Unlicensed Nebraska midwife charged with homicide

[louisa05]

The legislation Hock quotes on her website doesn't explicitly say that unassisted home birth or home birth attended by an unlicensed practitioner is legal. I can't find any Nebraska legislation that says that. It simply says that midwives can only attend births in medical facilities like hospitals or birthing centers and not in homes or other places. I'm thinking the notion of unassisted home births or unlicensed practitioners attending them didn't factor into the law when it was written. 

It's a loophole that people like Hock went looking for and are exploiting here. 

[Aine]

14 hours ago, Smee said:

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).

I also had my 24 week stillborn daughter on all fours on the floor. They moved blankets or something fabric-like under me- it's all a blur so I'm not sure. The hospital I delivered in also had bars set into the ground to help support squatting and for a lot of the induced labor, that was most comfortable for me, or using one of those inflatable balance balls and holding the bar. My best friend back in Australia had her first on all fours on the bed and her second standing next to the bed. I have heard from many midwives that those positions are the best for opening the pelvis for delivery and when able to move freely, tend to be the natural position women settle into naturally. There are Australian Aboriginal cave paintings/carvings not far from where I grew up on Wiradjuri country that depict women birthing on all fours in what appears to be a running creek or river- that cave system is considered a place for "women's business" and that the women from my people used to go there to birth according to our oral traditions. There would have previously been running water through there but it's dried out now into more of a canyon but it is a sacred place in my culture. 

To clarify all of my above posts, I'm not anti-medicine or medical intervention in birth. I think the two most important things always are: 1) the safety of mother and baby; and 2) the mother having as much choice in their decisions as is safe and sensible. If a mother wants an epidural, give her that damn epidural and all the pain relief she wants. But I wish all of the aspects of childbirth were talked about more openly as a society and it wasn't the exception for women to have all of the risks and benefits of every choice explained to them factually in order for them to make informed decisions. I am very lucky for the cultural tradition of passing on thousands of years of knowledge on my maternal side from the Elders, and to have a paternal side who have discussed this stuff openly at the dinner table (both the medically trained and those that are not) amongst themselves since I was old enough to understand. It was never treated as though it was 'disgusting' or 'too much information' nor was it portrayed as mythically wonderful although it was given respect. It just was. I only discovered as an adult how unusual the amount it was talked about to me and around me was.

[Duggarite]

I am really sorry for those parents. 
In most European countries (myou do deliver with a midwife, at a hospital,  and the OB is called in case of any kind of problem.  The OB is at the hospital all the time. In case you have any complication the OR is down the hall and you get any procedure you might need quickly. 
 

The USA is the only industrialized country in the world that legally lets those untrained midwifes to practice.  They are laypeople that have witnessed some births and have no formal training at all.  In Europe,  Canadá,  Australia,  etc,  you need to have a midwifery degree.  It varies from country to country but the minimal training is often three years of university training.  In Spain you need to have a nursing degree (three years in university)  and then you specialize in midwifery for two years,  working at a hospital in the L&D unit.  So,  five years of training.  They are highly ttained,  highly Specialized and deliver high quality care.  Laypeople...  Not so much.

 

Of course the USA has also highly ttained midwifes,  but most of them would not perform homebirths.  For this mom in a country with a high homebirth rate such ás the Netherlands,  where you deliver with a property ttained midwife,  she would be risked out of homebirth because of VBAC and breech presentation. 

I think the main issue is letting those untrained people do that job.  That is not a problem in Europe,  where those jobs are highly regulated and is a criminal offense to practice midwifery without a license.  You basically go to Jail if you do so. 

 

[nelliebelle1197]

3 hours ago, Duggarite said:

I am really sorry for those parents. 
In most European countries (myou do deliver with a midwife, at a hospital,  and the OB is called in case of any kind of problem.  The OB is at the hospital all the time. In case you have any complication the OR is down the hall and you get any procedure you might need quickly. 
 

The USA is the only industrialized country in the world that legally lets those untrained midwifes to practice.  They are laypeople that have witnessed some births and have no formal training at all.  In Europe,  Canadá,  Australia,  etc,  you need to have a midwifery degree.  It varies from country to country but the minimal training is often three years of university training.  In Spain you need to have a nursing degree (three years in university)  and then you specialize in midwifery for two years,  working at a hospital in the L&D unit.  So,  five years of training.  They are highly ttained,  highly Specialized and deliver high quality care.  Laypeople...  Not so much.

 

Of course the USA has also highly ttained midwifes,  but most of them would not perform homebirths.  For this mom in a country with a high homebirth rate such ás the Netherlands,  where you deliver with a property ttained midwife,  she would be risked out of homebirth because of VBAC and breech presentation. 

I think the main issue is letting those untrained people do that job.  That is not a problem in Europe,  where those jobs are highly regulated and is a criminal offense to practice midwifery without a license.  You basically go to Jail if you do so. 

 

This woman did go to jail so I am a little confused by your post! She was operating under the radar.

[Glasgowghirl]

Here most Local NHS authority's if not all have dedicated qualified midwives who perform home births, they follow strict protocol on when to call ambulance's to the hospital. While tragedy's like this may still occur, it is a lot rarer.

My sister was told that she could try a natural labour with her oldest, baby was breech plus her waters had broke 10 weeks early, they had said they could try and turn him but it would still likely end in a c section. She decided to have an elective section with him and with my younger nephew she decided that she would book her c section and if she went into labour before it then she would try a vbac, that never happened.

[Foudeb]

Highly agree. Homebirths can be perfectly ok if things are low risk and the transfer to hospital is quick as things can become high risk Halfway through. Obviously you need a proper midwife (a trained one not a SOTDT one) to accompany you through it and potentially made the call to transfer you to hospital. The problem wasn't the parents who believed the person who told them what they wanted to hear but the midwife who was completely incompetent. 

Saying all births have to be highly medicalised is a bit misogynistic imho - yes complications during birth can be fatal but complications are rare when you leave women alone. Strapping them in the worst position imaginable to give birth in and hooking them to all kinds of loud beeping monitors with compulsory vaginale exams every so often, however, is not conducive to a complication-free delivery. It is not at all irrational to want to avoid that if you have a low-risk pregnancy and feel more relaxed away from hospital. Saying it is is tantamount to saying women are so badly designed our bodies can't work alone and we need a string of doctors to do the job for us. Even the language is misogynistic - doctors don't deliver babies. Their mothers do! While the doctors are present, which is a bit different. 

And before someone says that in the good old days of yore women died in childbirth all the time so we need that supine position and those monitors and constant medical interventions - no. Deaths in childbirth were due mostly to blood loss (easy to avoid today with it fluids and hormones to help deliver placenta and contract the uterus) and chiefly puerperal fever, ie infection after the actual birth - better overall hygiene, trained midwives who don't unnecessarily tear the vagina with blunt objects and mostly antibiotics in case of infection can take care of that. Both btw can be done by a midwife at a homebirth. 

Im not dissing doctors btw - they do save lives and we're lucky to live in developed countries where going to hospital to give birth even is an option. And if you feel safer and more relaxed at hospital then by all means do give birth there, even if low risk! 

[Duggarite]

7 hours ago, nelliebelle1197 said:

This woman did go to jail so I am a little confused by your post! She was operating under the radar.

She went to Jail because of the dead baby or because practicing midwifery?  I understood it was because of a death.  If I am wrong I do apologize.  The point is in Europe without proper training she would go to jail, we do not wait for anything bad to happen,  she could be reported by anyone and that's it. 

[nelliebelle1197]

16 minutes ago, Duggarite said:

She went to Jail because of the dead baby or because practicing midwifery?  I understood it was because of a death.  If I am wrong I do apologize.  The point is in Europe without proper training she would go to jail, we do not wait for anything bad to happen,  she could be reported by anyone and that's it. 

I think it would be both. She will be charged with practicing unlicensed medicine and probably homicide or negligent homicide resulting from the unlawful practice. I don't know the Nebraska criminal code so I am spitballing.

Edited July 12, 2019 by nelliebelle1197

[Duggarite]

7 minutes ago, nelliebelle1197 said:

I think it would be both. She will be charged with practicing unlicensed medicine and probably homicide or negligent homicide resulting from the unlawful practice. I don't know the Nebraska criminal code so I am spitballing.

In Spain this web page can put you in Jail in case you do not have a 5 year study midwifery degree.

https://www.nebraskabirthkeeper.com/about

 

 

[nelliebelle1197]

2 minutes ago, Duggarite said:

In Spain this web page can put you in Jail in case you do not have a 5 year study midwifery degree.

https://www.nebraskabirthkeeper.com/about

 

 

Thank gods and garters for Spain. I think it is 100% right.

[Four is Enough]

This woman says she wants people to make informed decisions about childbirth.

I'm betting she never addressed the actual risks that attend all pregnancies and births.

So how can they make an informed decision?

[Pretzel]

1 hour ago, nelliebelle1197 said:

I think it would be both. She will be charged with practicing unlicensed medicine and probably homicide or negligent homicide resulting from the unlawful practice. I don't know the Nebraska criminal code so I am spitballing.

I think what @Duggarite was trying to say is that in Europe (quite the generalization btw, as I can only speak from a German perspective, she from a Spanish(?) one, I guess) there are no gradations when it comes to the midwifery profession and degree. You either are one -- after you've completed a very hard-to-get-into tough medical program that requires several years of studying and endless amounts of practical training under the supervision of other midwives and OB/Gyns -- or you aren't one. There is no gradation of CNM, CPM, lay midwife, etc. You can't pull a Jill Dill (and whoever Jill's supervisor/mentor midwife was), and pretend to know what you're doing when you've never even set foot into a hospital environment to work for a longer stretch of time under much more challenging conditions, and be called a midwife still. What you can and can't do as a midwife is regulated nation wide (not on a state by state basis). In some European countries (maybe Sweden? maybe @elliha knows more about this), midwives are trained to the point where they can even administer birth control, IUDs, antibiotics, etc. In Germany, this falls within the scope of doctors and doctors only. In Germany, however, public insurance covers the cost of a midwife's  services for every pregnant woman. You can even choose to have your midwife do some control check-ups in turn with your OB/Gyn, she supports you from the early stages of pregnancy all through the birth and post-partum months, does control check-ups on you and the baby, helps with nursing/bottle feeding issues, colicy babies, PPD, etc. Even if you're all for the classic, medicated hospital birth, you can still benefit from having someone by your side to turn to when you have questions. Only few midwives still offer home births, though I'd assume it's less to do with the popularity of home births and more with the unbelievably high insurance policies. It's a huge issue that contributes to midwives gradually restricting their services to pre-natal and post-partum care and staying away from the actual births. The German birthing system is not designed for nurses and doctors to attend low-risk births, so there's an ongoing debate over understaffed maternity wards and how these issues could be solved. Women AND hospitals need midwives, if they can't afford the enormous insurance policies and need to cancel services like assistance at birth, I have no idea who's going to attend these births. There are certainly not enough OB/Gyns to attend non-pathological births. 

Some members outside the US have quite eloquently described their observations and I agree with some aspects of those. I am among those who got the impression that there is a much bigger discrepancy between the essential-oil-home-birthing crowd and the feet-up-in-stirrups-hospital birthers in the US than in other western countries. I really am not entirely sure why that is and would love to hear some opinions (or scientific stats). My guess is that many people feel the design of a hospital birth in the US is counter-intuitive to their human nature. A fear of lawsuits and liability must have set protocols in place with the result that some women are afraid of being robbed of their autonomy in a hospital birth. A birthing center can be a great alternative, yet  questions like what kind of medical personnel is going to be present at the birth, are birthing centers accessible in my area, and so on will further complicate the decision. Not to forget the enormous costs of hospital births for even very low-key, uneventful vaginal births, which many people struggle to afford. If you add all that together, then a home-birth sounds really appealing, doesn't it? In other countries in the western world, maternity wards seem less intimidating: Delivery rooms are welcoming places that remind of living rooms/bed rooms rather than hospital rooms, lights are dimmable and medical staff will only be called into the room if there's a medical concern, otherwise only your midwife (and partner) will be present to ensure a quiet atmosphere. Midwives and medical staff usually support giving birth in different positions or on birthing stools. Most L&D hospitals even offer rooms with special tubs for water births, and the list goes on. If that is what you usually associate with births, then giving birth with your feet up in stirrups with tons of medical staff attending, bright lights and noise sound very exhausting and traumatizing. 

To be fair though, how many people living in Canada/UK/central European countries/outside the US have actually given birth in the US? Most of us draw our knowledge from documentaries, TV shows, medical dramas, or anecdata. I would love to know if there are women in the US who have experienced hospital births that are far from the 'cold and sterile environment' prejudice that many of us non-Americans seem to have?! 

Edited July 12, 2019 by Pretzel

[elliha]

@Pretzel Yes, midwife is a form of specialized training that you can take as a nurse. You have to be a nurse first (3 years), work for at least 12 months full time and then it is 1,5 years further training and then you can become a midwife. They run most of the care for pregnant women and most births are handled by midwives and even when a doctor is present it is common that he/she takes more of a back seat role other than for the things that only they can do.

Also, if you get a pap smear, need a basic check up, birth control etc. you often go to a midwife. If they can offer the care you need they will, otherwise they will send you to a doctor. I have only had a doctor examine me for anything "vagina-related" when I was checked with my induction with my first birth, everything else has always been by a midwife. All prenatal care was done by a midwife (maybe the ultrasound is done by someone else but I never had a vaginal ultrasound, only the ones they do on top of your stomach) and that is the norm if you have a normal pregnancy and even with a more high risk one a midwife is involved for some things.

All vaginal births will have at least one midwife involved to some degree and most are entirely run by midwives. Most work in hospitals and most births are in the hospital but they can be anything from highly medicated ones with "everything" to no drugs at all and midwives should know how to support and handle all these types of births and anything in between. I think the most common type of birth in Sweden is in a hospital, with a midwife and with some type of pain relief but not an epidural (nitrous gas is popular). Midwives do not give epidurals but they can suggest them and they arrange for them to happen but I know little about them as I didn't have one for any of my births.

Sadly we don't have the same midwife in prenatal care and at our births (generally) but you have the same one for prenatal care and then depending on how long your birth takes, the same one as long as her shift runs (I had one for my second and three for my first that took 28 hours plus a couple of hours of prep for the induction). I would have loved to have had the same midwife for the birth too, but I would frankly have had to change to another person than both that did my prenatal care as I found them medically very capable but there was not the right chemistry for me to feel safe with them at birth. Out of the three I had with my first one was a bitch and I fought with her a bit, the second was OK and the third was absolutely great. The one for my second birth was a little more than OK but I found her a little annoying too. You can ask for another midwife at the hospital if you clash but I never felt it was bad enough to do so. The one I didn't like was when I was early into the induction and not in a lot of pain so I just told her off instead of switching. 

The system is not perfect but overall I have been satisfied with the care I got when pregnant and while giving birth and when I have contacted a midwife for other reasons. The only thing I have not liked is the advice on birth control but I am not sure this would improve with a doctor though. I feel some midwives are not very good at giving advice based on one's personal situation and choices and a fair portion tend to give very general advice. General advice is fine if someone asks about the method but we are all different and general advice doesn't always work for each person, methods are different for a reason and that is because we are different.

[nelliebelle1197]

@Pretzel I missed you and I miss your old avatar!

[Duggarite]

Yes,  Pretzel,  that Was the point.  You have written this much better than me. 

I have not experienced USA maternity care,  so I can not speak a lot about it,  it baffles me that lay people are attending births,  but that is pretty much all I can comment on. 

 

I gave birth in Spain and as I had a preemie and I had some serious complications it was a C-section and highly medicalized.  During my stay at the hospital CNMs (5 years training midwifes)  did take care of me and they did provide amazing care.  They worked together with OBs as a team and they did spot some problems that I had. 

 

A close friend of mine did have an uncomplicated vaginal delivery at the same hospital.  She did not see the OB at all,  delivered under the care of two midwifes, decided herself on an epidural,  was able and encouraged to change positions as she wanted and had her daughter without any kind of problem.  As I said,  it was an uncomplicated delivery,  her daughter was externalizally monitored the whole time and the OR was lees than one minute away. 

 

Basically in Spain ( and, generalizing, Europe),  you Can have a very crunchy style birth with all the needed stuff in case things go wrong at any point. 

 

[Cleopatra7]

I think that Americans, much more so than Europeans, are drawn in by the idea that anyone can practice medicine and degrees and certification are just the government getting in the way of eternal youth and happiness. I think it stems from the same impulses that drive uniquely American forms of Protestant fundamentalism: a distrust of experts, a belief that the Bible’s true meaning is “plain” and can be understood by anyone, and a desire to be as self sufficient as possible. In terms of medicine, this translates into distrust for medical professionals, distrust of modern medicine, the fetishization of “the natural,” a belief that cures for various ailments can be found through common substances/folk remedies/Google, and distrust of institutions like hospitals, medical labs, big pharma, etc. While I think these concepts are not exclusive to the US, I think there are more widespread due to our specific culture.

[Hane]

@Cleopatra7, exactly! One of my adult ed English students was a CNM in Poland. Her experiences sound much like those of European FJers who have commented here. 

I hate, hate, hate it when Certified Nurse Midwives (CNMs) get lumped in with these dangerous, unskilled  nutjobs. How is lay midwifery still a thing in the 21st century?

[FloraKitty35]

I am looking the NE laws here's what I found that pertains to this topic:

https://nebraskalegislature.gov/laws/statutes.php?statute=38-611

https://nebraskalegislature.gov/laws/statutes.php?statute=38-612

https://nebraskalegislature.gov/laws/statutes.php?statute=38-613

https://nebraskalegislature.gov/laws/statutes.php?statute=38-614

https://nebraskalegislature.gov/laws/statutes.php?statute=38-615

https://nebraskalegislature.gov/laws/statutes.php?statute=38-616

https://nebraskalegislature.gov/laws/statutes.php?statute=38-617

https://nebraskalegislature.gov/laws/statutes.php?statute=38-618

 

Edited July 13, 2019 by FloraKitty35
corrected abbreviation

[louisa05]

26 minutes ago, FloraKitty35 said:

I am looking the NB laws here's what I found that pertains to this topic:

 

 

It's NE. NB is New Brunswick, Canada. The distinction is important. I once had a big mess trying to rent a car because someone entered my address on the reservation as NB not NE. When attempting to pick up the car, I was informed I could not rent because the company didn't rent to foreigners. 

[FloraKitty35]

3 minutes ago, louisa05 said:

It's NE. NB is New Brunswick, Canada. The distinction is important. I once had a big mess trying to rent a car because someone entered my address on the reservation as NB not NE. When attempting to pick up the car, I was informed I could not rent because the company didn't rent to foreigners. 

My bad.  I should have double checked that part. I fixed it. 

Edited July 13, 2019 by FloraKitty35
added more to post

[SrMaryEloquentia]

@Pretzel thank you for your well-balanced comment. 

I used to work in a big hospital (Southern Germany) with a huge maternity ward. There were a lot of high risk, highly medicated pregnancies involving multiples, premature and sick babies, so there was a lot of high-end medical care going on. 

However, this hospital also catered to a lot of muslim women (Germans of Turkish descent comprise 10% of the population in this city). They wanted the safety of said high-end medicine, but also a private space to give birth. So they installed a midwife-run delivery room for uncomplicated birth. A doctor is only called when there is a problem - and then it’s a highly trained obstetrician and an NICU team who are just one floor away. I like that setup a lot, and would have given birth there any day, if I had been in that situation. 

[quiversR4hunting]

On 7/12/2019 at 4:26 PM, Pretzel said:

To be fair though, how many people living in Canada/UK/central European countries/outside the US have actually given birth in the US? Most of us draw our knowledge from documentaries, TV shows, medical dramas, or anecdata. I would love to know if there are women in the US who have experienced hospital births that are far from the 'cold and sterile environment' prejudice that many of us non-Americans seem to have?! 

I'm American and had 3 babies in the hospital.  I have visited at least 3 friends in other hospitals (2 different states) after having a baby. They all seem to be very similar. 

It is sterile (like all hospitals should be) but not cold. Private room, tub, ball, and all traditional equipment in the room. I have labored leaning over the bed, with a massage therapist rubbing my back (before epidural, after epidural had to stay in bed because of high fall possibly), labored on all 4s, gave birth on my back and on my side. Last child was a csection, the OR was cold and sterile (it's an operating room) but everyone was nice and lovely. I even happened to have a student nurse and since she wasn't doing anything so she snapped all sorts of pictures for us!

And baby #2, I was supposed to have a doctor deliver her but he had to go do an emergency csection for a midwife. So the midwife watched over me. She was born before the csection was done, midwife did great. Doc came back in time to help with stitches! He said it was the easiest birth he ever did

[JermajestyDuggar]

25 minutes ago, quiversR4hunting said:

I'm American and had 3 babies in the hospital.  I have visited at least 3 friends in other hospitals (2 different states) after having a baby. They all seem to be very similar. 

It is sterile (like all hospitals should be) but not cold. Private room, tub, ball, and all traditional equipment in the room. I have labored leaning over the bed, with a massage therapist rubbing my back (before epidural, after epidural had to stay in bed because of high fall possibly), labored on all 4s, gave birth on my back and on my side. Last child was a csection, the OR was cold and sterile (it's an operating room) but everyone was nice and lovely. I even happened to have a student nurse and since she wasn't doing anything so she snapped all sorts of pictures for us!

And baby #2, I was supposed to have a doctor deliver her but he had to go do an emergency csection for a midwife. So the midwife watched over me. She was born before the csection was done, midwife did great. Doc came back in time to help with stitches! He said it was the easiest birth he ever did

My regular OBGYN wasn’t present for either of my births. The first time she was on maternity leave herself. Her son was born premature while I was pregnant so I was switched to another doctor in the practice. I didn’t really like the other doctor much. I like my regular OBGYN so much better. The other doctor delivered my first. Then the second time around I just delivered way too fast and my OBGYN didn’t make it to the hospital in time. I have no idea what the doctor’s name was that delivered my second kid. He seemed nice enough. He was just the doctor on duty at the time I came in. My OBGYN was so sad she missed it and she knew this was my last baby so she would never deliver one of my kids! She’s the kind of doctor that really likes to connect with her patients. 

[quiversR4hunting]

@JermajestyDuggar my awesome ob/gyn didn't deliver any of my children. First time, she was on a severe medical leave for herself. #2 came super fast (2.5 hours in the hospital before she came), number 3 was too big so we had to schedule a csection and we didn't want to risk me going into labor before she could do the surgery so we scheduled it with another doctor the next day. I would have loved her in L&D, she is a wonderful caring doctor. The first time we met, I was having a miscarriage, She was tearing up while I was crying. She did my d&c and was very caring. 

[Pretzel]

@quiversR4hunting Just to clarify, I meant sterile as in a sterile atmosphere, as in a not very welcoming, rather uncomfortable, cold-ish environment. 

Sterile as in sanitized...I surely hope that any delivery room is a sterile place.