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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Utah Midwive’s Association statement on the Vickie Sorensen trial

Here is the Utah Midwives Associations official statement:


We, the Utah Midwives Organization, are aware of the reported charges against Vickie Sorensen, a midwife in Cedar City, UT. The charges are very serious. We are always concerned when there has been loss of life or potential misconduct of a midwife. 

Midwifery care is meant for normal pregnancies proceeding in a normal manner, and there are definitely times when pregnancy is outside the scope of midwifery practice. We cannot comment on this case specifically as it must work its way through the legal process. 

We offer our condolences to the family who has suffered the loss of their child.

 
This statement reminds me a lot of when MANA’s death rate came out. They said that midwifery care is for low risk pregnancies (as to excuse the astronomical rates of death for twins, vbac, and breech births), but did not make any practice recommendations. The Utah Midwives Association has done the same thing- they have said midwifery care is only appropriate for certain pregnancies, but does not have plans to actually change anything legislatively to ensure that midwifery care is only dispensed to women with low risk pregnancies. 
 
It also reminds me of the Valerie El Halta fiasco. When that happened Utah midwives also acted as though this was some kind of isolated incident or a deviation from the normal, but I happen to know that two of the midwifery schools in Utah teach breech, vbac, and twin births to students. I know that the trade magazine for home birth midwifery calls all these conditions “a variation of normal”. I’ve read Ina May Gaskin books that say the exact same thing. 
 
The standard you walk past is the standard you accept, and unless UMA lobbies for common sense policies to ensure the safety of moms and babies I will be forced to assume that they find the legislative situation of utah midwives acceptable. 

The mention of the family is appreciated. I wonder if their condolences extend to plans to make sure no other family ever has to endure such a tragedy again?