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).

 

Advertisements

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.

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.

why are Utah midwives learning breech births?

found this photo awhile back, but didn’t have time to write about it until now.

breechesThis is from the community school of midwifery.

Here is utah state code regarding breeches:

(2) Mandatory Consultation:

(a) incomplete miscarriage after 14.0 weeks gestation;

(b) failure to deliver by 42.0 weeks gestation;

(c) a fetus in the breech position after 36.0 weeks gestation;

 

Direct entry midwives should not be attending these births, ever. Oregon learned the hard way that direct entry midwives aren’t equipped to deal with breeches. They have recently changed their legislation to reflect the problems caused by direct entry midwives in out of hospital birth.

The owner of the community school of midwifery (Tara Tulley) believes that the legislation against doing breeches at home is a problem:

The problems I see with having a state with two levels of direct-entry midwives are that midwives are less united. When there is a proposed change to the rules or statute both licensed and unlicensed midwives are more willing to compromise. There is an out. We saw this a few years ago when we compromised to not let licensed midwives to any twins, breeches, or deliveries before 36 weeks. The licensed midwives felt like they were safer to compromise, and then decided it was a mistake. The unlicensed midwives stayed unlicensed because they could maintain their rights in those situations. So now we have a larger problem. There are very qualified midwives to are licensed, who know by many years of experience and education how to appropriately screen when these women present, how to monitor, and when to transfer out of care who are not able to attend them.

According to her, the problem isn’t the danger inherent in taking on high risk cases, its that midwives are less united. The problem isn’t that patients are getting false information about the safety of out of hospital birth for breeches and twins, its that a dangerous midwife might not feel comfortable calling another midwife for help (instead of EMS).

One thing that I agree with Tara Tulley about is that unlicensed midwives cannot access the drugs that licensed midwives can, but they are the only ones who can take these high risk cases legally. This situation makes zero sense. Of course she believes the answer is probably less accountability, while I think licensing should be absolutely mandatory, with harsh consequences for people who break the law.

Its no wonder she feels comfortable teaching breeches at her school. After all, Tara Tulley started practicing when midwifery was illegal in Utah, so she has no problem circumventing the law to serve her natural child birth ideology.

The bottom line is that these practices are dangerous. Tara Tulley knows that, but thinks she has a better solution than legislation:

Yes, there are some scary ways of practicing. But I know if I have a relationship of trust with someone I am both more willing to go to them for help, and to also accept and consider feedback. I believe I am a good midwife, but my seasoning was not innate! I had to learn out to communicate. I had to learn that scaring my clients with the interventions of hospitals was not helpful when they became necessary.

She calls this solution “responsible inclusion”, as if there is anything responsible about accepting people who practice outside their actually competency as a midwife. Having another midwife to call isn’t worth anything in countless dangerous situations.

Tara Tulley isn’t an anomaly, she mirrors the position of MANA, the professional organization for midwives in north america. They have declined to define a ‘low risk’ birth as well, feeling more comfortable to leave it up to individual midwives to decide.

She talks like these choices have no real outcome, that no one will grieve a child or mother or their functionality when mistakes are made by midwives with “scary” practices. Making a choice because you feel it is safe, rather than having objective information to demonstrate its safety, is extremely negligent and should not be encouraged in any profession.  She talks so much about how its wrong to make fun of midwives who are young or stupid and have ridiculous ideas about birth, so you can imagine how she would feel about actually trying to stop women like that from practicing. Instead of deriding dangerous practices, Tara Tulley expresses that she thinks that serially negligent midwives should be wooed into safer practices by having trusting relationships with older midwives:

 

Regardless of how another midwife practices, or what her training is, if she is unlicensed then she does have the right to practice, and the parents have the right to choose her. If it is legal, then ostracising her will not make it illegal for her to practice, and she may decide that asking for help is too risky. She may be angry, and may not know how to forge relationships in hospitals. Perhaps, part of the reason the obstetrician was angry when you came in with your responsible well-charted transport. Perhaps he had just taken the client of a newer midwife, who transported, but did not know how to communicate in a way that was effective. Perhaps she offended him because she didn’t know how to see things objectively, not react to emotions, and validate and support him in order to foster a working relationship.

 

If a midwife decides that asking for help when a patient needs it is too risky for the midwife, and doesn’t call because of that, she has extremely poor judgment and should not be a midwife. Safety should overcome pride without any hesitation.

She lists several scenarios where midwives, who are tasked with delivering a baby and ensuring the safety and health of the child and mother, lack basic skills needed to perform their job adequately. The obvious answer to that problem is to change the law so that there are serious penalties for being a threat to public health and safety by endangering the lives of women and infants. Its deplorable. Midwives have always resisted common sense laws to protect consumers because they don’t want to be held accountable for their behavior.

The hardest lesson I had to learn about natural child birth is this: midwives don’t care about you. They don’t. They sell their services on acting as though they care, but when they are talking among themselves, or dealing with a death caused by someone in their community, their true colors come out. They couldn’t care less. Death is natural so its okay to them. That is the only way I can explain the blase and self-centered attitude of the midwifery community when it comes to safety of mothers and infants.