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.

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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.

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.

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.

remember, this meeting IS being recorded (part one…)

I found the recording of a meeting of utah midwives after the preventable death of a baby at the hands of a serially negligent midwife (Valerie El Halta). This post aims to summarize the meeting (click this link to listen). I have it saved on my computer if they decide to delete it. Descriptions of the meeting are in bold, my commentary is in normal text.

The first 6 minutes is murmuring and obviously not the meeting itself. You can skip it.

Tara Tulley leads the meeting with a statement, and stresses repeatedly that the meeting is being recorded and the media might get their hands on the tape because it will be posted online later. She starts the meeting by talking about how she doesn’t want to discuss the charges against the midwife, just how she wants to gear up the community to prevent any legislation from restricting a midwifes ‘freedom’ to practice without any licensing.

When a preventable death occurs in a hospital, there is usually a case review where people get together to try and figure out what they can do to prevent it next time. Here we see midwives behaving as the opposite of medical professionals, as these midwives are only seeking to defend their income source. This has nothing to do with the freedom to birth at home, because women are free to do that in many other states that require licenses for midwives (meaning every state except for Utah). It is about the freedom of midwives (sometimes self proclaimed, under qualified midwives) to conduct births however they please without having to face any consequences for the outcomes.

Around 13 minutes Tara says she wants a midwives organization to exist so that they can ‘develop standards of practice’. She wants to be able to say “look we are organized and have a standard of practice” when legislators come after midwives the next time a baby dies or is permanently injured.

The unstated assumption is that all these midwives know that another midwife is going to kill someone negligently, so they need to be prepared when it happens again. Tara stresses how important this is to unlicensed midwives, how important it is to ‘keep that option open’. I’m sure reckless people would very much enjoy keeping an option open that would let them do whatever they want to.

Around 17 minutes in she discusses ‘relative conformity’, meaning that they need a standard that most people can agree on but that midwives don’t actually have to adhere to 100%.

This is the opposite of an effective standard of practice.

An un-named midwife comes up and says “the frustration is that when one midwife chooses to do something, we all pay for it.” She discusses being upset at midwives who have bad outcomes. “How do we open our hearts and say: I do love you, even though you are hurting us.”

I cannot understand why anyone would need to profess their love for Teresa El Halta just because they work in the same profession. The woman is a reckless killer who has wronged countless people over the years. She has a pattern of using interventions that she is completely unqualified and untrained in, as well as doing forced vaginal exams and procedures all while taking on extremely high risk cases. Then she moves to a new state when she gets in trouble.

Tara agrees and  with the “open our hearts” comment, then talks about how important it is to manage public perspective on “events like these” (meaning the needless death of an innocent baby).

They are clearly more worried about appearing a certain way that actually preventing future deaths. El Halta would not have been able to become a licensed midwive in Utah because she had her NARM certification revoked. That can only happen if two separate people manage to file complaints against a single midwife. NARM gives grieving mothers the run around, so it is really a testament to how terrible she was at her job that NARM formally revoked her midwifery certificate.

These midwives, who are supposed to uphold the well being of infants and pregnant women, don’t want anyone to hold them legally accountable for what they choose to do. They want the appearance of accountability by having their own group, but they are not capable of meaningful legal action. Don’t be fooled by any by laws or standards of practice that are demonstrated by UMO- they don’t mean anything when there isn’t a real consequence for violating the rules. Getting kicked out of UMO would not make someone unable to practice in the state, so what good would it do for patients? None, really. It benefits midwives exclusively.

This entire meeting I just want to scream:

A BABY WAS KILLED.
A BABY WAS KILLED BY A MIDWIFE.
AND YOU ARE WORRIED ABOUT KEEPING THINGS THE SAME?

No normal person reacts to the death of a baby this way. I don’t know what is wrong with these women, but they should not be tasked with governing themselves. Stay tuned for part two later this week.

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.

 

Kristi Ridd-Young spins a tale about a homebirth death

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

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

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

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

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

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

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