01 May 2012

Midwifery Under Fire In Idaho

Story first appeared on FOX News.

Midwives and doctors are longtime rivals in the politics governing where women should give birth: Home or hospital.

The Baby Place in Meridian remains open, but its midwife owner and her daughte are barred for now from practicing, in part over decisions allegedly influenced by their distrust and frayed relationships with doctors in hospitals where they felt mistreated or disrespected.

A former employee who trained at The Baby Place said that the hostility that developed for doctors ultimately led to delays in emergency transports to hospitals. This antagonism caused them to make decisions against the best interests of mothers and babies, broadening the historic midwife-doctor divide to a wide gulf - with tragic consequences.

Idaho investigators who began scrutinizing the midwives after one of the three mothers who lost babies lodged a complaint with the state.

The midwives, whose website indicates they've helped 1,400 women give birth, declined interviews, including on Monday. A receptionist who answered the phone declined to say who is providing services to women following the March 23 suspensions.

St. Luke's Health System states that they are not anti-midwife. Women have the option to choose where they have their babies. But the facility wants to make sure that all the safety regulations are in place.

Though more than 99 percent of U.S. women give birth in hospitals, home births are increasing, accounting for 0.72 percent of deliveries in 2009, up from 0.56 percent in 2004, according to the National Center for Health Statistics. Significantly more Idaho women have a midwife-assisted birth or home birth than the national average. About 3.2 percent of the 92,000 total births between 2008 and 2011 were midwife-assisted, either at birthing centers or home birth.

Given that, remedying feuds like the one that influenced the midwive's decision-making is growing more important.

Midwives often feel disrespected by the medical establishment, while doctors' objections to out-of-hospital births may harden with every traumatic transport.

This comes on top of the already-existing divide between the two views of childbirth, with midwives emphasizing the safety of natural births in a familiar, comfortable setting, while the American Medical Association contends women are best off in a hospital, where life-saving technology is nearby if something goes awry.

There is a compulsory interaction between two value systems. A transport means these two systems have to come together - and work together.

The Idaho Board of Midwifery probe that preceded the suspensions highlights numerous instances where investigators said that didn't happen.

In August 2011, the daughter of the facility owner waited 11 minutes to call paramedics after a baby was born "limp, unresponsive and pale," investigators wrote. The mother labored for more than 48 hours, prompting the Meridian Police Department to launch an ongoing criminal negligence investigation after the baby died. There are some questions about the length of labor.

On Oct. 11, 2010, a student midwife improperly cut an infant's umbilical cord, resulting in significant blood loss before the baby died. The daughter then failed to provide medical personnel at St. Luke's Meridian Medical Center with relevant records, investigators wrote.
And on June 30, 2010, the facility owner delayed paramedics from entering The Baby Place for four minutes. When they were finally allowed in, she instructed them to drive past two nearby hospitals to St. Luke's in Boise, adding precious minutes to a journey that ended in the infant boy's death.

The mother, said in an interview that the midwife bypassed the closest facilities because she wouldn't be allowed to remain at the woman's side. The mother stated that she didn't care what facility she went to, she just cared about getting to a hospital.

The Baby Place's web site does indicate negative feelings toward hospitals, with one employee writing in a testimonial to prospective clients that she began her midwife studies after a hospital birth where she felt cheated out of the birth experience.

The Baby Place midwive's do have troubled relationships with doctors, according to a long time patron, who planned her eighth child's delivery at The Baby Place in 2007 but was forced by complications to transfer to nearby St. Luke's Meridian Medical Center.  Her family witnessed hostile doctors force Coleen Goodwin from the delivery room.

Still, she remains an ardent Baby Place supporter, and doesn't believe those experiences led the owner to endanger women or their babies.

In addition to the three babies that died, the midwive's were hit by a separate 2010 lawsuit, filed by the parents of a baby that suffered permanent brain damage. Last week, the midwives agreed to pay $5 million to the couple that sued.

The attorney on the case said that he pursued the case pro bono because he couldn't in good conscience dismiss the case as long as they continue to practice in this facility.

Objective measures of Idaho's midwife-doctor relationships - and their impacts on babies - are difficult to come by, because the state doesn't keep comprehensive records of the outcomes of midwife-assisted births requiring hospital transports.

A private effort, the Idaho Perinatal Project run by St. Luke's, documented 138 instances between 2005 and 2011 where mothers who planned a home birth were transported to a hospital.

Though its records are also incomplete - reporting is voluntary; there are no reports for 2012 - they do point to the trauma that accompanies a planned out-of-hospital birth where something goes wrong. There were at least nine cases where infants died at or before arriving at the hospital and several instances of birth asphyxia, fractures, post-partum hemorrhage and unexpected twins. Baltimore Birth Injury Lawyers are following the case.

For many doctors who don't see the cases of successful home births, these tense interactions add to already deep misgivings about midwifery.

Standards set by Idaho's midwife licensing that took effect in 2010 have fostered communication between most midwives and doctors, despite problems investigators found at The Baby Place.

Midwives now visit St. Luke's, attending some staff meetings. Doctors' appreciation for midwives' services has grown.

Hopefully when the Idaho Legislature reviews the state's midwife rules in 2014, when the existing licensing law expires, they'll make it mandatory for midwives and doctors to track outcomes of transfers. Hopefully, these measures will reduce the number of birth trauma and birth injury in both mother and infant.

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