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Tuesday
Mar042014

A Baby Died

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.

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Reader Comments (18)

When I was pregnant with my first, I moved about 6 miles at 35 weeks pregnant. The drive, done over two days, was the culmination of months of stress. The day after arrive, I had my first appointment with the CNMs to whom I transferred my care.

At my first exam, I was diagnosed with hypertension. I cried and cried and cried--I had planned for months to deliver at this birth center. I had just been through the summer from hell. I was sure, SURE, that I was going to be risked out.

And after I had my cry, I would have accepted it and moved on.

It turns out I wasn't risked out. I had NSTs done every couple of days. I was hyper-compliant with bed rest and my BP stayed borderline. There was no protein in my urine and I had been entirely healthy otherwise. Atticus volunteered to come at 37w1d, and was perfectly healthy, if a bit jaundiced that first week.

All of this to say…who the HELL are these midwives who won't risk people out? I am entirely confident that my midwives would have bounced me to the hospital in a heartbeat if my BP had not stabilized or if any other thing had gone a little bit amiss? If I had refused to go, I'm sure their response would have been "Well, that's probably not a good choice, but it's your choice to make BUT YOU'RE NOT COMING BACK HERE EVER."

I picked midwives because yeah, I wanted a less "clinical" experience. However, I still chose health care professionals. Sometimes, a professional has to deliver bad news. Such as, "You should see a doctor. I cannot continue your care because it's no longer safe for me to do so." You're hiring a midwife for her expertise--for the things she knows that you don't. If she can't/won't even be straight with you, then why bother?

March 4, 2014 | Unregistered CommenterKate

This was really brave and incredibly moving post.

March 4, 2014 | Unregistered CommenterMichelle

Thank you for this post. These deaths have always been happening, but as technology has become more widespread and utilized we are now truly seeing them unfold, now even in real time. Midwives can't hide behind each other anymore. These deaths won't just be whispers in hidden communities. Midwives must start acting like the professionals they claim to be, or they will be legislated out of existence.

Being in Las Vegas I plan to find out if Collins has an actual commercial office space and picket the location until she publicly admits she was the midwife and publicly apologizes for her lies and lack of professionalism that have so harmed this family. Women paying her deserve to know how she really treats clients, and how quickly she will throw them under the bus when things go wrong.

March 4, 2014 | Unregistered CommenterTesla White

Thank you, thank you, thank you for being a voice of sanity and having the wisdom and maturity to constantly reevaluate your positions.

March 4, 2014 | Unregistered Commentertrulyunbelievable20

Thank you for this article. Let's hope that the response of the midwifery community to this tragic death is to work to improve practice for the future, to try to prevent the same thing happening to other families.

March 4, 2014 | Unregistered CommenterSue

Very glad to read your view on this, Barbara. I agree completely.

March 4, 2014 | Unregistered CommenterAntigonos CNM

Thank you thank you thank you for posting this!

March 5, 2014 | Unregistered CommenterNoUseForANym

Thank you. Great post.

March 5, 2014 | Unregistered CommenterPrimaryCareDoc

This is a very important discussion to have. I lost a baby due to the incompetence of a homebirth midwife. I will have to live with the consequences of that forever. The fact that the same thing can and does happen in hospitals is small comfort, and does not excuse the midwife for her panic and utter mishandling of the situation.

My baby flipped to footling breech during labor. His shoulders became stuck. He was "revived" at the hospital (once my husband realized the midwife had frozen and was not helping he called 911). His brain was too severely damaged due to oxygen deprivation.

A few months later, speaking with others from the home birth community in my state, people told me the other midwives were circling the wagons and that my situation was unfortunate but blah blah blah. I said "They weren't there and NONE OF THEM contacted me." That's right, I did not once speak to any other midwife about my experience, but based on the account of the midwife who had panicked and gone into a terrified state of paralysis at my time of need, they had decided if I said anything about it, I was just a grieving mother with sour grapes over an unavoidable tragedy.

I don't know if my tragedy was unavoidable, and I never will. I DO know as I lay there watching my babies' legs turn blue hanging out of me that the "midwife" DID NOTHING TO HELP and did not even have the guts to call 911.

I lacked the mental and emotional energy to fight the asinine response of the other midwives in my state at the time. Now that it's been so many years, I don't see the point in going through it/putting my family through it. But on the other hand I don't want other families to have to go through what we suffered.

Midwives complain about how certain doctors have a "Boy's Club" mentality and don't hold each other accountable to maintain evidence based practices. The hypocrisy manifested when they in turn fail to hold their own accountable is revolting.

I believe in birth choices, and even after everything, I believe home birth ought to be a choice that is supported... by qualified, experienced, *licensed* midwives with genuine accountability.

March 5, 2014 | Unregistered CommenterKat

Hi Barb, Thanks for your courageous voice of reason.
I've been a long-time reader of your blog. I've experienced some of the same transformation of thought that you have over the years. It's painful because I love so much about midwifery and home birth. But there are also things about midwifery that are unacceptable to me. I'm not anti-homebirth or anti-midwife, but would really like more conversation among midwives about how to make midwifery and homebirth safer than it is. It's time.

March 5, 2014 | Unregistered Commenterex CPM student

Make no mistake--you may be her buddy if you are doing labor support in the hospital, but if you are attending births out-of-hospital, "Dr." A is your enemy.
You assume the midwife is at fault here though you make clear that you don't have all the information. She cannot talk to you if there is a court case--others can talk all they want--and say anything they want--but she can't.
And does anyone think that the mother is the final arbiter in choices made? Just perhaps? With choice comes responsibility.
And babies do die, in all settings, with all providers, regardless of what factors and decisions went into the outcome, and it is always heart-breaking.

March 5, 2014 | Unregistered CommenterKip Kozlowski

Thank you for a grounded and honest look at the needless loss that happened. My deepest condolences to Gavin's family as they enter into this dark season of grief. I am also a homebirth-loss mom, and I am saddened that -this- is the tragic 'sisterhood' that the homebirth movement is leaving in it's wake. It does not need to be this way.

March 5, 2014 | Unregistered CommenterLisa @CreativLEI

My heart breaks for Gavin and his family. I also lost my son, post dates, to reckless midwives. I know from the autopsy report that it was meconium aspiration, but the doctors just called it a stillbirth. I hope and pray there is recourse for the family.

March 6, 2014 | Unregistered CommenterMargarita

The whole problem with the homebirth/CPM movement is their constant preaching about, "Trust Birth" & "Hands off". The older midwives like Jan Tritten and Ina Mae Gaskin, Gail Hart, and Carla Hartley really ought to know better, but most of them have not practiced midwifery for many years. I'm very upset about the turn the homebirth movement has taken because when I started 42 years ago, we were all really just trying to change an abhorrent medical system into something more humane. However, the CPM's have bought into this "trust birth, no vaginal exams, minimal monitoring of the baby's heartbeat during labor, and condoning long unnecessary labors, calling 2-5 day active labors normal." I've delivered almost 2800 babies at home and am very conscientious about what I'm doing. I cannot stand the fact that doctors do inductions way before it's a danger to the baby or mother, do too many cesareans because of it, and are aiming for the 100% cesarean rate a doctor in the 1970's said was the goal for the future. There is no balance on either the part of doctors today, nor of the CPM's (who get a degree without hands on experience that really is necessary to know what birth is all about. We all want what is best for mothers and baby's- at the moment that is not happening in a society unwilling to look at both sides objectively. I've tried to give my input to the homebirth midwives, but have been slandered beyond belief and totally taken out of context. Whether anyone agrees with me or not is unimportant, but the fact is that no one is willing to even consider what us older midwives have to say- on either side of the spectrum of birth care. Too bad for the mothers and babies who could benefit from some truth.

March 17, 2014 | Unregistered CommenterLydi Owen

it is okay you moderate this. I have read your blog for years, months on occasion as I tried to understand who you were and who you now are. I remember speaking to you on more than one occasion in which you lectured me on how the internet was the place to be and why don't I have a profile. Well, now I do.

I've come to the conclusion there is a reason why you whine and cry about the other midwives in your area and how mean they are to you. It is because you are not a midwife, you are a traitor. A traitor to the ideals of midwifery, homebirth and nonintervention pregnancy. You are one of those fear mongering "birth workers" who make the maximum amount of money for the least amount of risk and work.

When I saw this blog piece about the baby dying on a Dr. Amy page I knew I had to say something. After all, being buddies with the most hateful, venom spitting doc on the web must be a source of pride for you, right?

I am only going to say, I walk away from your sensationalism, your spitting judgment and your I told you so tactics. Point fingers all you like, after all that is your trademark. It makes you money and notoriety. Which is what you are all about. It is not saving lives, respecting women or make a difference. It is about HATE. Hate yourself, other women and the ones who do make a difference. I'll not be a party to any of it.

It doesn't matter who I am, I left.

April 8, 2014 | Unregistered Commentermidwife

The challenge facing us in the United States is to educate midwives as thoroughly as they do in European countries. There has to be a balance between the medical and intuitive aspects of care. The "trust birth" talk is fine as long as things stay normal, but that is not always the case. Excellent education is the key to knowing when a pregnancy, labor, and birth are deviating from normal. We do not have this currently in this country. Another major flaw in the United States at the moment is the lack of respect shown to older, experienced midwives. Slander and gossip abounds to an extent that is unbelievable to me. How are we supposed to progress and find some semblance of sane balance between the medical and the intuitive when women do this to each other? I have worked for 42 years to bring about better conditions in maternity care, only to see it destroyed by gossip, which is completely untrue. But, I have no way of defending myself because no one asks me if what they hear or read is true? This reply is not meant to be about me, but I mention it because it is a large part of the reason that this baby died- the unwillingness of others to have an open mind before they practice in a way that is popular, but can also be fatal for a baby or mother if that information is lacking/wrong!

May 17, 2014 | Unregistered CommenterLydi Owen

I appreciate this post. I was unaware of this particular case, but have seen similar. I think some midwives confuse "trusting birth" with a guarantee of a good outcome. While birth tends to work, there are times when intervention is crucial. We all need to remember that death is also "natural," but is not the outcome that mothers desire. I've heard providers tout maternal choice in cases like this, but I believe that passes the buck in an unacceptable way. I think it's fair to say that a mother who fully understands the risk of a situation like what you describe, would choose differently. The onus is on the provider to make that clear, even if they have to face accusations like "playing the dead baby card."

September 6, 2014 | Unregistered CommenterEmile

I saw this happening in Real Time as well. That Christy, should have Done Time for Negligent Manslaughter. No Court action is pending at this time.

April 22, 2016 | Unregistered CommenterMichael Ray Overby

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