Utah health department: Home birth kills babies that would otherwise have lived

The Utah Health Department released a study on home birth, and it mirrors the findings of the data released in Oregon several years ago by Judith Rooks (CNM).

According to page 10 of the document, neonatal deaths in home birth happened at a rate 2.3 x the rate of hospital births. The statistics go on to note that the home birth deaths were reviewed by a committee which states that at least half of the home birth deaths were “strongly” considered to be preventable (meaning those babies would have survived had they been born in hospital). The remainder still had evidence of being preventable, just not as strong of evidence as the other half. None of the cases were considered to be completely unpreventable. The home birth fatalities were attended by midwives, midwives who likely told their clients that home birth is as safe as hospital birth.

What is shocking is that these findings actually skew the data in favor of home birth midwives- the real numbers are likely much worse. For instance, women that transfer to the hospital too late will have their babies death counted as a hospital death instead of a home birth death. You can read more in the “limitations” section of the document.

Here is all the proof anyone should ever need, in black and white- home birth in Utah kills infants that would otherwise have lived. Please refer to my Action Guide at the top of the page if you want to change things for the better.

UPDATE: this large peer reviewed study found nearly the same results. The authors have admitted to soft balling the risk in order to spare themselves the ire of the home birth community.

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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.

freedom of choice for birthing mothers

I support the choice of mothers to give birth where and how ever they want.

However, that doesn’t mean I think every birth choice should be endorsed by the state, either. There is a victim in poorly made birth choices, and that victim is almost always a baby. Babies deserve legislative protection to make the birth providers that facilitate dangerous practices accountable for their actions. Reckless home birth midwives are the ones who profit from spreading the fiction that home birth, water birth, etc is as safe (or safer) than hospital birth. They are the ones with everything to gain and nothing to lose, and that is why legislation should be aimed at controlling their actions rather than the parents who were duped into hiring an incompetent provider. Indeed parents should be able to choose what happens to their bodies and when, but that does not mean it is moral to legally allow a profession to flourish to facilitate poorly made decisions.

Right now any charlatan can call themselves a midwife and boast any safety record they want- there is no way for you to know if they are lying. Even if your midwife is licensed, you would have to trust that any negligence on their part was actually reported to DOPL. There are protocols in place that demand reporting adverse events in hospital births, and there are no such safeguards in home birth or out of hospital births. Home birth midwives who lose babies that could have otherwise been saved are very good at convincing clients (and seemingly, themselves) that the death was not preventable. They don’t have the clinical training to actually know if that is true or not most of the time. It is worth noting that I have never, not once, seen a home birth midwife admit that a baby that died in their care could have lived had they been born in a hospital. This is true even when the baby dies because the time between home and hospital was too long for the baby to endure. They won’t admit wrong and I’ve certainly never seen a home birth midwife that stopped practicing after a preventable death, unless the court ordered them to stop (like with Valerie El Halta and Gloria LeMay).

If your midwife loses her license because she hurt people through negligence, guess what? She can just keep on practicing as an unlicensed midwife. She can change her name if needed, and keep doing what she wants to, with full support from the midwifery community. You would never know.

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.

Link

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. 

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?

Vickie Sorensen and Camille Wilcox learned nothing from the death they presided over

The title of this post is a bold statement to make,  I know. How could someone preside over a preventable death and not change their practices? I can’t pretend to know the mental gymnastics needed to justify the practices at Pathway to Wellness birth suites. I have very good evidence that Vickie Sorensen and Camille Wilcox learned nothing from taking on a twin birth with additional risk factors, because they took on another twin birth with additional risk factors after that poor baby lost its life at the path to wellness birth suite (its called a birth suite because legally its not a birth center).

This birth story is told enthusiastically by the mother as a ‘success’, when to just about anyone else its clear that the midwives agreeing to take this case on nearly cost a baby their life. Its pretty horrifying. Here is the way the mom found Pathway To Wellness:

 I contact the midwives at the Pathway to Wellness Center. I sent them an email and asked if they would be willing to deliver twins. I also asked them if I could be supported with gestational diabetes and at the age of 41. I was so happy the day that I heard back from Camille, one of the midwives at the center, when she said “YES”- they could deliver twins, and that they don’t consider my age or the diabetes a risk because older women usually take better care of their health and I didn’t need medication to regulate the diabetes.

Wrong, wrong wrong.

Risks of pre-existing diabetes in pregnancy are numerous and requires a lot of monitoring– monitoring direct entry midwives are not able to provide.

Risks of advanced maternal age (meaning over 35) are quite similar to the risks for pre-existing diabetes, so it would not be unreasonable to think that each risk factors could exasperate the other.

If a mother is actually informed of the risks of such a pregnancy and decides to do it out of hospital anyway, then I support her right to choose out of hospital birth. But this case illustrates the problem with home birth and informed consent quite vividly- the midwives don’t believe that there is any significant risk, so they by definition cannot inform the patient of the risk. The only condition I have seen midwives reject uniformly is complete placenta previa, where the placenta grows over the cervix. Literally everything else has been fair game for them.

I don’t mean to imply the view that this was a good idea for an out of hospital birth is rare among Utah midwives, its actually quite common for direct entry midwives nationally. Trade magazines such as Midwifery Today declare that twins are just a variation of normal, along with a lot of stories of midwives delivering twins at home intended to support the view that this is entirely safe.

Anyway, one of the twins in the may 2014 delivery was very close to dying:

Mr. Alexander took us all by surprise by being born first. No wonder the midwives had had a hard time finding his heart beat during labor. He was moving down, down, down to be the first born! He was so sweet and innocent that I just laugh every time I think about holding him that first time, thinking it was Megan- but so obvious that he was not Megan.

Losing heart tones on a twin is an emergency, not a funny story. They did not know which twin was coming out first either, another total failure on their part when it comes to monitoring. Things get even worse when:

Again, another surprise! Giselle said, “I have a foot!” Megan’s feet were down and coming through the birth canal. The little girl must have turned around right after Alex was born! Giselle continued to help Megan with a now breech delivery… one foot, two feet…I reached behind me and felt little baby feet kicking in the water… legs, chest, one arm, then two arms were out. John could see that Megan stopped kicking and that her body was floating in the water with no movement.

There are a few breech presentations, feet first  is called a footling breech. It is the most dangerous breech presentation. I have an emergency childbirth guide for military OBGYNs that explains how and why footling breech births are the absolute worst presentation with a ‘significant’ increase in risk for complications and death.

Unbelievably, it gets even worse:

 When Megan was completely out of the water, she wasn’t able to breathe. The midwives held her white, limp body and started calling her name. She was given a breath through mouth-to-mouth resuscitation and they tried to stimulate her with pats and calling her name. Megan took one gasp and then stopped breathing again. They checked her heart and it was still beating. The cord was cut and the team rushed Megan into the other room and onto the crib so they could continue the resuscitation work.

John and the midwives continued to stimulate her, give her mouth-to-mouth breaths and also used some cayenne solution on her chest to get her respiratory system jump started. After about 4 minutes, Megan was breathing successfully on her own.

We found out later that the two placentas were fused together. When Alex was born, the placentas detached. By the time Megan was born, just 14 minutes after Alex, Megan’s placenta had completely shut down.

No one called 911 at any point during this, but they did pour pepper on a baby to try and get it to breathe. They are lucky that their child did not die, but there may have been some damage done by the lack of oxygen. The mother continues:

 We think Megan missed out on about a minute of oxygen from being delivered to her via the placenta. (fyi- newborns that miss around 20 minutes of oxygen may start to experience brain damage.)

Not sure why they think she only missed one minute of oxygen. They do not use electronic fetal monitoring so everyone has to guess about how long the baby went without oxygen.I don’t know who told her a baby can hold its breath for 20 minutes without brain damage (probably her clueless midwives), but they were lying to her. Every source I could find said 5 minutes before hypoxia sets in, even Ina May Gaskin  says so and she is the big name in home birth midwives. All the other indicators of hypoxic brain injury require hospital equipment to detect, and a lot of the time these brain injuries do not become apparent until years after the birth. There is no way of knowing if that tiny baby came out of this unscathed without following up in several years.

The mom is happy because she thinks she received great care. Her babies weren’t dead, although they came much closer to death than they ever needed to, and were attended by incompetent practitioners who think that sprinkling pepper on a baby is a better idea than calling 911 when they aren’t breathing.

I realize the birth story I linked to may soon disappear once it reflects poorly on the midwifery community (a story about a near dead breech birth was removed after I reported on it before), so I have saved this one in its entirety on my computer just in case. I hope the prosecution for the VIckie Sorensen case is paying attention- this additional birth shows a craven disregard for the life of newborns and mothers on Vickie Sorensen’s part. Delivering one dead twin wasn’t enough to discourage her from taking on twins again. Most people try to learn from their mistakes, especially when they are costly to others, but this mother-daughter midwife team seems to think that its normal or acceptable to ignore what they have been responsible for (when the outcome is bad, anyway). Regular people would be tormented by even possibly having played a role in a newborn death, these midwives are so unconcerned about it that they decided to risk it again.