MO - Raheem Gardner dies during birth, midwife charged, 26 Oct 2009

[Filly]

I had a hospital birth, simply because I didn't want the mess in my own home -

What? You didn't want an inflated blow up pool in your living room?:waitasec: Come on WAD, all ya have to clean up is some boiling hot water and clean towels. They always call for that in the movies.

O.K. where is Ricky Lake when we need her? I know she wrote a book about this. If I remember correctly she was having a home birth, but had to be rushed to hospital at some point. I'll look it up.

Indeed as Izzy said babies have been born and died being birthed at home for eons. Hey, they are also born in fields of rice while a woman works. Child birthing IMO can be dangerous. For that reason I'm all for hospitals.

Belinda gave us a good example. Back in the day she wouldn't have made it nor would her DD. As for me I didn't mind some lady with what looked like a crocheting needle break my water. I didn't mind there was hardly any and I was going to have a "dry birth". Labor for me was a cinch for 18 hours. I had endometriosis that gave me more pain.

However, I was not happy about passing a big head out of my coochie. Even that caranial cap stuck onto my unborn babies head was no biggie. I got my C-Section finally. Finally. I have mad respect for every woman who has birthed a child vaginally.

2GoldFish you're my hero. Then again like they say second and third babies are easier to birth. I have no proof of that and no way did I want to find out.

Let's see I'll look if Ricky Lake weighed in.

 

[T-Rex]

Here's an article with a little more info:
http://www.news-leader.com/article/...fe-facing-criminal-charges-after-baby-s-death

After two days of labor, the parents asked if they should go to the hospital, and Diamond said she had things under control, but then minutes later told them to go.
The baby was born in the parents' car in the hospital parking lot, and delivered by an ER doctor.
The baby didn't die at birth, but it had brain damage; it died three days later in the hospital, when the parents took it off a ventilator.
Diamond is not a registered midwife, but a medicine woman.
She has had previous complaints about her midwife skills.

 

[WhyaDuck?]

What? You didn't want an inflated blow up pool in your living room?:waitasec: Come on WAD, all ya have to clean up is some boiling hot water and clean towels. They always call for that in the movies.

O.K. where is Ricky Lake when we need her? I know she wrote a book about this. If I remember correctly she was having a home birth, but had to be rushed to hospital at some point. I'll look it up.

Indeed as Izzy said babies have been born and died being birthed at home for eons. Hey, they are also born in fields of rice while a woman works. Child birthing IMO can be dangerous. For that reason I'm all for hospitals.

Belinda gave us a good example. Back in the day she wouldn't have made it nor would her DD. As for me I didn't mind some lady with what looked like a crocheting needle break my water. I didn't mind there was hardly any and I was going to have a "dry birth". Labor for me was a cinch for 18 hours. I had endometriosis that gave me more pain.

However, I was not happy about passing a big head out of my coochie. Even that caranial cap stuck onto my unborn babies head was no biggie. I got my C-Section finally. Finally. I have mad respect for every woman who has birthed a child vaginally.

2GoldFish you're my hero. Then again like they say second and third babies are easier to birth. I have no proof of that and no way did I want to find out.

Let's see I'll look if Ricky Lake weighed in.

I didn't know a terrible amount about human births, but I had seen a lot of calf pulling in my day... and I knew I didn't want that on my floors or bed.

 

[Belinda]

I respect the decision to have a home birth, but you better be darned sure the midwife knows what they are doing. Where did they find this woman? Who recommended her? Why didn't they check to see if she had a license? I am so sorry for what they have gone through, but it seems they put the life of their child in the hands of someone who was not capable and that makes no sense to me. Especially with a home birth, you have to be sure everyone knows what they are doing. I'm sort of mystified by this whole thing.

 

[2goldfish]

ah, goodness. I dont want to start a huge homebirth debate in this thread and if I comment on everything in that article then it's inevitable.

so I will just say that in my very humble opinion, 3 hours of pushing is a bit much to be comfortable with. although if I recall correctly I forum-know a girl who gave birth unassisted (herself, no midwife, intentionally) to a breech baby with several hours pushing and all was well. although to move a labouring mother in stage 3 labour who does not wish to be moved can also lead to problems.

I think it really depends on what the mother is comfortable with - if it was the mother's CHOICE that's nothing the same as the mother wanting to transfer and the midwife actively discouraging her. in 3rd stage labour there is no time to argue because it activates the fight or flight response which will terribly delay labour and I see evidence of that because the mother had the baby IN THE PARKING LOT so obviously her body refused to give up the baby until she felt comfortable.

the problem is, I cant explain all that I know about birth and homebirthing without starting a great birthing debate, as my lil one is 3.5 I thought that was all behind me


all that aside, could someone tell me if they know if practicing midwifery without a licence is legal in that state? because that is most likely the problem here. no matter what I or any other homebirth supporter says, in a state that doesnt allow it or doesnt allow it with unregistered midwives, this is a null argument on my part.


and I have not lost sight of the tragedy that was a baby born not healthy and was lost.

 

[WhyaDuck?]

ah, goodness. I dont want to start a huge homebirth debate in this thread and if I comment on everything in that article then it's inevitable.

so I will just say that in my very humble opinion, 3 hours of pushing is a bit much to be comfortable with. although if I recall correctly I forum-know a girl who gave birth unassisted (herself, no midwife, intentionally) to a breech baby with several hours pushing and all was well. although to move a labouring mother in stage 3 labour who does not wish to be moved can also lead to problems.

I think it really depends on what the mother is comfortable with - if it was the mother's CHOICE that's nothing the same as the mother wanting to transfer and the midwife actively discouraging her. in 3rd stage labour there is no time to argue because it activates the fight or flight response which will terribly delay labour and I see evidence of that because the mother had the baby IN THE PARKING LOT so obviously her body refused to give up the baby until she felt comfortable.

the problem is, I cant explain all that I know about birth and homebirthing without starting a great birthing debate, as my lil one is 3.5 I thought that was all behind me


all that aside, could someone tell me if they know if practicing midwifery without a licence is legal in that state? because that is most likely the problem here. no matter what I or any other homebirth supporter says, in a state that doesnt allow it or doesnt allow it with unregistered midwives, this is a null argument on my part.


and I have not lost sight of the tragedy that was a baby born not healthy and was lost.

In the article, the chair of the certification board said, "if you call yourself a midwife, then you are," so I take that mean that it is indeed legal in that state. I agree that that is the major problem in this story for me - along with the fact that the midwife had other complaints recorded prior to this.

And I am actually kind of pleasantly surprized there isn't more debate on home birthing and such than what we are seeing. Most people seem pretty open minded about it, so far. I don't see much by way of "don't do it" - just people discussing what they did, and how they personally feel for themselves.

(My admission that I am personally too lazy to contemplate the clean up after a birth in my own home was in no way an attempt to invalidate the home birth option for others, as if I even had that power. FWIW, I totally agree that freedom of choice is far more important than the particulars.)

 

[WhyaDuck?]

Here's an article with a little more info:
http://www.news-leader.com/article/...fe-facing-criminal-charges-after-baby-s-death

After two days of labor, the parents asked if they should go to the hospital, and Diamond said she had things under control, but then minutes later told them to go.
The baby was born in the parents' car in the hospital parking lot, and delivered by an ER doctor.
The baby didn't die at birth, but it had brain damage; it died three days later in the hospital, when the parents took it off a ventilator.
Diamond is not a registered midwife, but a medicine woman.
She has had previous complaints about her midwife skills.

Thanks! That does clarify the case a lot. I was quite upset about the idea that she had disregarded the mother's wishes. Now I am left only to be upset that there weren't better certifications in place.

Seems to be just a tragic combination of a difficult birth and a not-so-competent practitioner. I am very sorry that nothing was done about her previous complaints - enough to stop her or retrain her, at least.

Certification processes don't have to be exclusionary or draconian - but the mandatory training/refreshers, references/credentials checks, periodic inspections, and a complaint board that go along with licencing would be a good safety precaution, IMO.

(ETA: Here, doullas can practice without a licence, although there is an official guild they can join, but midwives are required to be licensed. Just wanted to clarify my own experience point to put my opinions into context.)

 

[WhyaDuck?]

Another thought - it seems like the baby's brain damage (and eventual tragic death) was caused due to lack of oxygen during such a long pushing period. Basically, he was suffocated by the cord (it was wrapped around his neck, but, more importantly, the cord itself was likely crimped/stopped off which didn't allow him to get resources through the placenta).

My question here: I wonder what equipment this midwife had.

I personally don't agree with the policy of some hospitals to attach a constant fetal monitor, as this hampers the woman's ability to move, which prolongs the birth and increases the pain. However, periodic fetal monitoring would seem like a given during such a long pushing session - this would have let them know the baby was in trouble, I should think. (Though, granted, I don't know a whole lot about the process.)

From what I know, most midwives around here come equipped with portable fetal monitors so they can spy on the baby from time to time, and see how s/he is faring in there. I wonder if this midwife was able to do this, and if so why she ignored the fetal distress, and, if not, why on earth not?

These are the types of things I think certification and inspections might be able to help with, just to give an example to clarify my concerns.

 

[LadyL]

I'm still trying to understand the involuntary manslaughter charge. Does that mean she knew or should've known the baby was in trouble and showed reckless disregard for his life or something? I'm confused.

 

[Apostapler]

What? You didn't want an inflated blow up pool in your living room?:waitasec: Come on WAD, all ya have to clean up is some boiling hot water and clean towels. They always call for that in the movies.

O.K. where is Ricky Lake when we need her? I know she wrote a book about this. If I remember correctly she was having a home birth, but had to be rushed to hospital at some point. I'll look it up.

Indeed as Izzy said babies have been born and died being birthed at home for eons. Hey, they are also born in fields of rice while a woman works. Child birthing IMO can be dangerous. For that reason I'm all for hospitals.

Belinda gave us a good example. Back in the day she wouldn't have made it nor would her DD. As for me I didn't mind some lady with what looked like a crocheting needle break my water. I didn't mind there was hardly any and I was going to have a "dry birth". Labor for me was a cinch for 18 hours. I had endometriosis that gave me more pain.

However, I was not happy about passing a big head out of my coochie. Even that caranial cap stuck onto my unborn babies head was no biggie. I got my C-Section finally. Finally. I have mad respect for every woman who has birthed a child vaginally.

2GoldFish you're my hero. Then again like they say second and third babies are easier to birth. I have no proof of that and no way did I want to find out.

Let's see I'll look if Ricky Lake weighed in.

Ricki Lake did more than that, She was in a documentary about home births, which I've seen. And you see it all, let me tell you. If you're interested, check out "The Business of Being Born." I liked it a lot, other than the um, extreme details.

I have no problem with home births and I hope that I would be able to have one in the future. My aunt gave birth to 5 of 7 at home (with the twins she was pre-eclamptic- to the hospital no problem they went!) and I would feel fine with a medical professional present, provided we had a very clear understanding of how much is TOO much to handle at home and when to get to the ER.

Two things that bother me:
1) Why didn't the parents do their homework, why would you ever choose someone not certified??
2) I agree with everyone else that the woman should also be charged with fraud. There needs to be better regulation for those who pass themselves off as professionals.

 

[Tuffy]

Ricki Lake did more than that, She was in a documentary about home births, which I've seen. And you see it all, let me tell you. If you're interested, check out "The Business of Being Born." I liked it a lot, other than the um, extreme details.

I have no problem with home births and I hope that I would be able to have one in the future. My aunt gave birth to 5 of 7 at home (with the twins she was pre-eclamptic- to the hospital no problem they went!) and I would feel fine with a medical professional present, provided we had a very clear understanding of how much is TOO much to handle at home and when to get to the ER.

Two things that bother me:
1) Why didn't the parents do their homework, why would you ever choose someone not certified??
2) I agree with everyone else that the woman should also be charged with fraud. There needs to be better regulation for those who pass themselves off as professionals.

Why would she be charged with fraud? The article says midwives are allowed to call themselves midwives without having any type of certification. So, I'm guessing that she didn't misrepresent her credentials.

Also - Right off the bat, I posted kind of an anti-midwife rant. I guess I want to back off of that a bit because this has become a good discussion without being a debate on the merits of hospital vs. home births.

 

[Tuffy]

I'm still trying to understand the involuntary manslaughter charge. Does that mean she knew or should've known the baby was in trouble and showed reckless disregard for his life or something? I'm confused.

I was wondering this, too. I looked up involuntary manslaughter:

Involuntary Manslaughter

Involuntary manslaughter is the unintentional killing of another person. The death is usually caused by some careless action on the part of the accused. Involuntary manslaughter is considered a lesser form of manslaughter because of the lack of intent. Therefore, the punishment is usually less than murder or voluntary manslaughter.

There are multiple situations in which a person may be killed by another unintentionally. Involuntary manslaughter is usually divided into two categories:
Unlawful act manslaughter
Criminally negligent manslaughter

Unlawful act manslaughter is the unintentional killing of another while committing an unlawful act. The unlawful act is usually a lower level crime, such as a misdemeanor. This is different than felony murder. A felony murder is when a person is killed during the commission of a felony.

Criminally negligent manslaughter is the unintentional killing of another due to serious negligence or recklessness. This occurs when a person fails to perform a duty owned to another, which leads to death. For example, professionals, such as doctors, have certain duties to their patients. A doctor may be charged with criminally negligent manslaughter if a patient dies because of the doctor's failure to perform his duties.

I think the parts I bolded are the likely reasons in this case.

 

[2goldfish]

argh I still cant say anything without going off on a spiel about medical births vs homebirths.. I keep trying but I really cant.

I thought a lot about this thread since I posted last night. as you guys may have figured it's a particular passion of mine. but I dont think this is the place for it esp as we dont have nearly enough info for any of us to decide.

I'd like to say that I deeply appreciate all of you right now. I have met with vicious and horrible opposition to my choice to birth at home and it's well normal over here til it was over with and all was well. any other forum I would have expected the same onslaught of opinions about midwives and homebirths in general that I have seen many times before and I havent seen any of that at all here. I like that very much


I too agree with women's right to choose the best for the birth of their baby. in the US in particular it can be difficult if not illegal due to medical lobbying against homebirth if someone wants one. as my MIL puts it, she WANTED doctors, she WANTED help, she like someone else up there didnt want to clean a mess :biglaugh: and that's fine. I just think women should understand the merits of all before choosing out of ignorance or feeling forced to do things she isnt comfortable with


and that goes for this midwife if she kept the mother at home when the mother did not want to!

 

[WhyaDuck?]

Why would she be charged with fraud? The article says midwives are allowed to call themselves midwives without having any type of certification. So, I'm guessing that she didn't misrepresent her credentials.

Also - Right off the bat, I posted kind of an anti-midwife rant. I guess I want to back off of that a bit because this has become a good discussion without being a debate on the merits of hospital vs. home births.

BBM

I think that depends on what she told them, and what they can prove she said - she did represent herself at the ER as a certified midwife when she is not, so it is likely she did that elsewhere, as well.

 

[rosario]

midwife or not, in our contemporary world, most levels of socities know about 911 and it is scary to be in labor (especially your first) you are very trusting of anybody thats helping you, but 3 days in active labor not just mild contractions is very worrisome to me. gold bless all involved..

 

[nyc]

I used to live in Missouri and I know they have had horribly backward laws regarding midwives for years--it only became officially legal to use a midwife for a birth in the last several years! Before that, you could have a home birth with a midwife, and while probably no one would prosecute you, it was not technically legal. Because of this, no midwives were allowed to deliver in hospitals at all, which forced anyone wanting a hospital birth to be subject to a the much more medically-oriented approach to giving birth which is the standard American hospital approach (something which, btw, has led to the US having one of the higher infant mortality rates in the developed world).

As a result of these years of midwifery being illegal in Missouri, when they finally changed the laws, it was still impossible to find a midwife who could do a hospital birth, because no hospitals would agree to work with them. So the law was changed, but the reality was still the same. I don't know how much the situation has changed in the last few years since my friend was researching it for her birth in St. Louis, but I doubt it has improved much. Doctors and hospitals don't want the competition from midwives who charge a lot less and don't produce so many expensive C-sections.

I bring this up in this sad context because I wonder how much this history in Missouri has affected the possible lack of regulations regarding midwife training and qualifications--it also may have affected how many experienced midwives are available in Missouri, since it has been so difficult for them to build practices there.

It is so heartbreaking to think of this couple in this terrible situation without a trained and experienced midwife. This sounds like one of those situations for which a C-section is a welcomed salvation.

I'm afraid that a story like this will only bolster Missouri's efforts to exclude good midwives, when it may be possible that those efforts helped create this situation to begin with.

I delivered my first child here in NYC in a hospital with a midwife, who was great to work with. But unfortunately, being in the hospital meant that I was still subject to a number of unnecessary and unwanted interventions that made it a much more difficult experience than necessary. I delivered my second child at home in NYC with an experienced and certified homebirth midwife. The homebirth experience was better in every way to the hospital birth. I am so thankful that I live somewhere where I have the option to choose from a wonderful group of highly experienced homebirth midwives who have good relationships with hospitals and clear back-up plans in place when necessary.

I would never argue that anyone should have one kind of birth over another, but I think it is a great shame that in this country there are many places where women are not able to choose the safest birth option for them if they want it. In a low-risk pregnancy, a homebirth with an experienced midwife can often be the healthiest option for a mother and baby, and both that and midwife assisted hospital births should be legal and available everywhere, IMO.

I feel so sorry for this poor family and the guilt and grief they must be facing.

 

[ohiogirl]

In the probable cause statement it states that she had been banned from the practice of midwifery in Colorado. I am sure the parent would have liked to know this before choosing her.
So sorry for the baby.
http://www.news-leader.com/article/...fe-facing-criminal-charges-after-baby-s-death

 

[mom2six]

Ahhh, can't pass this one up. I am horrified for this family. I am horrified for the midwife. Sounds like a complete train-wreck for all involved. I have read enough of these stories from all the different perspectives to know that the media rarely gets the story straight when dealing with home birth. It's too easy to sensationalize and vilify. Prayers to all.

I have studied midwifery myself for over 10 years. I have done all the CPR, NRP, book training, workshops, and almost 2 years of apprenticeship. I stopped apprenticing a couple years ago when my youngest was born, father-in-law died in his fifties, and some situations cropped up with my kids that needed focused attention. I decided that balancing midwifery and motherhood is too difficult. So, I have a bit of a perspective on this.

Certification, in and of itself, is not the be-all end-all of hiring a midwife. Credentialing may show what you know, but it doesn't appraise how good a midwife you really are. MO is a hot button state for the past year or two. They had blocked allowing a well researched, level headed law to be allowed out of committee for a loooong time. Finally, a legislator who supported legalizing midwifery slid a line into a health insurance bill, and poof! instant legalization, no restrictions.

But, one of the hallmarks of midwifery care in this country is the sharing of responsibility between the midwife and the parents. It is soooo important for parents to know this. A midwife attends and gives her educated opinion, but the parents should be in the driver seat. They need to do their homework in advance, and they need to read and study to be good candidates for home birth.

On a personal note, after our first child was born in the hospital, I wound up with a terrible uterine infection. I learned later, procedures like internal fetal monitoring can increase risk of infection. In addition to other factors related to hospital birthing, we decided before even conceiving again that we would have home births. Second baby was born at home, but after apprenticing with this midwife for a short time, I decided she took too many risks with client after client. Third baby, we chose a different midwife. This labor was quite different from my first two, which were pretty straight forward 8 hour births, but I pushed 4 hours with #2 due to her funky head position. At 7 hours into labor, I started to feel slightly pushy, but was afraid of pushing because of the last experience. I should have listened to myself, but I listened to my midwife who encouraged me to push before she'd verified I was fully dilated. Unfortunately, I wasn't. After 6 hours of pushing and trying desperately not to push on a swollen cervix, I decided enough, and took myself to the hospital, despite my midwife's insistence that all was fine. I allowed a bolus of medication in my epidural space, which is just a shot rather than a continuous pump. This took enough feeling off to allow me to stop pushing and my cervix to unswell so that I could deliver my 10lb 14oz baby. I had regained enough feeling I could even squat again. Following this birth, I have learned that I'm in charge of me, and I don't push until I can't not push. All my other babies have been born in 4 hours or less from first contraction, 1 to 3 pushes. I have also found a wonderful midwife, who may live a little further away, but I feel completely comfortable allowing her to share my responsibility as a parent birthing babies. My point in sharing my own stories, is simply to show that parents are not held against their will by midwives at home. If they feel the hospital is necessary, they can make that decision.

I am sure all involved will be second-guessing themselves for years to come. I don't know that it can be proven that this child would have lived in different circumstances. Some babies suffer brain damage prior to labor, which can alter labor, prolonging it. A healthy labor requires the baby's active involvement. The stories in the media do not include enough detail to know if the midwife really was negligent. But, I am sure the political climate will call for her head.

Which brings up my last point, in this very long-winded post (I apologize!!). In many areas of the country, perhaps even most of the country, home birth transfers are not handled with respect by the hospital staff and midwives are often disparaged to the point of jeopardizing the health of the patients. This sort of attitude makes making a transfer decision more difficult than necessary. Parents feel they will get inferior care because of bias, midwives may or may not be allowed to be further involved in care. Sometimes a midwife's labor charts will not even be acknowledged, leaving the staff clueless as to the client's medical and labor history! In other countries (Great Britain, The Netherlands...), much smoother transfer processes have been implemented for the well-being of all involved. The politics of birth in this country should not be given a free pass when these stories emerge. Take the condescension in the tone of these stories, about the woman "calling herself a midwife"...

God bless you if you read all this!! LOL

 

[mom2six]

However, periodic fetal monitoring would seem like a given during such a long pushing session - this would have let them know the baby was in trouble, I should think. (Though, granted, I don't know a whole lot about the process.)

Standard of practice would be to listen directly after every other, or every pushing contraction. It is normal for heart beat decelerations to occur as the baby descends and crowns, but this shouldn't be allowed to become prolonged if decelerations are happening. There are means of getting babies out quickly if the midwife really needs to.

Also, one comment on the clean up. Midwives take care of the cleanup, other than taking the trash to the curb on trash day. They even start the laundry. Pools, though, are usually parents' responsibility.

 

[technicalconfusion]

I know that I wouldn't personally have the gonads to have a home birth, but I respect those who do. I ended up with an emergency C-section as we were both in trouble at that point. My hips were not wide enough to allow her to pass (TMI), so we would have both died otherwise. However, you can be transported to a hospital if complications arise. It's a very personal family choice and I can see the advantages of each.

I don't have the gonads to even go into labor. I was scheduled for a csection from the get go and was happy with that. I wasn't happy that the docs refused to knock me out - I'm a huge wimp you see.