hospital. Her husband was a big, stoic, navajo man. I was helping her through contractions and she decided to get into the tub. Everything was fine, until the next time the midwife checked the baby’s heart rate. She couldn’t find a heart beat. We all, very calmly, drove to the hospital to confirm what had happened. The doctors gave her the bad news that there was no chance of a live birth at this point. I remember her husband standing in the corner, expressionless, but tears were coming from his eyes. I hugged him, and then held the mother while she cried, too. There was nothing to say. It is important not to try to fix what happened. I remember us all admiring the baby after the birth and the way the nurses dressed her. Just because the baby died didn’t mean it wasn’t still their baby, it is important to always treat them with the care you would give a live infant.

They never tried to have another baby.  But the mother losing her baby at home made problems for her at work. The other nurses blamed her for the death because she tried to birth naturally at home. They went as far as having a meeting with a pathologist to tell the other nurses that these kinds of deaths can’t be prevented, they can’t even pin down the cause a lot of the time, and that it most likely would have happened if she birthed in the hospital.

I remember a red-headed woman leaving because she was way too upset to hear the entire story. I remember everyone buying this story, and I did too. It was my worst fear about natural birth- a sudden loss of heart beat. My heart ached for women who went through this, and I read more than one story about it. Every midwife made it seem like a sudden, unforeseen tragedy.  Now I know that there is ample warning for fetal heart problems during labor, and that it probably could have been spotted if midwives were actually trained in recognizing trouble. If there really was an abnormal sudden drop, the baby could have been born quickly, via c-section (and possibly revived)  in a hospital setting. I am doubtful that the meeting with a pathologist took place at all in light of this fact- how could L&D nurses be unaware of these facts?

Midwives only seem to be able to spot trouble if the heart rate has dipped lower than is normal, but cannot discern other information that could save lives via electronic fetal monitoring. They can never know how many minutes it has been since the drop unless they just happen to be listening when the problem starts. If the president of the midwives college, a midwife who has decades of experience, does not know this, how can patients be expected to see through the lies? How many women have gone through losing their baby only to believe their midwife, support her, thank her for doing a good job? We can never really know. The ‘it was an unavoidable tragedy’ line is very important for midwives to learn, so that when babies die they can avoid being accountable to the mother or the community (and keep her fee of course).

The fact that a woman who is the most powerful person in Utah midwifery believes this nonsense should be cause for grave concern for citizens and legislators- what other harmful myths does she teach midwives? How many lives will be lost as a result? I should have seen the red flags in my doula training- like when I noticed that Kristi Ridd-Young being more concerned about pimping her supplements and essential oils than reviewing HIV transmission prevention for doulas. There were a few pages on it in our binders, but it was never brought up during class.