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JermajestyDuggar

Unlicensed Nebraska midwife charged with homicide

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louisa05
Just now, Aine said:

Because it isn't that easy to find someone who will attend a home birth depending on the state laws, how much you can afford to pay them, and the availability of these 'birth attendants'.

There was a longford article in the Huffington Post not too long ago that I read at the time about the lengths women and midwives/birth attendants/whatever their qualification in the South go to in order to have some choice regarding their own care. For example, everyone meeting in a trailer park over the border in Georgia once the mother goes into labor where it is legal to homebirth.

While the article is very troubling and I would not personally make the choices these women do, I think the more concerning thing is that maternity care in many states is so poor (especially in rural areas of Alabama and all of Mississippi), maternal and infant mortality are higher than in many 3rd world countries in the hospitals, and women have limited options when it comes to their care.

https://highline.huffingtonpost.com/articles/en/alabama-midwives/

Having lived in the area where this woman is living, I can assure you that there are quality hospitals available throughout the area. Kearney (pronounced Car-knee, incidentally) has a population of 33,500 and a strong regional hospital. A college friend of mine is cardiologist there.  And certainly there is no lack of quality health care available in Omaha where this birth took place. Omaha is the main part of a metro area with a population of around 1.3 million. As the People article notes, the mother and baby were taken to the local University of Nebraska Medical Center, a world class health care facility. There are also ten other hospitals including a women's hospital that many people in the area choose for maternity care. 

There are areas of Nebraska without enough primary care doctors where access to healthcare is an issue. But the central part of the state where this "midwife" lives and the Omaha metro are where the parents live are certainly not in that area. 

I suppose if you badly wanted an unqualified midwife for a homebirth, you may be stuck with this woman. But it isn't for lack of good health care nearby. 

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Aine
Posted (edited)
9 minutes ago, louisa05 said:

Having lived in the area where this woman is living, I can assure you that there are quality hospitals available throughout the area. Kearney (pronounced Car-knee, incidentally) has a population of 33,500 and a strong regional hospital. A college friend of mine is cardiologist there.  And certainly there is no lack of quality health care available in Omaha where this birth took place. Omaha is the main part of a metro area with a population of around 1.3 million. As the People article notes, the mother and baby were taken to the local University of Nebraska Medical Center, a world class health care facility. There are also ten other hospitals including a women's hospital that many people in the area choose for maternity care. 

There are areas of Nebraska without enough primary care doctors where access to healthcare is an issue. But the central part of the state where this "midwife" lives and the Omaha metro are where the parents live are certainly not in that area. 

I suppose if you badly wanted an unqualified midwife for a homebirth, you may be stuck with this woman. But it isn't for lack of good health care nearby. 

I wasn't saying that Nebraska doesn't have good health care- just like there is decent enough care in the South too. What I am saying is that depending on Nebraska's laws, and my understanding is that planned assisted homebirths are illegal in Nebraska (as in a licensed midwife/nurse/medical professional), if you want to have a home birth for whatever reason then either you or the unqualified person attending are going to need to travel a bit maybe.

Edited by Aine
typo

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Tigerchild74
On 7/6/2019 at 12:23 PM, Cleopatra7 said:

I’ve heard of anti vaccine and anti doctors, but where does anti ultrasound come from? I guess if you reject hospitals and doctors, then you have to reject all the works that come from them, I suppose.

This has been around a long long time in 'natural birth/granola/' circles.  My oldest is almost 18, and there were tons of people in my attachment parenting groups that blamed ultrasound for all kind of diseases, intelligence loss, ect.  The same type of thing you hear tinfoil hatters talk about with power lines and the like.  I knew many people that planned to give birth in birthing centers or hospitals but refused all ultrasounds and looked down on those that had even just the standard 20 week one.  I always found it unintentionally hilarious that a lot of them used heartbeat finders (dopplers, that use ultrasound).  I can only imagine things have gotten more rabid since then.  

I also think that it can be incredibly cultish and hard to get out when you fall into a group that is bonded primarily by their lifestyle practices.  A lot of fundamentalists seem to have embraced the "natural" birth/avoid cesarean at all costs ideology (and it so totally is one), too.  That is a lot of pressure for very vulnerable people (I would call many pregnant women in these communities extremely vulnerable) to follow their guidelines.  It's not restricted to fundies, by any means, I remember the mom at the LLL meeting that visibly /recoiled/ from me when I explained my twins were delivered by planned cesarean, and even after she knew the story (TTTS, transverse position, prior emergency cesarean) it was very clear that she thought I was a shitty mom for not fighting harder to have a 'real' birth--and she was very NOT Christian fundamentalist, she was just super into AP and a few other groups.

 

So while I do get angry at the parents who permit this shit to happen, I have some empathy.  I still think they are partially culpable though.  It's like the parents who keep a loaded and unsecured gun in the house.  When their kid finds it and kills themselves or someone else, it is a tragedy, and I have a lot of sympathy for their pain, but it was NOT an "accident", it was /negligence/.

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JustEnough
Posted (edited)
On 7/6/2019 at 3:27 PM, JermajestyDuggar said:

On her blog she calls hospital births “birthing in captivity.”

Well I hope you enjoy living in captivity for awhile! 

This is what she posted on FB:

DE517DF9-BB3E-4F94-BC82-11D2F0C96F5E.jpeg

The message written over the ultrasound is obviously false but unfortunately she's not the only midwife out there who thinks it. Its a common belief (or at least the belief that ultrasound is dangerous is) among "Trust Birth" midwives. I read a book recommended to me by one when I was pregnant and there was an entire section on the supposed dangers of ultrasound to living things, especially developing embryos/fetuses.

I read it and rolled my eyes basically. I had a whole bunch of ultrasounds during that pregnancy. When any of my care providers said I needed one, I got one. I wanted to have (and my care providers to have) all the information we could have in order to have a safe pregnancy and birth.

Edited by JustEnough
Added a thought about my own care during pregnancy

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JermajestyDuggar
25 minutes ago, JustEnough said:

The message written over the ultrasound is obviously false but unfortunately she's not the only midwife out there who thinks it. Its a common belief (or at least the belief that ultrasound is dangerous is) among "Trust Birth" midwives. I read a book recommended to me by one when I was pregnant and there was an entire section on the supposed dangers of ultrasound to living things, especially developing embryos/fetuses.

I read it and rolled my eyes basically. I had a whole bunch of ultrasounds during that pregnancy. When any of my care providers said I needed one, I got one. I wanted to have (and my care providers to have) all the information we could have in order to have a safe pregnancy and birth.

One pregnancy I had a bunch of ultrasounds due to a possible kidney problem and then my other pregnancy I only had 2. I really don’t see a difference in their health or anything like that. My kids are fairly similar in health although their personalities can be pretty different. 

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Happy
PennySycamore

There was some concern in the early -mid 80s that ultrasound might be harmful to the developing fetus's ability to hear. (This was early in the ultrasound boom.)   That hasn't been shown to be the case.  I do know that I asked the CNMs and the OBs to use a fetoscope with my last baby.  I had plenty of ultrasounds though.  I was high-risk and needed plenty of sonograms, but I was fine with my caregivers using the fetoscope.  I didn't need to hear the heartbeat.  

A properly screened VBAC may indeed by safer than an automatic repeat cesarean which is major surgery.   A  breech presentation is one of the things that would rule out a VBAC as would multiples.  My daughter tried to have a VBAC with her second.  I still remember the call from my son-in-law when my daughter was in labor.  My granddaughter was footling breech and my daughter was about the be wheeled into the OR for a c-section.  Their third was an automatic repeat c-section.   Btw, the baby I referred to in the paragraph above was a successful VBAC after three (!) previous c-sections.  My OB had told me after baby number 3 where I had a unsuccessful trial of labor due to fetal distress (late decels) that I would have had no problem birthing an 8 pound baby. Baby 3 was 8 pounds 13 ounces; the VBAC baby was 8 pounds even.

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Katzchen24
On 7/7/2019 at 8:25 AM, Katzchen24 said:

It looks like there's a GoFundMe (look for Help the Nebraska Birth Keeper) to help raise money for her defence. It's raised just over $5000 so far. 

It looks like her GoFundMe appeal is no longer there. At least, I couldn't find it when I searched for it.

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jjmennonite

Does anyone here read skepticalob.com ? There’s a link to this story in the comments of her last post. She explores the misogyny of the natural birth movement, and presents a lot of statistics about how unsafe home birth is in the US compared to other countries. For some reason I read her blog almost as obsessively as I read FreeJinger. 

There is no glory in pain of any kind. Giving birth really hurts. If there is any safe pain mitigation, arrange it. An epidural sounds like the best. 

Giving birth used to be a very common cause of death. It still is in too many places. It’s sad when those places are in under served parts of our countries. It’s really sad when people deliberately choose to put themselves in danger. 

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Waffle Time
DarkAnts
56 minutes ago, Katzchen24 said:

It looks like her GoFundMe appeal is no longer there. At least, I couldn't find it when I searched for it.

Looks like GoFundMe ended it. I bet it went against their terms of use.

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Ozlsn
17 hours ago, Aine said:

I wasn't saying that Nebraska doesn't have good health care- just like there is decent enough care in the South too. What I am saying is that depending on Nebraska's laws, and my understanding is that planned assisted homebirths are illegal in Nebraska (as in a licensed midwife/nurse/medical professional), if you want to have a home birth for whatever reason then either you or the unqualified person attending are going to need to travel a bit maybe.

Yes my understanding of Nebraska's laws is that homebirth is legal, but attending a homebirth in a professional capacity isn't. So yes, you can give birth with attendants at home as long as those attendants aren't qualified in that field. (This probably explains the doula's statement about being a support person only and unpaid to boot.) So travel to somewhere homebirth with qualified midwives, going with someone completely unqualified or freebirthing are pretty much your options if you're set on a homebirth. 

I'd be interested to know how Nebraska's laws came to be that way - I'm wondering if it's partly a problem of insurance coverage (in Australia at least midwives are not covered by insurance for the birth or hour afterward but are indemnified for that time providing they follow NHMRC requirements), or something else. 

I do feel sorry for the parents and extended family, particularly the mother who was also cut up by someone with (as far as I can tell) no medical training and with no pain relief. That is the stuff of nightmares.

@jjmennonite yeah me. I started after a maternal homebirth death in my state which I was trying to find more information about. 

13 hours ago, JustEnough said:

I read a book recommended to me by one when I was pregnant and there was an entire section on the supposed dangers of ultrasound to living things, especially developing embryos/fetuses.

I had someone tell me they caused autism. Which was a total wtf moment for me, because it came out of nowhere as far as I could tell. Also my response was kind of "well... no idea if that's true but my baby survived because they were able to identify problems so..." (note to random people: please don't come out with this crap to people whose children are still in NICU. Not helpful.)

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JermajestyDuggar

The Bontragers live in Nebraska. The Bowers Bon girls both delivered at a birthing center with midwives. 

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Ozlsn
14 minutes ago, JermajestyDuggar said:

The Bontragers live in Nebraska. The Bowers Bon girls both delivered at a birthing center with midwives. 

Birthing centres are legal for midwives to operate out of - so maybe it's a minimum equipment requirement thing? (I really need to stop wondering and get some sleep.. although I still don't get the whole private members thing and how that would change anything. Especially when you're pretty much advertising the fact that you're illegally working as a midwife.)

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Pretzel
Posted (edited)

When I googled footling breech I stumbled upon this blog. 

https://katekennedybirthphotography.com/2017/11/06/the-footling-breech-homebirth-of-nylah/

The blogger/blog owner is a birth photographer, so she is probably not to blame* but it seems incredibly dangerous to me to deliver a footling breech baby in a birthing pool at home. They had a midwife there but only knew about the breech when the mom reached down to catch the head and only then realized it was a foot? On top of that, they were in the car and were not sure they were making it home within the next 30 minutes before they had their baby. It seems there was still enough time to prepare a birthing pool at home, though. My first intuitive reaction would be to go to the nearest hospital ASAP. 

From the blogpost it seems like they were all lucky, but Lord knows it could've been so different. 

My point being, I guess there are way more people in this world attempting risky births than we assume (and I am all for birth autonomy but only as long as it is safe for both mother and baby). 

*As this story was only told from the perspective of the photographer, I obviously don't have any information on what was medically going on there and about those people's circumstances, but the presentation of it on the blog makes it seem like delivering a footling breech in a kiddie pool at home is a cake walk and that is what I find incredibly dangerous. 

Edited by Pretzel
Added a thought

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Howl
Posted (edited)

I hate to be cynical, but I suspect that there have been deaths during homebirths gone wrong that have never been reported to authorities.  

On a happier note, How a Philly Ob-Gyn Ended Up Delivering a Baby Gorilla

Yes, they used an ultrasound to find the problem!  If you've never seen a newborn gorilla smiling....

Edited by Howl

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JermajestyDuggar

Braggie had a footling breech homebirth with her second twin. And she was lucky the baby is fine.

http://misformama.net/2012/09/5-things-thursday-birth-story.html

I think “midwives” like Angela Hock gain confidence in the lucky births. I bet she saw a footling breech homebirth that turned out ok. This made her more confident in her ability to deliver a footling breech. A good analogy is the people who say, “we never used car seats and seat belts when I was growing up and we turned out fine.” Those people got very lucky. Odds were not on their side if they had gotten into a car accident. So does that mean you never deal with the hassle of car seats? No. Just like going to the hospital for a footling breech May not be a wonderful experience, it’s better to be safe. I hated strapping my screaming toddler into a car seat every damn day. But I still did it for their safety.  

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danvillebelle

I really can't quite express how strongly I dislike the "natural homebirth as religion" crowd.  And not just because I had four un-eventful C-sections, either.  They're just...so self-righteously smug that all will go perfectly, when so many thousands of women around the world still die because of childbirth complications EVERY DAY.  And most of them are probably giving birth in the way these wackos claim is the "safest."

Start sending them to jail for these irresponsible actions.  Full stop.  

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JermajestyDuggar
23 minutes ago, danvillebelle said:

I really can't quite express how strongly I dislike the "natural homebirth as religion" crowd.  And not just because I had four un-eventful C-sections, either.  They're just...so self-righteously smug that all will go perfectly, when so many thousands of women around the world still die because of childbirth complications EVERY DAY.  And most of them are probably giving birth in the way these wackos claim is the "safest."

Start sending them to jail for these irresponsible actions.  Full stop.  

It’s the same smug attitude that anti-Vaxxers seem to have. They are so positive their children will never get a VPD and if they do, it will be NBD.

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VVV
3 hours ago, Ozlsn said:

.. although I still don't get the whole private members thing and how that would change anything.

It doesn't. These people think they can just make up their own rules and ignore the actual laws that don't suit them. They are wrong, and the fake midwife is about to find out just how wrong. 

@jjmennonite I read Skeptical OB too, and it was the first place I went after seeing the story here. Nothing makes Dr. Tuteur angrier than the unnecessary death of a baby.

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danvillebelle
3 minutes ago, JermajestyDuggar said:

It’s the same smug attitude that anti-Vaxxers seem to have. They are so positive their children will never get a VPD and if they do, it will be NBD.

Sadly, yes.  One of the anti-vaxx nuts I know feels her position was vindicated when all 3 of her kids got mumps and it was in her opinion NBD.  When someone pointed out to her that her sons could be sterile, she had no comeback.

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AmazonGrace
8 hours ago, Ozlsn said:

Yes my understanding of Nebraska's laws is that homebirth is legal, but attending a homebirth in a professional capacity isn't. So yes, you can give birth with attendants at home as long as those attendants aren't qualified in that field. (This probably explains the doula's statement about being a support person only and unpaid to boot.) So travel to somewhere homebirth with qualified midwives, going with someone completely unqualified or freebirthing are pretty much your options if you're set on a homebirth.

Why?? Why would it be more okay to give birth home alone or with your cousin and neighbor there than with somebody who knows what's going on?

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Ozlsn
1 hour ago, AmazonGrace said:

Why?? Why would it be more okay to give birth home alone or with your cousin and neighbor there than with somebody who knows what's going on?

No idea - which is why I'm curious as to how that legislation came to be. My honest best guess is that it was drafted in response to a tragedy - and it went a bit overboard in scope. I mean if you went into labour at home and were one of these extremely quick labour women* then I think you'd prefer to have the qualified midwife next door, or the ob across the street run over to help and check you out than Beryl from Accounting who gave birth four times and went to her grandkids births but really has no clue what to do if things go wrong.  Presumably there are exceptions for situations like these, and they're trying to target the unqualified people acting as midwives at planned births but it does seem a remarkably broad piece of legislation.

*there is a footballer's wife here who gave birth out of hospital three times, all unplanned. Her labours are excruciatingly short.

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Aine
7 hours ago, AmazonGrace said:

Why?? Why would it be more okay to give birth home alone or with your cousin and neighbor there than with somebody who knows what's going on?

I agree with @Ozlsn's reasoning.

That's why I was saying in above posts that besides misinformation being given to expectant mothers in many cases, I think the false dichotomy of birth supervised by an OB in a hospital vs a home birth assisted by an unqualified "birth guide" or whatever they want to call themselves is dangerous. Some states do it better than others and have more midwives in their hospital maternity wards or have equipped birthing centers staffed by midwives but for lower-risk women in many states, they really do have the options of those two extremes.

Birth trauma is also very real- my best friend here had a horrific hospital birth that could very well have been avoided had she had an attending midwife and nearly 2 years later, she is now being treated for PTSD. She had nurses/doctors barely give her an option around an epidural and they definitely did not educate her properly on the pros and cons of an epi (I come from a family of women who are all nurses and all have an additional midwifery qualification, although two no longer actively deliver babies as one went into psychiatric nursing and another is now a Director of Nursing). I have nothing against epidurals at all but I think a woman should be properly informed. My friend's epidural was given too early based on dilation, contraction strength and frequency. It was her first kid. The hospital did not want her moving around even before the epidural and she definitely couldn't walk or move after it. The maternity ward is meant to be one of the better ones in the state and it is not set up or equipped for much more than a woman delivering in supine position in stirrups. They also told her she couldn't walk down the hallways because of "duty of care" if something happened like someone walking into her or her falling over. By the time she delivered, the epidural had worn off, baby was in distress due to the length of the labor and not descending properly because of 8 hours in supine most likely, and nurses and doctors kept talking around she and her husband but not to either one. They told her to push even though she felt no pressure. Baby went into more distress. Performed an episiotomy without telling her what was happening. Tried vacuum and forceps. At that point, with no one communicating to either the mother or the father, they had a nurse assist in holding her down while the obstetrician put his hands in her and pulled the baby out. She tore all the way back to her anus. Baby was blue. No one told her anything. She started screaming and asking what was happening and one of the nurses told her husband to "Calm her down, NOW." My friend yelled at her husband to stay with their son. He ran after the team of people taking the baby from the room and she delivered the afterbirth and was being stitched without anesthetic by a nurse who kept telling her to "calm down" and the doctor would fill her in shortly. 

I have attended the births of my best friend's kids and my cousin's kids in Australia. I have given birth to my own stillborn daughter in Australia. I cannot imagine that kind of care there (not saying it doesn't happen, it's just worlds away from the teams of midwives and doctors I've experienced, observed, and heard about from others). Birthing in a lot of the US is not evidence-based and is more about maximizing convenience and control by medical professionals in order to minimize liability and it's not a good way to do it. There are different levels of risk based on the fetus and the mother and there should be some flexibility in the kind of care provided. Unfortunately, it often seems that some of the poorest states have some of the most dichotomous laws on the books that almost write trained midwives right out of birthing all together- no place for them in the hospital, no place at home. When making a 'choice' about where to give birth is also a financial decision in this medical decision and you only have two options, I can understand why some women pick dangerous options, especially when you have unqualified quacks promising them something that sounds so good at face value.

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Smee
On 7/8/2019 at 1:55 AM, Palimpsest said:

Sounds like Carri.  It was awful.  She did leave her abusive husband and was doing better.  But sadly she died quite recently.  Car accident.  He daughter notified us.  

And the incompetent "certified" midwife is still practicing in Indiana. 

Details and a good summary below, and the daughter's thread about her death was merged in here.

 

Thank you for this, I’m relatively new to FJ and hadn’t read this story. It’s heartbreaking.

 

I didn’t want an epidural for a couple of reasons with my first two births, none of which were because I thought there was anything special about enduring more pain. I also gave birth on all fours leaning over the bed three times, because that was where I felt most comfortable and in control, and I do think gravity did its part (& I recall learning something about it enabling a better pelvic shape or something). So I can totally appreciate wanting to avoid a birth where you’re put in stirrups and told to do what the OB says. If it was a choice between that and a homebirth, I honestly don’t know what I would have chosen. Knowing what I know now with PPH and a premature third birth, I would pick the hospital, but when you think you can beat the odds I can understand wanting to avoid being overmedicalised. I’m thankful that I had more options and was treated by midwives in a hospital right up until the moment an OB was needed, when a call was made and one appeared straight away. With baby #2 I didn’t see one at all.

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JermajestyDuggar

I feel like the happy medium should be a birthing center. Like I said earlier, the Bon/Bowers girls gave birth at a birthing center in Nebraska. If I didn’t want a hospital birth but also didn’t want a homebirth attended by an unlicensed person like Angela Hock, I would go to a birthing center with a licensed midwife. 

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Ozlsn

My ideal would be a birthing centre attached to a hospital. Qualified staff, a bit less medicalised environment (the one I was trying to get into had a pool, very relaxing environment - damn high risk pregnancy noped me out of it) but able to do checks etc - and a really handy button to push so the crash team can come running if everything goes really pear shaped. Problems can be identified earlier because you have staff who can bring in equipment (and there was at least oxygen in the one I looked at, but unobtrusively to one side) and expertise, which means that you can move towards different options if needed. Transfer times to theatres if needed are minutes and seconds, which lead to much better outcomes. It doesn't mean you won't end up with a traumatic experience - but I think it gives reasonable odds of a good one. 

I suspect this is part of what the legislation was trying to achieve - more birthing centres and fewer home births - but I suspect they'd have to put state funds into making them more accessible to everyone. And there was nothing to stop Angela Hock from qualifying as a nurse-midwife, getting a group of similarly qualified people together and opening a centre. (Well OK, time and money might have dissuaded her a bit).

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