Homebirth midwife Melissa Cheyney has a conflict of interest

Recently, I wrote about Melissa Cheyney’s role as the Director of Research for MANA (An open letter to homebirth midwife Melissa Cheyney). She presides over the project that has collected detailed information on approximately 20,000 homebirths since 2001 and she refuses to release the death rates to the general public. Dr. Cheyney, like other MANA board members has demonstrated contempt for patient safety by refusing to release the data.

Dr. Cheyney also has another role. She is Chair of the Oregon Board of Direct Entry Midwives and, as such, is in charge of midwife discipline and determining midwife scope of practice. In her dual roles, she has a serious conflict of interest. It is equivalent of the President of the AMA chairing the Medical Board of his state. In light of this conflict of interest, and in light of her commitment to preserving midwives’ reputations at the expense of patient safety, Dr. Cheyney should resign. Failing that, she should be fired and replaced with someone whose primary commitment is to patient safety.

Oregon is currently involved in controversy, and a lawsuit, over direct entry midwives scope of practice. The genesis of the controversy is a planned homebirth of a double footling breech, an uncommon breech position know to have a very high rate of neonatal death.

You might think that Oregon homebirth midwives would exercise extreme caution in planning a footling breech home delivery in light of a recent midwifery disaster involving a breech. As reported in the Register Guardian:

The call to paramedics came at 8:10 p.m., the instant midwife Anita Rojas realized the head of the breech baby she was delivering was stuck.

Twenty-one-year-old Kelsie Koberstein was swept up by medics in a blur of pain and fear.

Rojas rode in the front of the ambulance, with Koberstein’s mother and best friend rushing behind in their car…

On her back, her legs pushed up as high as they could go, she clutched the hand of a paramedic as if he were her only anchor to reality…

At Sacred Heart Medical Center, the on-call emergency room obstetrician-gynecologists, Drs. Elizabeth McCorkle and Brant Cooper, wasted no time.

As they instructed paramedics over the hospital radio, they learned this birth was going to be as difficult as they come: It wasn’t just a breech birth, but a “footling” – where a foot emerges first.

Just a few centimeters in width, a tiny foot might not open the cervix wide enough to allow the baby’s head and umbilical cord to pass through. If the head becomes trapped, the baby could quickly suffocate.

When medics pulled up to the doors, the doctors leapt into the back, refusing to squander precious seconds bringing Koberstein inside. The doctors had to turn Lucian’s head 180 degrees in order to free him, a move that took at least 20 minutes.

By then it was too late.

The infant was dead.

But undaunted by this disaster, the homebirth midwife embarked upon one of her own. Ultimately, the patient was transferred to the Oregon Health & Science University Hospital and underwent a successful C-section. Hospital employees filed a complaint against the midwife Jesica Dolin, alleging she violated professional standards by attempting a breech delivery.

And who was responsible for investigating that complaint? You guessed it, the Board of Direct Entry Midwifery, chaired by Melissa Cheyney. What happened?

The licensing agency recently withdrew the investigations of five midwives, after [their lawyer] refused to hand over medical records. The licensing agency also withdrew the case against Dolin, who said the withdrawals show the complaints were without merit.

How can we trust that the Board of Direct Entry Midwifery ended the investigation appropriately? How do we know that it was not an attempt to place the reputation of homebirth midwives above the safety of their clients? We don’t. These possibilities are especially disturbing in light of Dr. Cheyney’s dual role.

Dr. Cheyney should resign from the Board, or failing that, be removed by Oregon officials for an irreconcilable conflict of interest. She has already demonstrated her contempt for patient safety by refusing to release MANA homebirth death rates. She should not be responsible for monitoring homebirth practice, where patient safety is supposed to be the highest priority.