A baby died.
Several of us watched it happen on Facebook. I came into the conversation right after the death of the baby. On Jan Tritten’s Facebook Page, a midwife “crowdsourced” (asked a question of the masses) the following scenario:
“What would you do? Primip with accurate dates to within a few days who has reassuring NST at 42.1 weeks, as well as reassuring placenta and baby on BPP, but absolutely zero fluid seen. 42.2 re-do of BPP and again, mom has hydrated well, but no fluid seen. Baby’s kidneys visualized and normal, and baby’s bladder contained a normal amount of urine. We’re in a state of full autonomy for midwives and no transfer of care regulations after 42 weeks. Absolutely no fluid seen…what do we truly feel are the risks compared to a woman whose water has been briken and so baby/cord has no cushion there either. Cord compression only? True possibility of placenta being done although it looks good? Can anyone share stories/opinions? Technology isn’t perfect and I like Gloria Lemay’s visualization of a glass tub above you…how much water will you actually see below someone in the bathtub? But, my hands feel nothing but baby (who again…is doing well and recovers well after spordic contractions). Mom feels everything is fine and wants to leave things alone.” (Quoted verbatim with spaces and misspelling intact.)
Some commenters (some of whom are midwives) were unbelievable with their recommendations that ran the gamut from homeopathy to Stevia to cell salts. It was a debacle that unfolded real time on Facebook and, sadly, it ended in the death of the baby.
“Very sad news on this baby: The baby didn’t make it. Had aspirated meconium a while back they believe. Even after another BPP that showed everything was fine today. I listened to the baby afterwards and heart rate was on the low side. We came in, chose a c-section, and they worked on the baby for 47 minutes.”
You can read the entire thread here.
Instead of expressing horror, several women wrote sympathy comments for the midwife and expressing that, sad as it is, some babies just die.
This baby did not have to die.
Questions that have arisen include: Who did the Biophysical Profile and said it was fine with no amniotic fluid? Was the mom on the fetal monitor for at least 30 minutes in order to get the BPP accurately? Who was the doctor and why did s/he say it was okay to keep going with the pregnancy when there was no fluid? Was there a doctor looking at the BPP?
In other places, it has been said this wasn’t the whole story. That the woman was being followed by a doctor as well as the midwife. That the midwife did an NST in the car after the BPP and that’s when she found the fetal heart tones going down. (An NST cannot be done with a doppler even though it is, in my experience, a standard of care for home birth midwives.) That the midwife tried and tried to get the client to the hospital for an induction. However, what sounds like a letter to the parents, the midwife says, among many things:
“Instead of … telling you to “be prepared that the perinatologist doing the NST is likely to tell you that your baby could die if he doesn’t come out;” those should have been MY words. You might have been really pissed at me for pushing you into a corner where you felt you didn’t have a choice, but … I wouldn’t care… I am angry at myself for being the midwife who tried to be as firm but gentle as possible when advising to go in when I could’ve waved the dead baby flag…”
There is a problem with midwives not wanting to be The Bad Guy with pushing women to go into the hospital. Doctors tell women bad news all the time and can’t take it personally. But, midwives take pride in becoming friends with their clients and don’t want to hurt anyone’s feelings. Look what that attitude did.
There was an assumption of who the midwife was, but I didn’t want to say until there was proof. Today, in Dr. Amy’s piece called “In Memory of Gavin Michael” the baby’s grandfather verified the midwife was Christy Collins in Las Vegas, Nevada. I have offered Christy a forum for sharing her side of the story, but have not heard back from her yet.
What more do I have to say about this that hasn’t already been said? I hope midwives around the country, specifically CPMs/LMs will take this lesson and learn from it.
First, don’t ask for advice on the Internet! If you feel you need to, then you are working outside your scope of practice – transfer care! Plus, there are HIPAA violations abounding.
Second, going post-dates has consequences. It isn’t as benign as you think it is. There’s a reason so many protocols force a referral for post-42-week pregnancies. All the anecdotes of babies over 42 weeks are terrifying. That one midwife let a woman go 19 days post-dates (and bragged about it!) is abhorrent.
Third, it’s important to start your NSTs at 41.3 weeks and then progress every two to three days after that. Starting later doesn’t offer a good baseline and isn’t good midwifery. BPPs should start in the 41st week and progress twice a week at least. Again, a baseline is important to have.
Fourth, when a midwife loses a baby, don’t just assume she’s in the right. You have to look at the whole picture (which, admittedly, we still don’t have yet… that will probably come out in court) and give the benefit of the doubt to her being wrong, too. We do make mistakes and we must look at them to see what we would do differently.
Fifth, when you are considering doing something outside your comfort zone or that is unusual, think, “What will this look like in court?” or more directly, “How will this look on the Internet?” If you are comfortable with your decision, then proceed. If it will look damning in court, reconsider moving forward.
Sixth, if you get a client that doesn't want to do what you suggest, DOCUMENT IT!
Lastly, Dr. Amy is no longer the enemy. While I disagree with many of her styles of communication and don’t consider her a friend, the parents are going to her and we can no longer ignore her or her website as the truth about these cases comes to light on her pages. By doing so, we are sticking our heads in the sand and, as she calls it, burying the baby a second time – first in the grave and the second by ignoring the death and circling the wagons around the midwife, protecting her from any questions or investigation about the death.
Let’s not forget Gavin Michael.