Famous Midwife Sued Over Stillbirth

i have had two stillbirths, from pure neglect. I was in a hospital, both times. with a high risk specialist.. it doesn not matter where you are. HOw dare people blame the parents. Kara is a "Professional", and should have taken action after a certain time, i am sure she saw the signs of distress.. Catherine was a first time other and trusted her Midwife. You are supposed to be able to trust your midwife, your Dr, whoever is taking care of you. Baby Noa's death with brough on by pure neglect from Kara, and she should face the consequences. NO parent should have to go through that. Catherine and Ricardo will forever live with the fact that their daughter is not with them, why should Kara, live life like nothing happened. She should not be able to practice anymore!!!

The sad thing is that babies die in hospitals in the 21st century too. And mother's die. And sometimes it's from a provider's negligence, and sometimes it's because even the best technology in this modern age cannot remove all risk for mother and baby. Sometimes, gasp, it's because our modern technology is over-used, and actually cause iatrogenic issues that can be fatal.

This family has lost their baby. They will hurt over it for the rest of their life. This midwife lost a baby too. She's never gonna be the same again. I hurt for both of them, and hope, desperately hope, that no one can be righteously blamed. It's a much much worse tragedy when it's caused by neglect or stupidity.

I am so pleased I am not American - with your over medicalised approach to childbirth and the attitudes expressed here.

I'm a New Zealander and my two boys were born at home. The birth was assisted by two fully qualified and experienced midwives, experts not in medical operations but in managing the normal, natural process of women giving birth. As experts in the normal, they are also best placed to recognise when there is a departure from the normal. Had this occurred, my partner would have been transferred to a hospital in no more time than it would have taken to move to theatre from another room in the hospital. Here, she would have been attended by people whose expertise is in the realm of the medical complications of childbirth.

It is very important that those who make the call on when things are no longer normal in childbirth are midwives (people with expertise in the normal) not obstetricians (people with expertise in the abnormal).

New Zealand's midwife-led maternity system gives better choices to women, and better outcomes for mothers and babies. And it delivers these better results at a far cheaper price. Mothers and babies are at greater risk of harm in the US than in New Zealand, and that risk is primarily coming from the practice of doctors, not the marginalised midwives.

I dont know the facts of this case and would not rely on media reports. But I would urge caution before sending a lynch mob out for this or any other midwife.

http://www.facebook.com/group.php?gid=35776666002&v=wall

You...didn't really read this, did you? The story is about a baby dying during a midwife delivery.

Of course I read it. The story itself provides nowhere near enough information to make a judgment. Describing this tragic death as coming at the end of a 'three day delivery' is inherently mischievous. Three days from when - starting with the first niggle? It reads as though the midwife was with the mother for three days of uninterrupted second-stage labour. But that would clearly have been impossible - the midwife and mother would have passed out from exhaustion, and the baby would have died long before the 3 days were up. So how long was the second stage? And at what point and in what ways did the birth start going wrong? And what was the cause of death? If it was strangulation in utero as some have reported, that can be one of the things that cause babies to die wherever the mother gives birth. Would being in a hospital have prevented this? Maybe. Maybe not.

Horrible tragic things sometimes happen in childbirth. Sometimes they are caused by the action/inaction of those attending the birth, and in some such cases they are preventable, and in some of those cases the professional attending the birth is to blame, and in some of those cases that blame may be so great that it constitutes negligence. And in litigious societies like the US there are major financial incentives for people to try to establish negligence.

This tragic death was deemed newsworthy because it was a well-known midwife in attendance and because it occurred outside a hospital. It certainly does not constitute proof either that midwifery is unsafe or that home-birth is unsafe - or even that the midwife in this instance was to blame.

Babies die in childbirth. They die in hospitals, they die in home. Neonatal death is not picky or exclusive.

There is no way to say that this baby would have survived if it had been born in a hospital. Anecdatally speaking, I know several women who had stillbirths in a hospital setting due to an umbilical cord around the neck.

It's foolish to try to speculate on what could have been. Just like it's foolish not to take personal responsibility for your birth choices.

This is your baby's life, NOT yours. If you want to be all mystical and hippie, do it with a procedure that effects you and ONLY you. Don't risk your baby's life. Hospitals deliver babies for a reason. Do it there.

These people, like most people who use a midwife rather than a professional, acted out of selfishness. NOW their baby is dead.

Good job.

I first want to state that i personally do not have anything against midwives. As a paramedic in brooklyn, I have definitely come across them numerous times in the field when things go wrong. I do believe she is extremely negligent for not attempting to contact proper medical sources when the delivery became prolonged and unstable. I remember one time when we were dispatched to a residence where they were attempting a water birth at home, and the call came in as the baby not breathing. Fortunately when we arrived, the baby had spontaneously begun to breath, but now came the issue of having the child checked in the hospital. Strangely, the parents were not the obstacle here, the midwife was. She condemned me and the whole "hospital establishment" as she put it, states that the baby should stay home and all is fine. Funny enough, she was the one that dialed 911 when the baby wasn't breathing. Checks and balances should definitely be put in place to make sure this does not happen again in the future

i don't understand why if a woman wants to give birth au naturale she must be a crazy hippy. we lasted many thousands of years without hospitals and c-sections, so to assume we need that kind of intervention is just fucked and ignorant.

yes it is helpful if the baby is in trouble, but hospitals are in the business of clearing rooms. even if that is by artificial means. women should be made aware of their options and not be scared off by an abnormal and unfortunate event like this one

uh i think making the correlation between natural child birth (something our bodies are designed to do) and a shark attack is ridiculous. yes, it's awful this happened. but so many children die in conventional hospital childbirth every year..which is reflected in the fact that it is not reported. but for some reason when a kid dies in natural birth it's like ahah! told you so! natural is bad.

whatever, i highly recommend anyone ever planning to have kids to explore all their options

Our bodies were designed to be eaten by sharks -- why else would we be so unbelievably tasty? (NomNomNom)

Children die in hospitals in part because women with high risk pregnancies usually have the good sense to go to hospitals. Correlation is not causation -- hospitals aren't killing people, they're the places you go if you might die.

The Dutch study looked at low risk births -- and it turns out that if you have a low risk birth, location doesn't much matter. That's hardly shocking -- that's why they're called "low risk." But there's a reason the Dutch study looked only at low risk births -- high risk home births would not just be unsafe, they'd be nuts. Some of those high risk kids are going to die, no matter where they're born (the hospital isn't "killing" them, it's failing to save them) -- but a lot more of the high risk kids would die if "nature" were allowed to take its course.

In this case, the woman had a child in distress -- a low risk birth that turned high risk -- and every indication is that the child could have been saved by medical intervention. It's not that their initial choice to try to birth the kid at home was wrong -- that's a viable option. Rather, it's that they could have had a living kid if they'd been willing to go to a hospital when things went bad. So why didn't they?

No one disagrees that kids can be born at home -- your cootch, your choice. But one theory is that they didn't go to the hospital because they were being pressured to have the kid "naturally," being told that 3 days in labor was just "nature," and being told that they'd be bad parents who were harming their baby if they called 911 or went to the evil hospital. That's not an "option" -- that's just nuts.

IMO, if someone wants to have a "natural birth", fine, but stack the deck and have a doctor handy.

Looks like Carla Muhlhahn did not have one available and resisted common sense and just kept going.

also, people act as though having a baby is like having a spleen removed or something! as if it's not completely natural and takes it's own course. every other animal does it on their own, why not us

It's natural -- but "natural" is not the same as entirely safe. (Swimming with sharks is natural -- when they eat you, it's just nature taking its course. But it ain't what you might call a good idea.)

Women and children have regularly died in childbirth for tens of thousands of years. Where natural birth is a safe choice -- particularly where it's a safe choice as a first option, with medical backup available -- I don't think anyone has argued against making that choice.

Rather, people have argued three things:

1. That waiting three days with a baby in distress before calling the hospital is nuts.

2. That actively avoiding hospitals or acting like they're evil -- like the person who didn't want children born in "places of death" -- is also nuts. Hospitals aren't perfect -- but they're a very good choice for many women.

3. That a culture of mommy competitiveness that pressures women into having "natural" births is nuts as well. (Junior's personality is going to be shaped by his genes and his upbringing -- not whether the lighting he encounters when exiting mommy's hoo-hoo is bright or dim.)

If natural is what someone prefers, hey, that's cool. If things go pear-shaped (never has that expression been less well placed, by the way), I hope they call a doc. If things go well...great, but hopefully they won't be obnoxious about it to the mommies who chose a hospital. In the pantheon of good/bad parenting, where you plopped the bastard out is probably about the least important concern.

There was a really good homebirth study in the Netherlands this year of 529,000 women who birthed at home between the years 2000-2006

The outcomes were analyzed by planned place of birth. Specific information on reasons for transfer does not seem to be available, but 78.8% of those women who planned a home birth with a midwife had one, and 96.9% of those who planned to be attended by a midwife in a hospital did so.

"The authors found no statistically significant differences in the low risk of perinatal mortality between the 3 groups, at 0.35/1,000 for planned home birth, 0.57/1,000 for planned hospital birth with a midwife, and 0.64/1,000 for planned hospital birth with a physician. There were no deaths from 8-28 days of life. The authors also observed lower rates of obstetric interventions for planned home births with midwives than with either hospital group"

so in looking at these results, it is safer to birth at home!

FYI, i am a midwife in australia and a similar incident happened to a woman and babe in a private hospital with a private obstetrician. You don't find these headlines on the news do you? People need to do the research before they open their mouths...

sorry the births were all low risk women not all homebirths.

Oh, and here is a link re the 783,000 deaths in the US - (Deaths induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures)

http://www.ourcivilisation.com/medicine/usamed/deaths.htm

We could have an even higher death rate by using Dr. Lucien Leape's 1997 medical and drug error rate of 3 million. (14) Multiplied by the fatality rate of 14 percent (that Leape used in 1994 (16) we arrive at an annual death rate of 420,000 for drug errors and medical errors combined. If we put this number in place of Lazorou's 106,000 drug errors and the Institute of Medicine's (IOM) 98,000 medical errors, we could add another 216,000 deaths making a total of 999,936 deaths annually.

I probably wouldn't have my baby in a hospital

So here's something that isn't usually raised in the whole home-birth vs. hospital-birth debate that's worth keeping in mind. If you live in NYC and your home birth goes south for whatever reason, the time taken from dialing 911 to being in the OR is probably quicker than the time taken from your in-hospital birth going south to being in the OR. Or at least it's not any slower. Even in the hospital, the OR needs to be prepped, you need to be consented, people need to scrub -- this all takes time. And with a good midwife who has a hotline to a good OBGYN, this can all be happening while you're in the ambulance on the way to the hospital. The point is that being in the hospital isn't really a big advantage to being five minutes away from the hospital.

Now why this midwife/the family didn't head to the hospital after three days in labor is completely beyond me. Either the midwife is out of her mind (and these people are right to sue), or else she pushed for them to go to the hospital but they declined, only later thinking she should have "pushed harder" -- in which case they're douches.

Oby-gyns get their butts sued off left right and center every day too. Pretty soon women will have to deliver their own babies because no professional will bother anymore thanks to the vampire lawyers.

no, your statement has nothing to do with what I said

If someone wants to skip the hospital and have a home birth, that's fine, but the possibility of something going tragically wrong is part of the deal, you know? Don't try to blame the consequences of your decisions on someone else.

The world spins on uncertainty. Ultimately, we have to take responsibility for our own fate.

Dem cowboy I hope you die a slow painful death. I hope we cross paths someday.

Awwwwww, was that for me? Thank you for taking the time to show me something other than indifference. I don't know why you've decided that I should die slowly and painfully, but I definitely hope we cross paths too. From what I can tell, you need to be shown some humility, and I'm just the person to do it.

Asshole.

You are way too sweet to me, Felix. Thank you for your comment and remember that assholes are just like opinions... everyone has one; yours are particularly horrid due to the amount of bullshit running through your body.

I saw this couple on the Today show a few weeks ago.

I'm terribly sorry they lost their little girl.

That being said, IMO, they are just as responsible as the midwife. If that midwife isn't a doctor, then everyone there should have been ready to go to a hospital.

Hospitals weren't invented to diminish child birthing, but to save lives. When my wife gives birth to our daughter, we'll be in a hospital to give our daughter the best chances.

This story would make a great horror movie.

*AHEM* Being pregnant, with friends having used midwife birthing centers/home birth I have done some research...

There are MANY reasons to choose home birth over hospital birth; the #1 reason is CONTROL. In major metro areas, women like me choose a PRACTICE and whomever is on-call delivers the baby. We are supposed to see every MD at least 1x, but if it is a night/weekend the on-call is likely to be from a sister practice with "similar philosophy" that I have NEVER EVEN MET.

My entire pregnancy medical history is apparently in a packet which I am supposed to carry everywhere as my due date approaches so that Dr. X (mystery doc) has the info--I refer to this as the "Paddington Bear" method of delivery, where expectant mom lands in the hospital wearing her packet round her neck (always! with! you!) much like Paddington arrived in London with a note tied round his neck "please take care of this bear" in the classic children's story.

Add to that the disproportionate # of C-sections (a friend of mine had labored for only a few hours--not days--and monitors showed NO signs of fetal distress nor problems with position of baby--yet because she was overweight the doctor decided to do a C-section on the grounds her baby would be "too big" to come out normally--keep in mind ultrasounds give an approx. baby weight & as she was in a hospital this could have been verified--her son turned out to be small to normal weight/size) in hospitals and the fact that despite having a "birth plan" the OB's even TELL you that most of the birth plans get scrapped once you get to the hospital (what the OB's don't mention, I am sure, is that in your moment of stress if they or hospital personnel encourage you to do something by saying "it's for the baby's good" you do it).

As an example, many hospitals have relaxed their policies on labor and delivery position (half lying down in stirrups is not the ideal position and can make it take longer/hurt more in many cases--depending on the mom and baby's position, baby will ram into the pubic bone rather than slide under and out). BUT if you are "high risk" and/or use an epidural, you will be hooked to a fetal monitor around your belly that makes it impossible to move around/take a shower (which relieves pain for many women), with an epidural you get an IV and *constant* BP monitoring (which is annoying to painful), and you basically can't walk and probably end up with a urinary catheter....they don't allow food and drink no matter if your labor is 24 hours + due to possible C section and general anesthesia (total BS if you've already got an epi b/c they can use that to do a spinal block if you need a C section)...and if you can't walk or stand what position other than lying down can you deliver in?

If hospitals were more flexible I'm sure more people would choose delivery there...unless the situation is truly grave use the fetal monitor intermittently instead of all the time so a woman can walk around etc...only do C sections if positioning or the vital signs of baby or mom warrant, not because it's been "too long" (time varies widely esp. w/first babies)...

All of that said, birthing centers run by midwives (often very close to hospitals) offer a "middle ground" with a lot of features and choices for women. Many midwife practices do not accept high risk patients (a friend was just turned down for being overweight as that is a risk factor despite her excellent health otherwise and the fact that she has been working with a personal trainer improving her fitness for over a year). Good midwife practices also have relationships with doctors that can admit the mother to a hospital if necessary---and you know, even if not, call 911, if you come in an ambulance in distress in labor they can't turn you away even if you don't have a dr. who has admitting priv.!

No, I'm not using a midwife, birthing center or home birth. Because I've been on medications, I chose a hospital that has its own neonatal intensive care unit--JUST in case. However, I would like the hospital to do more to assure people like me that we won't end up with UNNECESSARY procedures.

You do realize that most of these things happen because of lawsuits just like this one, right?

Bingo. All those hassles are likely related to small risks of each phase of care. OB related lawsuit awards run into the tens of millions.

Skip the epidural and you'll probably avoid some of the CYA annoyances you've complained about.

Being in labor for three days is fairly common during natural childbirth. Its standard medical procedure in hospitals to induce labor (using pitocin) if labor doesn’t progress at a speed the doctor prefers. Pitocin kinda compresses the whole childbirth process from hours into minutes (so the dr. doesn’t miss his golf game!!). Additionally the reason drugs and epidurals are often used as they offset all the pain and pushing that is now compressed into hours instead of being managed over time. Many of the mother’s I know mention that all the yelling and screaming you see on TV comes after the pitocin as been applied.

I would suggest that anyone that wants a homebirth verify that their midwife has access to a hospital and have a clear, well thought out birth-plan with worst case scenario situations discussed. FWIW - our midwife did have direct access to a hospital and we met with a doctor just in case something bad were to happen.

As a person who had her water break, was given pitocin a day later and was in labor for over 12 hours before having her child get stuck in the birth canal and had to have a c-section. I can tell you that pitocin is by no means a wonder drug that assures your child will be born in minutes.

No doubt. I meant minutes in a relative sense.

Being in labor for 3 days is NOT common. And I know very few people who were given pitocin during their delivery.

When I write labor I mean the entire process including early labor, transition, and pushing.

Also, your friends are luckly. Pitocin is commonly used to induce labor when not progressing or slowing. As I understand it, many hospitals will start a pitocin drip if labor hasnt progressed significantly after 12 or more hours.

Medical doctors have been know to make similar mistakes. I had a friend who lost a child the same way because her doctor told her not to worry and it wasn't nesc. to go to the hospital yet. However I'm a big believer in listening to your gut and if something feels wrong then it probably is. Plus considering how much this midwife charges they could have afforded just to drop by the hospital to make sure everything was under control.

Perhaps this is also a reflection of a large number of American's who actually want a Nanny State. If you always rely on someone else to make the big decisions for you you never have to worry about making the wrong one yourself.

"Medical doctors have been know to make similar mistakes."

Not a helpful argument here, when they're suing someone for failing to get her to a doctor.

Or maybe the infant mortality rate went up because of the absurd number of c-sections and hospital-related interventions (epidurals, etc).

I would think a big part of your research into using a midwife would ensuring she has a connection to a hospital/birthing center/doctor. Babies almost never respect whatever birth plan you've created for it, there has to back up plans and discussions. I'm not going to judge the parents, they lost their baby and that's punishment enough.

While I certainly think that home births are not for everyone, especially high risk pregnancies, it's worth noting that the infant mortality rate in the U.S. is higher than most other developed nations. Home births are quite common in many other developed nations, with the U.S. being the leader in hospital births.

From Time Magazine:

About 99% of all births in the U.S. take place in hospitals, yet we rank 29th in the world in infant mortality — below Hungary and tied with Slovakia and Poland — with 6.71 deaths per 1,000 live births. That compares to a rate of about 3.5 deaths per 1,000 live births in Far Eastern and Scandinavian countries such as Singapore, Japan, Norway and Sweden.

Just sayin'...

Well, let's see why is that?

Singapore - has a universal health care system where government ensures affordability, largely through compulsory savings and price controls.

Japan - health care services are provided by national and local governments. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee.

Norway - maintains a Scandinavian welfare model with universal healthcare.

Sweden - also provide its citizens with universal health care.

United States - The United States is the only industrialized nation that does not have a universal health care system.

Gee, maybe having affordable access to healthcare could be a contributing factor to lower infant mortality?

There is a considerable disparity in infant mortality between countries that do have universal health care. I would bet that income and educational differences within a society play a huge part. Poor and/or uneducated people are less likely to put in the effort pre and post natal. Adding universal health care in the US is unlikely to lower the infant mortality rate dramatically or quickly without other cultural changes.

Or maybe the infant mortality rate went up because more women over 40 are attempting to have kids.

Another good point. Gothamist posters should run the world.

OK with me, but Bloomberg stays.

Nope, I'm pretty sure Mr. Shankly is closer to the truth. All the universal healthcare in the world won't make fat asses healthier. Our poor people have free health care and highier infant mortality.

Those high rates could have to do with babies here making it to full term that would be miscarried in less devoloped countries. Thats just a guess by me.

And the fact that a disproportionate amount of Americans are lazy fatasses.

Personal responsibility?

Poor baby, had to die because parents were so hip and with it.

Exactly. If a doctor saw that the baby was obviously taking too long, they would've gone through with a C Section ASAP.

The baby probably suffocated midway down her snatch. What a terrible way to die.

C-sections are for Republicans.

Shouldnt the parents be charged with a crime?

The parents? Probably not. On the other hand, I wouldn't be at all surprised to see an ambitious D.A. go after Muhlhahn.

How? If their negligence caused the baby to die before delivery, which is exactly what happened, I don't see any legal sanctions that can be made in the matter.

Perhaps the Midwife should sue for libel.

oh I see what you mean - baby wasnt born yet. not really a person yet. yeah i guess

I dont know anything about home births - but it reminds me of christian science parents refusing medical care fo thier children - they've been held accountable for it.

at some point the father has to step in and say something.

maybe he did and got brow beaten, who knows.

my brother in law went nuts when he was told his wife will need an episiotomy. same with the circumcision question, He adamantly said NO.

Easy for him to say.

why use a midwife?? they're just hippies in disguise as medical professionals trying to sucker you. use a REAL doctor.

And people wonder why there aren't any doctors practicing obstetrics anymore.

The NYer article is pretty damning.

This clown probably belongs in jail.

You beat me to it.

Maternal death during childbirth was common in the past. This could have turned out even worse.

There goes the Worst Parent of The Year award.

I don't know the whole story but both partiess seem to only be thinking of themselves here; that is midwife and parents. If you're stuggling in labor after 48 fricking hours, think of the baby before your damned will to impress all with your "natural birth". Does it make your vagina superior to all now that you've been in labor for three days with no medical assistance? Nice going. That was totally preventable.

By the way, my typing skills suck.

tragic but why wait 3 days? poor baby.

This is terrible, tragic, awful, all sorts of adjectives. But wouldn't you, at some point, think to take yourself to the hospital?

Much as I think some people take the homebirth thing too far, the midwife didn't cause this baby to die. YOU are responsible for getting to the hospital if your homebirth isn't going right. After two days they still didn't go to the hospital two blocks away? Then you are much more culpable than the midwife, it was your baby.

Sorry- were the McKenzies being held hostage by the 3 midwives?

Exactly, must have been. I assume they were being held at gunpoint and not being allowed to call 911. Why else would they, well... not call 911?

I don't understand why people want to give birth outside of a hospital. I have family members and friends who have had home births and it just seems so nuts to me.

I wouldn't let someone pull my tooth at home, I certainly wouldn't want someone yanking a baby out of my vagina at home either.

Without getting into all the reasons why I wouldn't give birth in a hospital I'll simple say, why would you want to bring a life into this world in a place of death. Look up the latin roots of hospital, it basically means place of death.

Not to pile on, but the Latin root of Hospital is the same as the Latin root for Hotel and Hospitality. It means "guest house" or "house for those in need."

Unless ancient Roman hotels resembled the one in The Shining, your etymology sucks.

Hate to pile on, but ABSORB's comment is indeed one of the stupidest things I've seen on the internet all day. Hospitals help people, they do not channel "Death" or "bad vibes" or "cooties" or anything else. Hospitals are staffed with serious health professionals who can avert catastrophe in the event of an emergency.

Yes, and women AND babies used to die in childbirth quite regularly. Isn't it nice to live in a world where you can choose to turn your back on all the medical advancements and take all those antiquated and charming chances with yours and your babies life?

If your building caught fire, would you refrain from calling the Fire Department for the same reason?

Yeah, because hospitals NEVER save lives. Quit with the semantics and the bullshit mysticism that dominates your life, and join the rest of us in the 21st Century.

after 24 hours - you should have gone to the hospital! gotten seen by a doctor and been given some options - I blame the family