utah midwives are doing external cephalic versions (ECV) at home

ECV is a procedure that is meant to flip a breech baby in utero so they can be born head first. Here is a run down of it by web md. I am going to note the bits that make it a very bad idea for home birth midwives to attempt an ECV:

Fetal monitoring
To avoid harm to the fetus, a version procedure is closely monitored.

Fetal ultrasound is first used to confirm the fetus’s position, where the placenta is, and the amount of amniotic fluid. Fetal ultrasound is often used to watch the fetal position during the version attempt.
Electronic fetal heart monitoring is used before, possibly during, and after a version attempt. An active fetus whose heart rate increases normally with movement is usually considered to be healthy. If the fetus’s heart rate becomes abnormal, the version procedure may be stopped. (…)

Version procedure

Before the version attempt, you may be given an injection of tocolytic medicine to relax the uterus and prevent uterine contractions. The most commonly used tocolytic medicine is terbutaline.

While the uterus is relaxed, your doctor will attempt to turn the fetus.

(…)

Potential risks of version, for which the fetus and mother are closely monitored, include:

  • Twisting or squeezing of the umbilical cord, reducing blood flow and oxygen to the fetus.

  • The beginning of labor, which can be caused by rupture of the amniotic sac around the fetus (premature rupture of the membranes, or PROM).

  • Placenta abruptio, rupture of the uterus, or damage to the umbilical cord. The potential exists for such complications, but they are very rare.

There is also an extensive list of reasons not to perform a version, and many of them are things home birth midwives cannot actually monitor or recognize.

Here is a screen shot of utah home birth midwife of 35 years Raeann Peck talking about how she performs ECV, as do her colleagues.

evc pic

This is dangerous and stupid. If someone wants an ECV they need to go to a doctor in a hospital.

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Not even sorry

I’ve covered the VIckie Sorensen manslaughter charges extensively before, but I thought readers might be interested in the absolute lack of remorse on vickie’s part for her role in the death of a newborn.

vickie sorensen cheers to my haters

vickie sorensen witch cartoon

 

vickie sorensen haters

vickie sorensen status stringing up midwives

She also made a point of accusing valley view medical center of having a conspiracy against home birth mothers.

valley view medical center accusations

 

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.

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.