Henry’s Story: Did Lax Oregon Laws Contribute to His Death?

Last week, KVAL in Eugene did a series on midwifery in Oregon,  highlighting the experiences of Kristine Andrews, Mindy Bizzell, and Margarita Sheikh with homebirth midwives:

 

I applaud these women for their courage and strength to tell their stories in the face of criticism from random strangers and homebirth supporters alike. These are things that we all need to hear, and especially those of us who are considering giving birth at home in Oregon.

Of course, while I commend Beth Ford and KVAL for bringing these stories to light, I understand that it is hard to give them the attention they deserve in a scant two minutes on the evening news.

I discussed Mindy’s story with her, and there were a few things that didn’t make the cut that she wanted to get out there.

10Centimeters: Is there anything that didn’t get said in the KVAL story (or that did get said) that you’d like to highlight?

Mindy: The KVAL reporter didnt note that Henry was in fact frank breech, she reported he was footling breech, which was not the case. She highlighted the fact that we didn’t know the difference between midwife care and hospital care, which just isn’t true — obviously we know the difference; what we were trying to convey was that Tamy Roloff was licensed in the state of WA, and we expected a professional who had a certain degree of education and experience. We inquired about what school she had gone to, we asked how many births she had attended (somewhere in the 300 range). We were not just picking up someone from the street to help us have our baby, we hired someone who had a credential and who was state licensed.

10Centimeters: When did Tamy tell you that Henry was breech? Was it before you left for the hospital? Or not until he was delivering in the car?

Mindy: Tamy told us that Henry was breech after my water broke and there was VAST amounts of thick meconium on the bathroom floor and I asked her to check me internally (because I reached up and checked myself and mistakenly though I felt a cord, which had been my worst fear concerning homebirth, I never imagined that he would be breech and Tamy wouldn’t know.  He was a huge baby — 9lbs — and he had evidently been breech for awhile. She was not competent enough to know or to catch it when she palpitated my stomach at our weekly visits). It was at this point that she told us that protocol dictated we go to the hospital, and that she “didnt like it,” but we would go ahead and go. I remember thinking, “WTF, I WANT to go to the hospital lady!” I had no intention and never had of giving birth to a breech baby at home.

10centimeters: Was there any indication that something might be wrong before labor started? In early labor?

Mindy:  In hindsight I can see that absolutely there were indications he was breech. I called her the night before labor started and specifically told her that I thought he was in a strange position and it did not feel like his head was engaged in my pelvis. She told me outright that “I know you want to hear that something is wrong, but that nothing is wrong, Trust me, I hear this from all my mothers.” We talked for 20 minutes about my fears about his position, which she would later deny to the state investigators (I had to produce phone records to prove it). I was also leaking brown fluid before my water broke, and asked her about it at least two separate times, and she told me that it was “fine and normal.” I showed my husband a third time and told him I thought it was strange but we both trusted Tamy when she said it was normal; we presumed she had seen this before. This was the same brown fluid that covered my hands as Henry was being born in the backseat of our car over the Astoria bridge.

10centimeters: That was one of the things that really stuck out to me about your story. Why on earth would your midwife have you drive from your home in Washington more than 45 minutes to Oregon when there was a hospital just minutes away?

Mindy:  At the time, Tamy did not tell us we were going to Astoria until we were in the car and pulling away.  I thought we were going to the hospital two minutes away from our house. She claimed they “would not take me” and that we had to go to Astoria. My mother had asked her earlier in the house why we didn’t call and ambulance and she told her that an ambulance would have to come all the way from Astoria to pick me up (Which we found out later was a lie.  There are ambulance services all over the peninsula. The WA state investigator said she called on of them and their estimated time for getting to me at my home would have been 2 minutes).

I honestly think that a big part of Tamy’s decision to go to Astoria was because she felt that she could still deliver the baby, and if she had me in the car on the way to the hospital and the baby was born in the car then she couldn’t have been held liable for trying to do a breech at home. During my pregnancy she had frequently bragged to me about a birth she had done in a car where the baby was born safely, she had clearly felt like a hero and it was a story I heard her tell many times. I think she felt that she had the power to make any baby be born safely, because she had an incredible earth-mother goddess trip where she felt like some kind of all powerful purveyor of birth. She also told me when we got in the car, after I told her that I was needing to push (and she knew full well that Astoria was 45 minutes away), that “well, we’ll just have the baby in the car then”. She really and truly believed she could do it, I don’t think she ever imagined that he would get stuck like that. She told me outright that she had never done a breech birth before after Henry died, but at the time she behaved as though she knew just what she was doing. I trusted her implicitly. This woman had thrown me a belly casting/baby shower party two weeks before. She was a friend, a confidante, and at the time I was in transition, I had no part of my brain available to question her or to wonder at the sense of what was happening. In hindsight it all seems absurd that none of us called an ambulance, but we had really and truly trusted her. We believed that what she told us was the right thing, we even believed her when she said no ambulance would come for me in time and that the local hospital wouldn’t take me (which we found out later was also untrue).


10Centimeters: When I heard your story, my first thought was that you were transported to Oregon because it was against Washington law for your midwife to attend a breech birth and she knew that she could not get in trouble if you delivered in Oregon. Do you think there is any truth to that?
Mindy: It didn’t occur to me, honestly, for the last two years to think that Tamy took us to Astoria to avoid the laws here but now that you said that it is definitely a possibility and it left me reeling. I do think it’s a possibility, but I never would have said that right after Henry was born. My eyes started to open about what kind of person she truly was after we saw the WA state investigators report, how she attempted to make us look bad, claiming we wanted her to “stand in the other room during our birth”, and all of the other lies and half truths she told (and how she omitted the leaking meconium fluid from her charts). The truth is that Tamy was in it to protect Tamy, and no one else. I don’t believe she cared about Henry more than she cared about her own professional career and her own lifestyle. So I suppose in the end I can say it’s a definite possibility that the lack of laws in Oregon influenced her decision, but I also think it was her own God complex, her need to prove any baby can be born at the hands of a midwife.


10Centimeters: Did she say anything else to you after Henry was born?
Mindy: This woman did her very best to brainwash me after Henry’s birth, immediately whisking me out of the hospital, into her own waiting car (a few hours after I had surgery to repair my severe 4th degree tear). She insisted on driving me home, and then insisted on driving me herself to Portland to see Henry (which is 3 1/2 hour drive from Ilwaco where we lived) who was at OHSU in the NICU. During the entire car ride she took great pains to talk to me about what happened and she kept repeating how “we” had done this or that, and how “we had done the best we could” — she was very intent on creating a bond between her and I and refusing any culpability whatsoever. She also repeatedly told me that my inability to urinate at all after his birth was normal and ok — resulting in permanent nerve damage and 2 solid months of catheterization for me. I still cannot urinate normally and frequently experience bouts of painful bladder spasms (the ER took 3100cc’s of urine out of me four days following Henry’s birth).


Mindy, I want to thank you from the bottom of my heart for sharing your story. I know that it can’t be easy. I’m sure that I speak for everyone reading when I tell you that we are so, SO sorry for the tragic loss of your son.


Tamra Roloff, Mindy’s midwife, has had six Washington case investigations against her license: Case #2009-138744, #2009-142066, #2010-145607, #2010-142794, #2010-143829, #2010-143971

OHLA Direct Entry Midwifery Board is a JOKE (and a hazard to your health)

What is the purpose of a board of … whatever? When it comes to licensing boards, it is to protect the public by ensuring basic levels of competency. For example, the Oregon State Board of Nursing, which licenses Certified Nurse-Midwives, says

The Oregon State Board of Nursing safeguards the public’s health and well-being by providing guidance for, and regulation of, entry into the profession, nursing education and continuing safe practice.

The Oregon Medical Board, which licenses MD’s and DO’s,  also has the same mission:

The mission of the Oregon Medical Board is to protect the health, safety, and well being of Oregon citizens by regulating the practice of medicine in a manner that promotes quality care.

In addition to its licensing functions, the Board conducts investigations, imposes disciplinary action, and supports rehabilitation, education, and research to further its legislative mandate to protect the citizens of Oregon. The Oregon Medical Board is also responsible for the scope of practice of First Responders and EMTs.

What does the Oregon Board of Direct Entry Midwifery and the Oregon Health Licensing Agency do? Well, the stated mission of OHLA is

The Oregon Health Licensing Agency (OHLA) protects the health, safety and rights of Oregon consumers by ensuring only qualified applicants are authorized to practice. OHLA establishes, communicates and ensures compliance of regulatory standards for multiple health and related professions.

That, however, is far from the truth when it comes to licensed midwives in the state of Oregon. In reality, the BDEM and OHLA have…

  1.  Failed to remove the license of a midwife who abandoned a woman with a retained placenta.  Seriously? Someone who’s read one book on childbirth knows that a placenta that doesn’t come out within a couple of hours of the birth of the baby is a serious problem. And a midwife who leaves a woman in that situation? Well, that’s a serious problem as well. But apparently the Oregon Board of Direct Entry Midwifery doesn’t think so. When the Board declined to do anything about it, board member Kate Davidson, CNM, resigned in protest, saying in her resignation letter:

 After the Board’s decision not to revoke the license of a midwife who left a patient with a placenta undelivered, I do not feel I can honestly continue to serve and maintain my own personal integrity. I feel this was an egregious act and failure to revoke the license conflicts with the Board’s duty to protect the public.

  1. Progressively reduced the number of absolute risk criteria so that Oregon DEMs can attend riskier and riskier births. Between 1993 and 2009, eighteen different criteria were either loosened, reduced to non-absolute criteria, or removed from consideration altogether by the board.  Oregon midwives are now not required to even consult with a medical doctor when an infant is born at home at 35 weeks, much less transfer care.
  2. Refused to discipline midwives whose actions contributed to the death of a child. Case 05-4228 brought before the board was a complaint about a midwife’s management of fetal heart rate which led to fetal demise. According to notes from the board’s meeting on 5/19/2005, the board found that the midwife DID NOT CHECK FETAL HEART TONES APPROPRIATELY but did not discipline the midwife or make her name known to the public.
  3. Ensured that DEMs are not required to provide risk information about homebirth with malpresentations, multiple gestation, VBAC, and postdates.  The disclosures have been required by the legislature, but every time the deadline approaches to implement, OHLA pushes it back.

The Oregon Health Licensing Agency filed temporary administrative rules with the Secretary of State Office on Octoner [sic] 15, 2011, to extend the implementation date to June 1, 2012, which will require each licensed direct entry midwife provide risk information to clients, as published on the agency’s website, regarding out-of-hospital birth, malpresentation birth (breech), multiple gestations (twins), vaginal birth after cesarean (VBAC), and births exceeding 42 weeks gestation (post-dates.)

  1. Allowed multiple members of the board (the chair and vice-chair, in fact) to have a serious conflict of interest. Melissa Cheyney, board chair, is also the director of research for MANA, whose stated goal is “to unify and strengthen the profession of midwifery,” basically a lobbying group for midwives.  Somehow Cheyney and Susan Moray, who is MANA’s press officer (and is also employed as continuing education coordinator by the Oregon Midwifery Council, yet another lobbying organization for Oregon midwives) are allowed to maintain their positions as virtual lobbyists for midwives while running a board that is supposed to be protecting Oregon women from bad midwives.
  2. Hired a private midwife advocacy/lobby group, who has refused to release data to them in the past, to collect safety data on Oregon midwives. That’s right. Starting June 1, 2011, OHLA started requiring Oregon licensed midwives to submit data to Melissa Cheyney’s MANAstats. Totally disregarding the fact that they have requested data from MANA before, and Cheyney denied the request. According to board meeting notes from August, 2010:

Cheyney stated that OHLA requested a state account from the MANA, in order to have the ability to retrieve aggregate data for LDMs in Oregon. Cheyney stated that the MANA board’s official policy is to give state-level accounts to professional organizations as a tool to evaluate areas where more training might be needed for the purpose of self regulation, and to not provide the data to regulatory entities. Cheyney explained that MANA’s policy was generated taking into consideration that MANA is a voluntary database. Cheyney explained that MANA suspected that, due to some state regulatory boards having very hostile relationships with midwives, the quality and quantity of data submitted might be adversely affected if regulatory authorities were provided access. Due to this policy OHLA’s request for a state level account was denied. Cheyney stated that due to multiple requests made by regulatory authorities to MANA for a state-level account, the MANA board decided to re-evaluate this policy. However, based on feedback received from contributors to the MANAstats database expressing concerns, MANA determined that state-level accounts would not be provided to regulatory entities at this time.

  1. Published worthless information about licensees while obfuscating information vital to making a truly informed decision about which midwife to use for a homebirth. Want to know if the midwife you’re considering has ever been disciplined by the board? Well you’re out of luck! For example, Jennifer Gallardo has had at least two final orders (case numbers 00-01 and 02-12) that resulted from cases of fetal or infant demise. What do you find when you look up her license on the OHLA website?

 

Unresolved Disciplinary Action: None. That’s right. OHLA will only tell you if a midwife failed to pay her fine, not whether or not she’s been disciplined. What about a midwife who gave up her license rather than have it revoked? Clare Loprinzi, the midwife who abandoned the woman with the retained placenta, eventually agreed to surrender her license to the board “in lieu of revocation” in 2002 after she was involved in an infant demise in 1999. What does OHLA say about her license?

The same thing it says about midwives who failed to pay their renewal fees. And no mention of case number 99-01, including a “proposed order to revoke license due to unprofessional conduct” which resulted in fetal demise. (an aside, because I don’t have enough hours in the day to detail all that is wrong with OHLA and the OBDEM: Why the f*ck did it take THREE YEARS to take her license away?)

And what about midwives who currently have complaints against their licenses? Shouldn’t the public be aware of that? OHLA doesn’t think so. Adele Rose of Andaluz is currently under investigation for her involvement in a fetal demise in 2010 as well as another 2010 incident. Incidentally, she was given a one month suspension (during which she was allowed to continue practicing as a midwife…) as a result of case 08-5222, which was a VBAC attempt that ended in fetal demise and an emergency hysterectomy. What does a search of her license tell us?

 

Nothing. Not shocking when you consider the rest of this, but it should be.

But maybe this is par for the course when it comes to reporting actions taken against licenses?  I mean, Birth Without Fear is constantly telling us about how hospitals are hiding things from us. Maybe the Oregon Board of Nursing refuses to report actions against their licensees as well? Oh, look. If you go to the OBON website, it has all of the disciplinary actions taken in the last year, complete with details and the area in which the disciplined nurse lives. And if you look up those nursing licenses individually? Those violations are listed on the license with a .pdf of the final order. Nurses, schmurses. Surely the medical board, with those evil doctors who are hiding ALL those terrible hospital outcomes we always hear rumors (but never see any proof!) about on MDC, isn’t telling the public about actions taken against medical licensees!  Nope. They have final orders, current to those handed down LAST WEEK, on their site, complete with names and copies of the order. Not only that, but they have temporary orders taken against doctors who are being investigated listed! And violations are all listed on the medical license look-up as well.

Oregon women who are considering a homebirth should be OUTRAGED at the lack of oversight, protection, and transparency provided by OHLA and the Oregon Board of Direct Entry Midwifery. It is clear that their real agenda is to promote midwifery and not to protect Oregon families, in direct opposition to their stated goal. When are you going to start speaking out?

 

Whaaat??!? The Danger of Placenta Previa is Really Just “Hospital Drama”

You may remember the Whaaatt? post regarding birthing at home with placenta previa. If you need to refresh your memory, it’s right over here. As it turns out, the original page is the gift that keeps on giving. Birth Without BS posted a link for discussion on her facebook page, and many people were appropriately shocked at the poorhideously awful advice therein.  However, one commentor took it upon herself to educate the masses:

Ahhh, I see, that makes so much sense. If we could all just have a slightly more Traditional — with a capitol “T”! –indigenous paradigm (which has apparently been proven, as opposed to the “unproven male mechanistic medical paradigm”), things like placenta previa just wouldn’t be a problem! We can just keep calm and that placenta will take care of itself. Our reptilian brain will kick into gear and somehow get that baby THROUGH the placenta and out first. Not only that, if you manage to acquire that Traditional, indigenous paradigm, you WILL be able to just read something off the internet and go for it. Change your paradigm, people!!

 

 

Nine Times Nothing is Still Nothing

Please welcome guest blogger Mrs. W! She is a a health economist, a mom and a modern feminist who lives in British Columbia and blogs at Quality Care for BC Mothers.

The Nine Statements of Consensus from the Home Birth Summit: Nine Times Nothing is Still Nothing

There are substantive and real issues confronting the home birth and obstetric communities in the United States.  Having a summit could have moved things forward, fairly substantially, if they actually took the 9 pre-determined agreed upon consensus statements and used them as starting points, instead of accomplishments – because nothing is accomplished as a result of the statements made.

  •  We uphold the autonomy of all childbearing women…
 Autonomy in the absence of complete and unbiased information is meaningless – there cannot be free informed choice when the information given to women on childbirth is incomplete or biased.  A woman must be informed of the risks and benefits of the choice she is making if she is to be empowered to make the choice that best meets her needs and the needs of her child.  If the autonomy of childbearing women is to be upheld, there must be a consensus on what the real facts of childbirth are, and a commitment to providing that information to women in an unbiased and accessible way.  
  • We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes…

Again a really lovely idea, but, clearly there are substantial barriers to making this a reality in the current system.  In order to collaborate, midwives and OBGYNs need to speak the same language.  In order to collaborate, midwives and OBGYNs would need to hold each other in esteem and respect.  In order to collaborate, they need to facilitate the work of one another.  This means that when a woman who is at risk in labor is transferred to hospital for care, the hospital is prepared for her arrival before hand and the midwife is capable of giving full and appropriate information about the woman and her labor to the OBGYN upon arrival.

  • We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes…

Homebirth as it exists in the US today does not ameliorate disparities in access, delivery of care, or outcomes – it accentuates them.

Women in the US are far more at risk accessing the homebirth system than the hospital birth system.  They are at risk of having a care provider who does not undertake standard and appropriate prenatal care (gestational diabetes testing, group B strep testing, weight and fundal height measurements, and pre-natal ultrasounds).  They are at risk of having a provider who does not have adequate and appropriate education and experience.  They and their babies are at greater risk of death or disability and they are at risk of having a provider who does not carry malpractice insurance and who would be held accountable to a lower standard of care in the event of death or disability.

There will continue to be disparities in access, delivery of care and outcomes seem unavoidable in the current context.

  • All health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice…
This begs the question what is the appropriate standard?  Furthermore, in the absence of legislation, what would be the consequence of failing to meet the standard?
  • We believe that increased participation by consumers … is essential to improving maternity care…
Is this the facilitation of informed joint decision making during the care delivery process?  If so, See number 1.  Or, perhaps more meaningfully, will this mean that consumers would have a way of voicing their concerns and having those concerns heard in much the same way that hospital patients can have a formal review of the care they received?
  • Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings…
See #2.
  • We are committed to improving the current medical liability system …
Another starting point – what medical liability system currently applies to homebirth midwives?  Doesn’t a system need to be in place before it can be improved upon?  Is there an insurer that would take on the risk in the current environment?
  • We envision a compulsory process for the collection of patient … data on key … outcome measures in all birth settings….
So. Data is collected. MANA collects data. Does a $#!T load of good – unless you commit to releasing the data, it means nothing. Data existing does nothing without it being available to be analyzed, actually having it analyzed and releasing the results of that analysis.  Furthermore, there needs to consensus on what data elements are critical and the definitions of those elements – this is essential if the data across birth settings are to be comparable and the data is to be transformed into meaningful information.
  • We … affirm the value of physiologic birth … and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies… 

This seems at odds with valuing patient autonomy, particularly when not all pregnant women giving birth would choose physiologic birth if given complete information to make an informed choice.  Furthermore, valuing the particular process of birth (physiologic, a.k.a. “normal birth”) places form over function – shouldn’t the ultimate goal be healthy moms, healthy babies regardless of delivery method?

 

 

Margarita Shares Her Story on KATU

Great job, Margarita! I know the reporter didn’t put in everything you told her, but I think your story came across loud and clear, anyway. And kudos to Representative Greenlick. I’m looking forward to seeing what he puts forth this coming legislative session.

And the best comment award goes to Tara, for this:

This tells a good portion of her story but leaves out some of the most chilling details. The “midwives” Darby Partner and Laura Tanner looked great and talked a good game but failed to deliver on their promises. But worse than that, their actions were self-serving. This was Darby’s first primary birth and she wasn’t going to have a hospital transport as her first birth. So they in effect, kidnapped Margarita. They took away her phone and forced her friends to leave. M’s husband was in India and was not allowed to talk to her. Her friend called the police multiple times and got no help. So margarita was alone with these charlatans, and in pain and helpless. They actually left her so they would not have to hear her pleas to go the hospital. They didn’t even know enough to tell that they were picking up her heartbeat and not the baby’s. They also did not even have a bulb syringe or knowledge of CPR. They forced her to labor for 8 days with all the warning signs. Meconium in the fluid, post dates etc. They misrepresented themselves and because of the lack of a system that Oregon has there is no way to tell the difference. I saw Darby’s and Laura’s websites myself, they looked legit. Full of pictures of happy mamas and babies and Darby looking like some benevolent mother earth figure. This is why this mother is fighting so hard, so that no one else is duped by fakers like she was. But is goes deeper than that. Natural child birth and homebirth can be wonderful, but there is an undercurrent of sickly sweet lies that has overtaken the NCB world. The blame lies heavily on the false prophets of the community that peddle the most egregious tripe. They spew such platitudes as no woman can grow a baby she can’t birth, and breech is another variation of normal. They employ fearmongering techniques and tell mothers that doctors only want to cut them so they can get to their golf game. They are zealots and they are cult-like in how they maintain rigid control over the content on their sites. Margarita’s own story was deleted from the most popular of these pages. They do not allow dissenting points of view and commenters, myself included, are deleted for raising up a voice of reason. They deny that there is any risk to birth at all and scoff at known complications like pre-eclampsia, previa and gestational diabetes. Worse, they push bunk remedies like garlic vaginal suppositories for group B strep. They viciously cut down any women who have inductions and c/sections and their followers follow suit. It’s common to hear how women who have c sections are selfish and shouldn’t be allowed to have children. They have created an impossible ideal in the name of being “natural” and and any woman that doesn’t follow in this ideal of homebirth, breastfeeding,cloth diapering,not circing, not vaccinating, etc are denounced and verbally flogged by hundreds of women. I’m actually surprised there aren’t more suicides from this, although we hear of a great deal of postpartum depression and difficulties bonding with the children that result from the “failed birth” I personally know a mother that has spent the last year regretting her homebirth transport and feeling like a failure because of it. Is it any wonder that vulnerable mothers go running to midwives? And these saccharine phonies are there with arms wide open promising to give them the birth experience they always wanted and failing them in the 11th hour. There is nothing we can really do to prevent this kind of propaganda from saturating the internet, but there is damn well something we can do about the lying, self-proclaimed “midwives” that exploit a mother’s fears. We need to demand stricter educational standards(25 births, are you kidding me?) mandatory regulations, mandatory licensing, malpractice insurance and the strictest review board that will drop the hammer down on these incompetent wanna-be midwives. You know, what’s really sad? Because these midwives aren’t insured, there isn’t even any civil action that babyloss mothers can seek. They literally get away scott-free. And they go on to harm even more babies and mothers. If they want to be professionals, then they need to be held to professional standards.