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this is the future, if we choose not to learn from the past

Safer Midwifery for Michigan is the group that inspired me to start Safer Midwifery Utah. The founder of SMM lost their child during a breech birth by a home birth midwife. They won a settlement but the midwife filed for bankruptcy so she would not have to pay. The same midwife is still practicing (Audra Post), and she is still willing to attend a breech birth. Safer Midwifery for Michigan says that she has attended at least 2 deaths, and on Audra’s web page she claims to have attended “over 300” births. Lets round it up to 400, to be charitable, and then she has a notably high death rate of 1 per 200 births. That is shameful, absolutely shameful. Direct entry midwives are like walking cases of dunning-krueger effect, their incompetence is what feeds their sense of confidence in their practices. 

This is the future for our state if something is not done soon. I have no doubt that our state has one or several Audra Posts in our midst, but its impossible to hold anyone accountable in a system like ours or find out who they are until its too late. The victims of home birth midwives can be made silent in many ways. It takes remarkable strength and dedication to go through a lawsuit when the plantiff knows the judgment will likely go unpaid, and their child will never be brought back by a judgment. To rehash every detail in front of a judge, to your lawyer… the pain of it makes many loss parents turn away from fighting. It is completely understandable. Some might believe the convenient lies that their midwives cook up to cover up what happened. Without very strict record keeping requirements there is no way to determine exactly how many babies died preventable home birth deaths in Utah, though if Oregon’s numbers are any indication its far too many (these numbers were collected when Oregon had the same legal requirements for midwives that Utah currently does). 

Please click on the action guide on the left side of the page to contact your legislators about preventing the next home birth tragedy. 

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Reasons I believe the Vickie Sorensen Allegations

I’ve seen a lot of attempts to whitewash the tragic death of a newborn during a birth that Vickie Sorensen attended at her free-standing birth center in Utah. The child was a twin that was born premature, two risk factors that should have excluded the patient from an out of hospital birth. The arguments the pro-vickie, pro-home birth camp put forward are pretty pathetic. It is the same garbage I hear every time a midwife is arrested. The first response is that no one is allowed to have an opinion on the validity of the charges until the verdict comes through (interestingly enough, every single case I’ve followed ended in a conviction).

Courts rightly presume innocence until guilt is proven, but regular people are under no such obligation when forming their opinions.

The first argument is “we don’t have all the facts yet”! But we do have the fact that the attorney general felt that there was enough evidence to base a manslaughter charge on. We have the fact that the Salt Lake Tribune felt comfortable enough with the findings of police and interviewing witnesses to run the story.

Another important thing to remember is that if ANY of these allegations are true then it was an appalling way to behave. I have a hard time believing that *none* of the allegations are true, and they do not all need to be true for this incident to serve as a wake up call to Utahans and our legislators.

There are other factors that lead me to believe that these charges are based on fact.

The sheer number of witnesses which would have to conspire against Vickie Sorensen (for no known reason) is pretty astronomical. I could accept one or perhaps maybe two witnesses testifying for some known reason against Vickie, but if you read the allegations it becomes clear that the minimum number of witnesses far exceeds reasonable doubt:

baby’s mother

baby’s father

baby’s grandmother

first EMT

second EMT

at least one doctor

at least one nurse

 

That is, at a minimum, seven people who witnessed the case at hand. I would imagine that if the testimonies were mixed there would be no case- the district attorney generally tries to avoid wasting time on cases that are not able to be prosecuted successfully. I find it much more likely that the accounts of 7 (or more) people corroborate the manslaughter charges.

Even if there was some attempt to persecute Vickie Sorensen for a reason not apparent at this time, there is the problem of the medical records. All the workers involved would have to falsify their records while the events were taking place or shortly after. I find this highly unlikely.

The other possibility I have been able to come up with is that police officers would have to tamper with the evidence, risking their career (again for no known reason). Since most of the evidence would probably be witness accounts and medical records it would be pretty difficult to fake, and would be found out rather quickly at trial. I find it unlikely.

The other major reason I find the allegations plausible is that this is exactly the same as every other home birth disaster. Anyone who follows them knows there is a theme. There are three phases to many home birth disasters:

First, the midwife makes a mistake.

Second, it becomes apparent that she doesn’t know what she is doing and real medical professionals are called.

Third, the midwife lies about her involvement in the delivery, or opts to lie to the hospital about her mistake.

Here is a collection of stories that fit the pattern:

Magnuss’s death (midwives told the mother breech birth was safe, the baby got stuck and brain damaged from oxygen deprivation, the midwife told EMTs they weren’t aware it was a breech birth until the delivery)

Shepphard’s injury (midwives told mother it was normal to labor for days, kept finding reasons not to show up to help the mother, baby was injured by days and days of labor and had to have extensive hospital stay to recover, midwives denied that any of this happened and threatened a lawsuit if the mother told anyone what happened)

A mother’s injuries (midwives told her to push and that she was crowning, when she was not fully dialated and had a blood clot coming out due to pelvic organ prolapse, midwife refused to give hospital any information about the birth, mother has injuries to her pelvic organs that are only fixable by surgery, baby was in distress but saved by c-section)

Sam’s death and mothers near death (midwife ignored signs of placental abruption, transported too late, baby had severe oxygen deprivation injuries and mother almost died from post partum bleeding. Midwife lied about her involvement to the board and blamed the physicians for her mistake. Sam died at 3 years old due to his brain injury.)

Mary Beth’s death (midwife didn’t show up for the birth on time, so EMTs were called. the midwife said everything was fine even though there were signs of respiratory distress. The baby died later that day, and the midwife falsified medical records to avoid arrest, as well as trying to convince Mary Beth’s mother that the death was not preventable)

Newborn baby birth injured, mother gets sepsis (breech baby had a brain bleed, mother had a fever after home birth delivery. Midwife told her not to go to the hospital, but things kept getting worse. The midwife asked the mother to sign a form that said the midwife did not attend the birth and begged her not to tell because she was concerned about her own license)

Aquila’s death (another placental abruption, mother begging for transfer that was denied, midwife put that patient refused transport on medical documents to try and avoid consequences, baby dies)

Lia’s death (midwife said twin birth after cesarean is safe, one twin is born not breathing and isn’t resuscitated, midwife denies that the baby could have been saved in hospital)

Gavin Michael’s death (a midwife lied to their patient about the safety of going past 43 weeks or pregnancy with a measurement of zero amniotic fluid, the baby died in utero from slow suffocation, the midwife lied about attending the birth in public and then in private blames the mother because they would have “hated” her if she had decided to be harsh about the emergency)

It is worth noting that in the last story, the midwife decided to ask other midwives what to do publicly on facebook instead of admitting that she really had no clue what she was doing. A parade of other clueless midwives, including Jan Tritten (editor of Midwifery Today, the trade magazine for direct entry midwives) all suggested that they either wait longer or take worthless remedies like stevia. None of them have taken any responsibility in the death despite being questioned about it relentlessly via facebook and email.

I decided to take 10 minutes to find these stories, there are many more out there. There are unknown stories, where the patient believed the midwive’s lies and decided not to seek disciplinary action as a result. This is normal for midwives.

As I have pointed out before, midwives have a handy guide to avoiding responsibility for deaths (called From Calling to Courtroom) which advocates Lying to hospitals, to patients, to police. I have also pointed out that the Utah Midwive’s Associations peer review guidelines encourage lying to conceal illegal behavior.

It is so predictable, it would be boring if it weren’t so tragic. The point of this is not to say that you can always believe a midwife is guitly, it is to demonstrate that this is by any standard a completely ordinary event. Ordinary events do not require extraordinary evidence in order to be believed by regular people. If I am wrong I will make as many retractions as needed, but I’m not holding my breath.

 

 

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. 

It was just a matter of time

Previously on this blog, I’ve made a point of warning Utah’s midwifery community that another preventable home birth death was inevitable, and that we should push for legislation to protect moms and babies before its too late.

I’ve been proven correct, unfortunately. Vicki Sorensen has been charged in relation to a death caused by negligence in a home birth, and like other midwives before her she falsified records and refused to transport a mother (according to police documents, anyway). This practice is so common in home birth deaths that I find it very plausible, though to people who do not follow home birth deaths or issues it may seem outlandish.

The salt lake tribune reports that there have been more deaths under Sorensen’s care.

Midwives in the state are likely to claim that this is just a ‘rogue’ midwife, like they did when Valerie El Halta killed a baby in a home birth in our state, but make no mistake; Vicki Sorensen is a pillar of the Utah Midwifery community, and the right of people like her to practice midwifery any way they choose to is exactly what the Utah Midwive’s Organization wants. If midwives did not support this kind of behavior they would not be throwing a fundraiser for her, now would they?

I will be continuing my coverage of this death tomorrow. I send my condolences to the family that lost their children and hope that something positive can come from this death. Click the ‘action guide’ sidebar if you want to help to pass laws to prevent another tragedy in the future.

Seriously? Part 2

practicing medicine 2“A client has a pretty sever prolapsed cervix. Any advice?” (this is during a pregnancy, in the 2nd trimester)

Other midwives recommend kegels in a certain position or useless homeopathic remedies. Neither of these things have any evidence backing them as a treatment for a prolapsed cervix.

If I had access to the midwife I would say “Yeah, how about you google “cervical prolapse pregnancy” and look at the first result?”

Uterine cervical prolapse concurrent with pregnancy is rare. This article reports three cases of second-degree cervical prolapse during pregnancy. Two women developed prolapse in the late second trimester while one women had preexisting prolapse. Both women with prolapse developing during mid-pregnancy were treated unsuccessfully with a vaginal pessary to maintain cervical placement. Premature labor occurred in both of these women, resulting in one preterm birth. Although cervical prolapse is rarely encountered in pregnancy, the threat of preterm labor and delivery warrants close observation.

Oh wow, sounds like something a lay midwife should never, ever try to manage on her own. Too bad none of the other clueless lay midwives recommended a consultation with a physician as a result. I’m sure they just say its a ‘variation of normal’. When I read this post I immediately thought of ‘incompetent cervix’, a problem where the cervix is unable to hold the weight of a baby and generally ends in either suturing the cervix to retain the pregnancy or a miscarriage or premature birth. The direct entry midwifery law in Utah spells out certain conditions that licensed midwives should never manage, but it is not a complete list. Unlicensed midwives are free to try to manage any condition if they feel up to it. The gap in legislation is evidenced well by these screenshots.

Next up is Utah midwives organization trying to manage a liver problem in a mom:

practicing medicine“Any ideas or experience with preventing the recurrence of cholestasis in a mom”

Cholestasis is a condition where flow of bile from the gallbladder to the liver is restricted. It causes symptoms similar to liver failure or cirrhosis(jaundice, fatigue, loss of appetite, dark urine, light stools, etc). A midwife cannot differentiate between cholestasis and other types of liver disease. They can’t even order the correct lab tests to tell the difference, much less interpret them.

One midwife suggests an essential oil blend called zendocrine. One says “exercize (sic) and a veggie diet”. The rest recommend a ‘liver cleanse’, which generally means a fast with specific allowed beverages or foods.

There is absolutely no scientific evidence that ‘cleanse’ diets do anything beneficial to non-pregnant men and women, much less women who are pregnant and have a history of a liver problem during pregnancy. These midwives don’t know what they are talking about. They spread around rumors and alt-med nonsense as genuine advice for managing conditions that midwives should never try to take on.  Here is what the american pregnancy association says about cholestasis:

How will the baby be affected if the mother is diagnosed with Cholestasis?

Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity.

When lay midwives were discussing their profession with Utah legislators they claimed that it was not the practice of medicine, but from what I can tell they absolutely intend to practice medicine. What is there to know about medicine that other midwives can’t fill you in on via facebook? Nothing, except for the 4 years of intensive study and practical experience that physicians go through before becoming physicians, of course! They have “other ways of knowing“, which basically means ‘trust your gut’ instead of established research. These women like to play doctor, but they are far from qualified. It was only in 2012 that they were burdened with having to obtain a high school diploma before attaining the title ‘midwife’.  Even the midwives college of utah was unable to tell that the (long awaited) release of MANA death statistics actually revealed a 5.5X increased rate of death instead of “evidence that home birth is safe”. How could they make such a massive mistake? Its because they aren’t actually trained in interpreting medical studies, so they are happy to accept the conclusions presented by other midwives instead of understanding the numbers involved. This pathetic excuse for a study is the best case scenario in home birth, and despite the fact that it shows an unacceptably high level of perinatal mortality, it is still better than what the actual numbers are likely to demonstrate. The study has a 30% participation rate, with no explanation of the percentage of participants lost during the course of the study. Midwives with poor outcomes were likely to simply drop out, as to avoid tarnishing lay midwifery in general. The navelgazing midwife pointed out that the description of statistics in the study (that midwives and their patients were enrolled at the beginning of prenatal care) is completely false.

The bottom line is this- roughly 1% of births are purposely performed out of hospital, but these births represent 100% of the profit for home birth midwives (overwhelmingly lay midwives). Would you trust the tobacco industry to tell you the truth about smoking? If not, why would you expect the midwifery lobby to tell you the truth about the danger of out of hospital birth? When midwives in Utah get together to try to influence policy they have to rely on deception to get their way. If the legislature knew about the way that midwives conduct themselves, and had real data about the outcomes of out of hospital birth attended by a non-nurse midwife, I am sure they would want drastic changes in legislation.