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.

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.

The sorry state of midwifery in utah

Midwives in Utah are  unaccountable for their actions. There is a deceptively long list of requirements for licensed direct entry midwives in the state of utah, but the law has no real teeth in it. Midwives who choose not to be licensed are not subject to any of the requirements. You can just declare yourself to be a midwife and practice, if you so please. You can declare yourself a licensed midwife in utah and face no consequences for misrepresenting your credentials (I know because this happened to me, I went to a midwife who claimed to be licensed and was not, and every avenue I tried to address the problem with told me they could not reprimand her).

Is it any wonder that women like Valerie El Halta come to utah to practice after being banned from several other states? . When Valerie ran into legal trouble in multiple states, she finally landed in Utah. She abused a woman and negligently caused the death of a baby by using drugs and a vacuum extractor. She was not qualified to use the drugs or the vacuum extractor. Here is a horrifying quote from the mother about valeries conduct:

“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.”

This is a disgusting way to treat people. What is worse is how the midwifery community in utah decided that it was persecution for an investigation to occur. Simply investigating after a perinatal death is considered inappropriate, according to utah midwives. They seem to believe that any level of accountability for patient outcomes is too much. Utah midwives formed a watchdog committee in response to the investigations. There is no sympathy on the part of midwives for the parents of the child who died needlessly. The people hurt by the midwife are a non-issue in the minds of most Utah midwives, apparently.

You would think that a charge of negligent homicide would result in some real penalties for El Halta, who had caused other deaths by negligence in the past, but she was not sentenced to any prison time. Her sentence was probation and a court order to not attend any births. People who carefully read the salt lake tribune article about El Halta’s history will note that being charged with crimes in the past has never deterred valerie from attending risky homebirths, and it is unlikely that she will stop in the future.

Valerie El Halta has also been sued for a previous infant death in a different state, but the fact that she did not carry malpractice insurance means the debt is basically un-collectable. Utah midwives are not required to carry malpractice insurance, so it is hard to get an attorney to assist when utah midwives hurt a pregnant mother or their baby. There is no safe guard in place to prevent a tragedy of this sort from happening again. I find this totally unacceptable. Birth attendants (of any type) are bound to make mistakes a certain percentage of the time, and should be accountable for the outcome. They should pay for any damage caused by their mistakes.

Midwives in utah are also not bound by HIPAA. They have no legal obligation to keep your private health information confidential. Better Birth of Utah has resorted to talking about the (alleged) mental health status of past patients when negative reviews  were posted to the internet, breaking the contract that states they will not discuss health information with anyone not involved with patient care  (unless legally obligated to do so).

There are midwife-run review boards like utah midwives organization or NARM, but they also do not have any real power to punish midwives. Valerie El Halta had her credentials revoked by NARM several years before the negligence in Utah, it did not prevent her from legally practicing in Utah.

The other thing I found out too late was that the health department does not regulate one room birthing centers. You can run a birthing center however you want to as long as you restrict it to one room. This is a major loophole in the law that could cause many problems for utahans who assume that their birth center is up to code- when there isn’t one. I know that when I used Better Birth LLC as my birthing center I was perplexed at the fact that they had a washer/dryer combination in the SLC birth suites (“bellanatal birth suites). I knew from my time working in hospitals that medical linens usually have to cook at a high temperature in industrial laundry services in order to kill transferable diseases. Better Birth was under no such obligations to sanitize the sheets, blankets, towels, etc used at the birthing center. I am sure there are other examples of why it is a bad idea to let lay midwives self-regulate their birth centers.

If a midwife harms you or your baby your only real recourse is court, and if you can’t find an attorney willing to represent you then you have to try your luck at small claims. There is a maximum of 10,000$ that can be rewarded in small claims (about double what most states offer), but it doesn’t even begin to compensate someone who lost their life, child, or functioning at the hands of a midwife.

I doubt that most Utahans find this state of affairs acceptable. Utahans generally place a high value on children and family, and these regulations undermine the safety of infants and pregnant mothers. Mistakes in the world of prenatal care and childbirth carry a high price for the parents and children affected. I believe that people who manage labor and prenatal care should be held accountable for their actions.