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.

No Remorse

Vickie Sorensen, a midwife charged with negligently killing a baby, is going to trial.

I have seen people die when I worked in health care. I saw the deep sadness that surrounded those cases, as well as the institutional review systems in place that were meant to analyze what could be done differently next time. Home birth midwifery seems to lack both of those things. Providers who are under review after a death rarely feel persecuted because they know the gravity of the situation and would rather be held responsible. This is what we see from midwives, time after time:

vickie sorensen is going to a jury trialPeople familiar with the reported facts of the case would find it to be totally preposterous to dismiss these charges. Vickie instead feels entitled to a dismissal on the grounds of “common sense”.

None of this has stopped Vickie from delivering babies, by the way. That is because there is nothing in place to stop anyone from delivering babies in the state, even the serially negligent or incompetent. All they have to do is brand themselves a midwife, and legally they are one. It seems like if a midwife is being charged with reckless endangerment and manslaughter in relation to her practice, she should be monitored or sanctioned somehow until the justice system has determined innocence or guilt. This reminds me very much of the Josh Powell case, there was nothing in place to prevent him from visiting his children despite being the prime suspect in the murder of their mother. That lack of legislation cost lives, just like the lack of legislation of midwives in Utah has cost lives. No one involved with the Direct Entry Midwifery Practice Act is willing to be accountable for the lives lost. Not only do they not feel responsible, they don’t even feel sorry.