What are the odds that the peer review of Texas homebirth midwife Gina Phillips will be a whitewash?

Paint Can and Paintbrush

Gina Phillips, the homebirth midwife who was supposed to be at the labor of baby James‘ mother, but was home “resting” instead, will be the subject of a homebirth midwifery peer review next week.

It’s difficult to learn the details, because this process, which is supposed to be a form of accountability and a way to improve safety, is shrouded in secrecy by Texas homebirth midwives. But I’m going to go out on a limb and make a prediction. Despite alleged grievous negligence:

  • she reportedly left a VBAC patient who had been labor more than 24 hours under the care of her student while she went home;
  • the patient’s excessive bleeding was allegedly reported to her by phone, but she told her student it was normal;
  • the patient allegedly experienced an abruption;
  • transfer was delayed so long that the baby allegedly suffered a catastrophic brain injury and subsequently died;

I predict that the peer review will be a thorough whitewash, with minimal if any consequences for Phillips, and no new standards that will bind other homebirth midwives.

What is supposed to happen during clinical peer review?

According to Wikipedia:

… The primary purpose of peer review is to improve the quality and safety of care. Secondarily, it serves to reduce the organization’s vicarious malpractice liability and meet regulatory requirements… Peer review also supports the other processes that healthcare organizations have in place to assure that physicians are competent and practice within the boundaries of professionally-accepted norms.

Peer review is not a morbidity and mortality conference where anyone present can contribute to analysis of the case. Peer review is a formal process in which reviewers are carefully selected, documents and information are introduced and the person who is the subject of the review can explain why he or she chose a specific treatment course.

I have been told that the plan for the peer review of Gina Phillips is that she will be reviewed by other midwives who are there to have their own cases reviewed. If true, that would be horrifying. As mentioned above, I would like to obtain definitive, official information about the way that this review will be conducted, but there is no official information. The process appears to be entirely informal, random, and obviously biased.

It is, of course, rather difficult to hold a homebirth midwife to specific safety standards when their national organization, the Midwives Alliance of North America (MANA), rejects ANY safety standards, preferring to leave the determination of safety up to each individual midwife. Presumably that means that if a homebirth midwife thinks abandoning a VBAC patient during a prolonged labor to go home and “rest” is safe, then it is safe.

These stories of egregious practice by homebirth midwives are replayed again and again, and babies die as a result. Homebirth advocates like to pretend that such midwives are outliers and every profession has “bad apples.” I predict that this peer review is likely to reveal that there is no such thing as a “bad apple” in homebirth midwifery, that the real purpose of homebirth midwifery peer review is to exonerate the midwife in question, and that dead babies are merely excusable collateral damage.

If a homebirth midwife faces no consequences or minimal consequences for literally abandoning a high risk patient in labor, then there are no standards in homebirth midwifery at all.

Let me speak directly to those in charge of the Texas homebirth midwifery peer review, whomever they may be:

We will be watching the outcome of this peer review. I hope that you will prove me wrong and recommend major curtailment of practice or even surrender of license in this case. We want James to be #notburiedtwice, first by his parents, and then by the homebirth community, which typically acts as if dead babies are just an unavoidable cost of doing business and require no response beyond a slap on the homebirth midwife’s wrist, leaving her to go forth and preside over other homebirth disasters and deaths.

Don’t whitewash the death of baby James.

  • Mapat

    I am appalled at what I have read about Gina. As a wife of a physician in New England, my daughter who resides in Texas, had Gina as her midwife….She had a horrendous experience…and in my view it was malpractice..plain and simple. I am grateful that mother and baby survivied!!! There must be something done to police this situation using real doctors and medical professionals. I am so grateful for Dr. Amy bringing this to the light!

  • MLE

    Is there anything someone in the DFW area can do? I hate feeling impotent!

  • Renee Martin

    There IS one occasion when these reviews actually do something, like take away, suspend, or revoke a license, and punish MWs with fines:
    When the board, and the HB community, does not like the MW!
    Easy as that.
    One MW in TX got revoked or suspended for a long time (can’t recall) because of paperwork errors. No deaths or injuries. All because she wasn’t one of the in crowds. I suspect she was less of a fanatic. I learned this when Faith Beltz was given a slap on the wrist for killing Aquila P, and looking into other actions they have taken.

    If they like you, or you are part of their club, well, kill away! You won’t even be asked one hard question,. just lauded for your bravery, and asked if you are doing self care. Wish I was kidding.

  • birthbuddy

    The standard escape clause in New Zealand was ‘the midwife has no case to answer as she was only supporting her client’s choice’.
    Imagine that as a defence where you gave the keys to a drunk driver that kills someone.
    I was only supporting him in his choice to drive drunk.

  • auntbea

    How come in my field, where nothing more is at stake than the potential publication of yet another crappy paper about the 2008 election, peer review is absolutely vicious, but when someone actually dies, peer review is about handing out a pass?

    • http://kumquatwriter.wordpress.com/ Kumquatwriter

      Because you’re working with professionals who give a crap?

  • https://dreahlouis.blogspot.com/ Dreah Louis

    Grievance Review is nothing more than a waste of time, paper, and energy.

    • attitude devant

      Dreah, I am a reader of your blog. I am so sorry for your loss. If my feelings about your midwife were made public I have no doubt she’d take out a restraining order against ME too.

    • anion

      I hope you’re doing okay, Dreah. It’s nice to see you here again.

      I cannot BELIEVE, though, that you’re getting nasty comments on your blog telling you to “get over it” and stop “harassing” the woman whose negligence killed your precious baby. What the hell kind of person tells a woman who lost a baby to just get over it already and stop whining about it? How cold and callous do you have to be, to look at a woman who has to live with that loss every day for the rest of her life and tell her to cut out the complaining?

      And these women claim to love babies and women. They only love themselves. The feelings of others are irritating and distasteful–or rather, the feelings of others which are NOT pure admiration and heroine-worship and adoration for the HB midwife. They’re happy to listen to those feelings, while they preen and smirk and pretend to be modest.

      But negative feelings? What’s wrong with you for having those? Just get over it, lady, the important person here is ME, and your feelings are killing the birth-junkie buzz I deserve to get at your expense.

      Disgusting. First they took your baby girl, and now they’re trying to make you feel like something is wrong with you for being angry about it and speaking up about it.

      • http://kumquatwriter.wordpress.com/ Kumquatwriter

        Well said!! I’m glad to see you posting too, Dreah. Can’t improve on anion’s comment above.

      • Renee Martin

        It happens to ALL loss moms that dare to even say that their MW might have been to blame. But go after the MW to stop this from happening again, try to hold her accountable, or try to warn others? A real witch hunt ensues. It is disgusting. I could not believe the harassment and some of the things said to Liz and Bambi, among others. Its shocking.

    • Renee Martin

      Yes it is, when its HB MWs doing it. It is an utter disgrace. You have know nothing fools, kissing the asses of other know nothing fools. It is the prime example of how a mom can have a HB loss, and do everything to get accountability, and get zip.

      I listened to Liz P’s “peer review”, and it was so offensive (the link is below). I was told the MWs even winked at the killer MW! In the end, faith Beltz, killer CPM, got to be supervised by another know nothing for 6 months, and had to learn more about chorio from yet another know nothing. (she then went and opened a BC where she lied about her past! Thankfully she has since quit)

      Later on, Liz got MANA to do a “review”, and it was just as bad. I wa there for this, and not only was it like 3 years later, they did nothing. Even less than the TX board did.

      Horrible. I cannot even imagine how bad yours was. Freaking murderers.

  • Liz p

    If you want to know how a Texas midwifery review board hearing goes – you can read my transcript – google – Liz paparella , transcript

    • Busbus

      Liz, I just downloaded the transcript. I wasn’t able to read more than the first few pages yet, but I am horrified at the way this hearing went. At the type of questions they asked, the insinuations… I am so, so sorry for your loss and everything you and your family went through. I am also in awe that you stood up to them the way you did (and I am sure it cost you much.) No one should ever have to go through this. These irresponsible ….. (insert worst expletives) have to be STOPPED.

    • attitude devant

      I listened to the tapes of that review. Outrageous. These people don’t give two cents for moms and babies. They protect each other at all costs

      • moto_librarian

        I encourage anyone living in Texas to write their state AG and ask that an investigation be opened into consumer fraud by MANA.

    • MaineJen

      Liz. OMG. I haven’t read that in a while. My heart hurts for you.

    • Trulyunbelievable2020

      Can someone provide a link? I’m having a tough time finding this. Thanks.

      • Houston Mom
        • Trulyunbelievable2020

          Thanks. My searches were only leading me to that ludicrous “Lifting the Veil blog” (where, I will proudly note, I am listed by my real name as a “troll” for telling Jan Tritten that she’s a fucking idiot).

          This is the part that struck me:

          “Thalia: In the hospital, it takes ten, twelve people, it seems like, to do a birth. [Laughter]

          Sylyna: Only three at my hospital. [Laughter] But the point is, two heads are better than one, two sets of hands are better than one.

          Faith: I agree. I agree.”

          Yes, keep laughing you idiotic witches. And if Faith actually agreed, she wouldn’t have been asking a doula if it was meconium. Fucking moron.

          I’m so sorry for your loss and so grateful for your efforts to make sure it doesn’t happen to another innocent child.

          • attitude devant

            How effing incredible was it that Faith couldn’t recognize an abruption that was whacking her upside the head? Unusually strong and painful contractions: check. Unusually heavy bleeding: check. When I read narratives of that birth I want to scream TAKE YOUR CLIENT TO THE HOSPITAL!!!!!

          • LMS1953

            Even more incredible was the fact that the reviewing Midwives sitting on the review board (after the OB recused herself for some contrived reason) ABSOLVED Faith of missing the (clinical) diagnosis of placental abruption because the placental path report said there was “no evidence of abruption”. I was not aware that placental abruption was a pathological diagnosis and that the clinical diagnosis could be refuted on path. It can be confirmed, but not refuted. What the path DID show was acute chorioamnionitis and “old” meconium staining (which the gaggle of midwives dismissed as inconsequential which is MOST CERTAINLY is not) and Faith completely and negligently mismanaged all the signs and symptoms of that as well. She did not take a single BP. At most she took a single Temp. She dismissed all the fever and maternal/fetal tachycardia to the mom having stewed in a hot tub. Her documentation was deplorable if not non-existent.
            If she botched a haircut as badly as that, she would have lost her cosmetology license. But, for some unfathomable reason, she continues to be a midwife.

          • attitude devant

            I listen to those midwives and it becomes abundantly clear that they have no idea what they are talking about

          • DaisyGrrl

            What really struck me was when one of the reviewing midwives said to Faith “I really wish you hadn’t said that” when Faith pretty much admitted that she didn’t know what constituted an initial exam. First, the reviewer was basically telling her to shut up and stop incriminating herself. Totally unacceptable. Second, it was a HUGE red flag that further comprehensive review of the midwife’s practices was needed.

            In my job, if there’s a complaint to the outside oversight body, they come and investigate. They get a copy of what we did, then ask us why we acted as we did. If there’s any indication that we are routinely following what they believe is an unacceptable practice, the oversight body will self-initiate a broader investigation into our practices. They’ll ask for a sample of our files (selected by them) and look further into our rationale for our practices. And I just push paper for a living. That anyone on that panel could believe they acted appropriately shocks the shit out of me. I can’t make any judgement as to their knowledge, but their reviewing skills need tons of work.

          • PrimaryCareDoc

            That was horrifying to read. It may take ten or twelve to deliver a baby at Thalia’s hospital, but it only took one mindwife to kill Liz’s daughter.

          • Beth

            seriously. It takes 10 or 12 people at the hospital because the people at the hospital consider it important that the baby ends up alive.
            If ending up with a live baby isn’t necessary for a “successful” birth, of course you don’t need a lot of people. Or any training or expertise.
            Their only criteria to consider a birth a success are “happened at home” and “baby came through vagina, dead or alive.”

          • Amazed

            I find their obsession with other women’s vaginas downright creepy. I don’t want anyone so interested in mine so very near it. Give me an OB who sees this part of me as business and prefers it boring and predictable, thank you very much. Boring is good.

          • LMS1953

            Well, let’s see. In a recent home birth narrative it took:
            1) the CPM
            2) her student
            3) a baby sitter to watch the other kids
            4) a doula
            5) a photographer/videographer
            6) an ambulance with EMT and driver
            7) a policeman or two to secure a scene of death.
            Works out to about the same number of people to attend a home birth as in the hospital. Except at the hospital they put a live, healthy baby in your arms.

    • yugaya

      Reading the transcript made me physically ill. You were manipulated, coerced into answering exactly what they needed and made to ‘own your birth’ and take sole responsibility for ‘misinterpreting’ what the midwife was saying and doing. I am so, so sorry you had to go through that but I want to thank you for being brave enough to put it out there in public view so that everyone can see for themselves to what lengths these repulsive creatures will go to avoid any and all culpability.

      Thank You.

      • LMS1953

        It made me feel exactly the same way. I presume the baby died due to placental abruption. The classical signs and symptoms were present: vaginal bleeding and tetanic contractions. Yet the review’s purpose was to couch these as “variations of normal”. As in: was it bright red blood or dark blood? Was it dripping because of its volume or because you got out of the tub? Was it Meconium or was it Meconium staining – their is a difference, you know, okay? Are you sure you wanted an epidural? Those “tetanic contraction” – don’t you think maybe you were going into transition and just needed some more “you go momma, trust birth, FEEL the empowerment” support? Did you ever say that you demanded to be transferred to the hospital – that is YOUR responsibility, you know, okay? Knowing when to let go is part of life, okay?

        Just disgusting. It should be mandated that such reviews be held at a state level review board with mandatory presence of an obstetrician and neonatologist in addition to “midwife peers” – any “recusal” would be cause for immediate replacement.

        • Siri

          I agree 100% with every word of this comment.

        • Beth

          I was wondering about what they said about the placenta not showing signs of an abruption. They seemed very definite that it couldn’t have been an abruption since the medical examiner would have seen evidence on the placenta. Is that accurate or not?
          I also agree that they were horribly manipulative throughout and trying to lead her into the answers they wanted. Just wondering about the above since I don’t know anything about whether the M.E. findings really ruled out an abruption. Am I correct in guessing that was bs?
          also appalling that they let the only OB on the panel recuse herself without being replaced. If she felt the need to recuse fine, but not to replace her with another OB is inexcusable.

          • LMS1953

            Beth, you ask an extremely good question. As a Board Certified OB/GYN, (I am not a pathologist), I was not aware that you could PROVE that a placental abruption DID NOT occur on microscopic, pathologic examination. I always thought it was a CLINICAL DIAGNOSIS (as opposed to one that could be made by ultrasound – it can be missed on ultrasound; or by a blood test). Here is an expert article from ACOG from 2006 on abruption.

            http://www.utilis.net/Morning%20Topics/Obstetrics/Abruption.pdf

            It confirms that abruption is a clinical diagnosis. How a gaggle of midwives can be so adamant that there was no abruption, especially after the OB MD conveniently recused herself is beyond me. The article also says that intrauterine infection (chorioamnionitis – which WAS CONFIRMED on placental pathology and WAS consistent with the clinical presentation of maternal fever, maternal tachycardia and fetal tachycardia) is a RISK FACTOR for abruption. On emergency C/S for abruption, the uterus often assumes a peculiar appearance called a Couvelaire uterus – similar in appearance to the blood moon this week – it is dusky and purplish-cyanotic with purple streaks all over. That is pathognomonic for abruption.
            So, the midwife WAS criticized for not doing an initial assessment. No VS: BP (she NEVER took a single BP), Temp, Pulse, Resp Rate and Fetal heart rate). Also for deplorable documentation. She did NOT even do an initial cervical exam – the usual bullshit about not wanting to do them after rupture of membranes. So they have the MOTHER do a self exam. So there was no way to objective document failure to progress. (Oh, I’m sorry, labor is not a bus schedule. We are to entertain NO notions of Friedman Curve progress, as I have been PERSONALLY told by CNMs). The negligent midwife mismanaged THREE potentially lethal conditions that contributed to the baby’s death: 1) failure to progress, 2) acute chorioamnionitis and 3) clinically evident placental abruption. Did wallowing around in a tub of water exacerbate the acute chorio? Probably, it certainly didn’t help.
            When I listened to the entire audio file, I literally cried when Mom, her own voice breaking, said she wanted the review because it was being said about her that SHE caused her baby’s death by refusing transfer to the hospital. It was beyond inhumane to have done that to her, most especially in the face of deplorable midwife negligence.
            Beth, I will review my textbooks to see if, in fact, a clinically suspected abruption can be DISPROVED by microscopic pathological examination.

          • LMS1953

            Beth, here you go. Yes, placental abruption IS primarily a clinical diagnosis and pathologic criteria are poorly defined and whatever there are correlate POORLY with the clinical diagnosis. A lengthy quote follows as well as the link:
            The gaggle of midwives who stated so adamantly that there was NO abruption because the pathologist said so, and that the only “physician” they needed was his in abstentia, un-cross-examined report (once the OB recused herself) – well, they were completely full of crap.
            QUOTE:

            3. The pathological identification of very acute abruption

            When an abruption has a rapid and witnessed clinical onset, an emergency Cesarean section will usually deliver a living infant. Typically, the placenta will show a retroplacental hematoma in situ at Cesarean section. The pathologist often can not identify the retroplacental hematoma from the examination of the placenta. In a brief interval, there would also be no anatomic evidence of villous necrosis. The existence of clinical abruption without pathological retroplacental hematoma was noted by Gruenwald who also noted retroplacental hematomas without clinical abruption[107]. He reviewed the clinical chart and the pathology of 612 cases with either a clinical abruption or a pathological diagnosis of placental separation. And found that the two designations overlapped in less than half of either category alone. He did not define the pathological criteria for placental separation, but did classify them as marginal if they extended over the placenta less than 5 cm from the margin, and major if they extended over the central placenta for more than 5 cm from the margin. He did note that after 28 weeks of gestation having both diagnoses had a higher rate of perinatal mortality.

            A recent paper by the New Jersey Placental Abruption Study also noted the poor correlation between the pathological and the clinical diagnosis of abruption with only 49 of 162 clinical abruptions confirmed pathologically[108]. This study also looked at a broader range of pathological correlations, but the results can not be interpreted since the cases included 55% with gestation under 35 weeks (7% below 25 weeks) compared to 12% in the controls. The cases had 14% preeclampsia compared to 1% of controls. Some of the lesions studied are already correlated with prematurity (lesions with acute inflammation) or preeclampsia (lesions such as infarction and villous changes of utero-placentla ischemia). Some of the lesions are of unproven significance and reliability such as villous dymaturation or decidual vasculopathy (which included muscular thickening, not just acute atherosis).

            If a lack of findings can occur in the witnessed abruption, could it not also occur in very acute partial abruptions that occur just prior to vaginal delivery? Adherence of the blood clot may not be a reliable criterion, since the conditions of post partum and immediately prepartum separation may be similar. In very acute separation, the overlying villi may show vascular dilatation compared to other areas. In some cases, this is associated with intravillous hemorrhage. The association with intravillous hemorrhage was postulated as a cause of abruption in a paper describing the lesion[90]. An equally plausible hypothesis is that a large retroplacental hematoma could cause both ischemia of the endothelium in the overlying villi, and sufficient hypoxia/acidosis to produce heart failure and elevated pressure in the right heart. An ischemic capillary or venule distended by increased pressure might hemorrhage.

            http://www.pediatricperinatalpathology.com/id37.html

    • Renee Martin

      It is even more horrible if you could hear it. Their derision for her was clear. They were acting like they were a sorority calling out a member for sleeping with a guy from a less popular fraternity. Utterly disgusting.
      MANA was just as bad. They could not care less.

    • LMS1953

      Liz, I was literally in tears when I listened to the hearing. Your motivation was to be absolved of the blame that was being placed on you, when you and your hubby had placed your faith and trust in the judgment and skill of your care-giver which was sorely lacking indeed.

      I see where the hearing was back in 2010, so perhaps this has been explained to you in the meantime. Contrary to the assertion of the midwives on the review board, you indeed had an abruption. The chorioamnionitis was an associated risk factor for abruption, and that was overlooked/mismanaged as well. Abruption is a CLINICAL DIAGNOSIS, not one made on pathological microscopic examination. The microscopic criteria are poorly defined and correlate with the clinical diagnosis less than 40% of the time. If you scroll down to a reply I made to Beth on her question about this issue and I provided a link to the extensive article as well as a cut and paste of the pertinent section. Perhaps you could forward it to the arrogant/ignorant midwife on the review board who chastised you for protesting the absence of the refused OB by stating the report from the medical examiner who said there were no findings of abruption was the only physician input they needed. The OBs you said you talked with were precisely correct. My heart-felt prayers go out to you and your family that you have received or will receive the absolution of guilt that was so unjustly transferred to you.

  • LMS1953

    I seriously doubt this was a placental abruption. It is too easily a “throw-down” diagnosis. Unpredictable, relatively uncommon (but notice how the obit described it incorrectly as “rare” ….playing the “some babies are just meant to die” card, melded with the “babies die in hospitals too” card and the “part of life is knowing when to let go” card. A throw-down diagnosis frequently used in the hospital setting to deflect liability for maternal mortality is amniotic fluid embolism.

    Anyway, I think it was much more likely a uterine rupture in a home TOLAC which was in its 20th hour.

    OBs are expected to be in “immediate availability” when they are attending to TOLAC. There are sleep/call rooms available in case of fatigue. Why didn’t the CPM call for a pizza and say, “Do you mind if I roll out my sleeping bag in your guest room so I can take a nap? My student Mindy Mae here will come get me for any problems like bleeding or fever or FHT problems. Whatever you do, remember to Trust Birth, momma!”

    • The Computer Ate My Nym

      Also, in the hospital there are nurses, residents, other attendings, etc around so that someone can be constantly monitoring the patient while still allowing the primary attending to sleep if the situation is stable and the labor is expected to continue uneventfully for some time–but they’re still within easy call if something does occur.

  • Karen in SC

    For an additional perspective, read the account from a mother who lost a second twin at her “grievance meeting.”

    http://dreahlouis.blogspot.com/2014/03/the-midwife-didnt-even-show.html

    Second twin loss, another situation where birth attendants excel.

    • Houston Mom

      Wow. Midwife’s a no-show and files a police report on the grieving parents for harassment.

      • The Bofa on the Sofa

        Bizarre, isn’t it?
        The patient wants to go to the police to get the midwife to show up, the midwife goes to the police to keep them away.

      • MaineJen

        They *really* don’t like to talk to people who could call them on their BS, do they?

      • Trixie

        Yeah. In this case, incredibly racist, too.

  • Captain Obvious

    A new “sister in chains”.

    • Renee Martin

      If only they were in chains.

  • Nate

    No matter how much everybody discusses this and other cases. Other than having a dead baby, it’s mostly guesswork as to the specifics. Unfortunately, the best way to ensure better accountability in this country is to go through a liability claim. The truth often comes out there. Painful but effective.
    No lawyer is likely to take this case on unless there is money in it. Therefore, like in 100% of midwife deliveries in other countries such as England, Canada, German, Holland, midwives must be required to carry liability insurance. Very simple. If you want to attend a delivery as a midiwife you must carry liability insurance. In the hospital or at home.
    That simple requirement will quickly eliminate homebirths in the US as insurances are unlikely to cover the deliveries because of the huge risks. See, insurance companies deal with calculating risk, that is all they deal with, and they are too smart to insure homebirths.
    http://en.wikipedia.org/wiki/Risk

    • LMS1953

      Crunchy, progressive Vermont was one of the first states to mandate that CPMs be reimbursed by Vermont state Medicaid. There were no standards nor exclusionary criteria as part of that law. After all, why do you need anything like that when all you have to do is Trust Birth? It is ingrained in the very culture. The law also required third parties payers to pony up too. BC/BS said fine, all the CPMs have to do is to be on the provider panel like is expected of every other provider. To be on the panel they are expected to 1) carry malpractice insurance and 2) have a written transfer agreement with a hospital and staff OB(s). Well, that really pissed off the legislature because they thought it ran counter to the purpose of the law they were so proud of, which was to expand the scope of practice and availability of CPMs for the woo-infused citizens of Vermont. (Many there also believe that pasteurization destroys the woo in milk so there is a vibrant underground distribution of raw milk. It is also one of the leading states for refusal of childhood vaccination. And it is the leading state for prescription narcotic abuse). So, all we have to do is write to Socialist Party Senator Bernie Sanders and he will take care of our concerns on the Federal level so we don’t have to fight this battle in all 50 states.

      • Mishimoo

        Considering the raw milk and narcotic abuse, I’m curious as to how many cases of Brucellosis there are (and whether they’re being diagnosed properly, or simply treated with alternate ‘medicine’ which is followed up by sneaking some pain pills)

    • attitude devant

      Couldn’t agree more. You get the lawyers and actuaries involved and there will be no more HBAC, no more vag breech, no more twins. That would do a lot

      • Amazed

        But poor midwives cannot afford it! It is an obstacle in the way of their job!

        I cannot believe someone would fall for this but people do.

    • lawyer jane

      I agree. Pretty sure that if Dreah could get a lawyer she could try filing a tort suit. She would never get back what she lost, but at the least the midwife could lose her house & get her wages garnished.

  • Trixie

    NCB zealots complain that OBs section women so they can fit in 9 holes before dark, and yet going home to take a nap is totes okay CPM behavior.

    • anion

      And while they tweet and post on FB about the labor(s) in progress, their equally psychotic and irresponsible friends reply to them with comments like, “Make sure you’re taking care of YOU!” and “You must be so tired, poor thing!”

      Because the mother isn’t what’s really important here; the Birth Angel costume isn’t complete without one, but in the end the laboring woman is still just another accessory which can be set aside if the Birth Angel gets tired of carrying it around, or needs a hand free to hold a drink.

  • The Computer Ate My Nym

    It’s surprising that the case even came to peer review, however inadequate the peer review might be. Is that automatic in neonatal deaths in Texas or is someone making a fuss and driving the need to at least appear to do something?

  • The Computer Ate My Nym

    I have been told that the plan for the peer review of Gina Phillips is
    that she will be reviewed by other midwives who are there to have their
    own cases reviewed.

    Wait, WHAT? Will she then in turn review their cases? This seems like such an utterly corrupt and abusable system that I’m going to have to ask for a reference because I can’t believe that any professional or even semi-professional organization would use it.

    • Deena Chamlee

      It is not professional or semi professional: high school education was not a requirement until 2012. And again we know what we are dealing with so of course it is corrupt.

    • Are you nuts

      I’m thinking that can’t possibly be true!! It would be like accused felons sitting on one another’s juries.

      • Anj Fabian

        I was thinking a parole board made up of other offenders:

        “So, guys and gals, do you think our friend Jenny Lou will reoffend? She’ll be sitting on my parole board so I think we should cut her some slack. She means well. Should we punish her for one mistake?”

    • Zornorph

      And what goes on at such a review? I mean “Really, Vulva, next time you must remember to put on the Yanni CD. How do you expect a baby to come Earthside without music to guide him?”

    • LMS1953

      Just like the “peer reviewed” journals they publish their BS in.

  • stenvenywrites

    She will be reviewed by other midwives who are themselves under review? This is not a profession. It’s a sorority.

    • Houston Mom

      This is the makeup of the Texas Midwifery Board

      http://www.dshs.state.tx.us/midwife/default.shtm

      The Texas Midwifery Board is composed of five licensed midwives with at least three years experience in the practice of midwifery; one physician certified by the national professional organization of physicians that certifies obstetricians and gynecologists; one physician certified by the national professional organization of physicians that certifies family practitioners or pediatricians; and two public representatives who are not practicing or trained in a health care profession, one of whom must be a parent with at least one child born with the assistance of a midwife

      • Amy Tuteur, MD

        It is my understand that the Board is not involved. It only gets involved if there is a complaint filed. This is purely peer review.

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          Who defines “midwife” in this context? Will they be CNMs, or CPMs, or just anyone who likes the title?

          • Trixie

            I believe this board is specifically for non-CNM midwives.

        • Houston Mom

          So she’s safe from formal review if the family choose not to complain?

          • Are you nuts

            Can I file the complaint? I live in Texas.

          • Houston Mom

            http://www.dshs.state.tx.us/midwife/mw_rules.shtm

            Here are the rules. About 30 pages. I didn’t see anything about needing to be a patient yourself to make a complaint but it does say you need to specify what part of the law has been violated.

          • Medwife

            Surely a coroner will be involved at some point?

          • attitude devant

            Medwife, not necessarily. Coroners in the US don’t investigate every death

          • Medwife

            I just figured they would investigate this one.

          • attitude devant

            No. Very unlikely. In all but a few states perinatal death is not routinely investigated. There is nothing equivalent to the UK system of coronial inquest here. More’s the pity, really.

            I was actually investigated early in my career by the coroner. A baby with multiple anomalies incompatible with life was born and given only comfort care in our nursery, after we had thoroughly counseled the mother about our findings on ultrasound. We surmised that a very religious nurse in the unit had filed a complaint. Looking back I marvel that we didn’t have a lawyer advising us. We felt quite clear about our thought process and our diagnosis. We assumed that telling the truth was all we’d need. And it was.

        • Trixie

          So they just sit around the table and share placenta recipes and complain about how meen you are?

      • Trixie

        I like how they weight the board so there are only two actual medical professionals on it. And 5/9 are lay midwives, so they always have a majority.

      • Thankfulmom

        I’ve never heard of the national professional organization of physicians. Is this a group of pro-homebirth doctors who made up a title for their group of two?

    • anne

      One of the things that frustrates me so much about the homebirth/CPM movement is that it looks somewhat legit on the surface; medicaid reimbursements in some areas, a credential, a review board, journals, but it’s all facade and no substance. You have to dig deeper to see what BS it all is.

    • guest

      A coven?

  • stenvenywrites

    I just ran this through my thought model: a resident calls her attending in the middle of the night to report that a patient is bleeding. I can almost see that happening, kind of, although it’s discouraging to say so. I then pictured a doctor who responded not by ripping a new one … er, that is, calmly and patiently instructing the resident of standard of care … but instead replied, “don’t worry about it” and then rolled over and went back to sleep. That’s not *totally* impossible to imagine either, sadly. Then I wondered what would happen if the patient died in that scenario. How would the resident and the doctor prepare for the inevitable institutional review? (Basically, as I envision that, the bus is getting revved up, and *somebody*’s going under it.) Then I saw the post where the midwife tells the student midwife — that would be, the student who killed the patient by following the advice that is about to get the midwife in a whole lot of trouble — “I’m so very *proud* of you.” Extrapolating that occurrence to a medical training setting broke my brain.

    • The Computer Ate My Nym

      I’m not an OB, but if I understand correctly, in a similar situation in my field I’d be ripping…um, calmly discussing the case* while dressing and heading out the door to go to the hospital.

      *Actually, just reporting that you’re seeing blood in a laboring woman probably doesn’t call for any censure as long as the resident started standard of care treatment for it as best she knew how and called for further instruction as soon as possible. So the implied yelling and blaming would be unjustified. A calm but energetic discussion of the case is called for.

      • Deena Chamlee

        Unless you are in a high risk setting such as a home. Heavy bleeding in a prior LTCS calls for transfer immediately. Wait a minute, the darn patient should have never been there in the first place.Period end of story. Nothing calm about a review that is ethical.

        • The Computer Ate My Nym

          Well, yes, but I was talking about the equivalent situation in the hospital. The equivalent of the resident call, not the student midwife call. No one with serious hematologic or oncologic issues expects home chemotherapy* or home treatment of hemophilia with a brain bleed or similar. Fortunately. Certainly if a resident did call and say, “I’m at pt X’s home and they’re experiencing severe nausea, vomiting, and diaphoresis after their first dose of rituxin and I can’t tell if they’re wheezing or not because I’m not doing that invasive stethoscope monitoring” I’d tell them to hang up and dial 911 and I’d meet them at the hospital. (Saving questions like “why the hell are you giving rituxin, especially first dose, at home.)

          *Well, mostly not. There are a few exceptions…

          • Dr Kitty

            There are teachable moments where you can calmly discuss what happened, and there are “&@£* ! You did what?” moments.

            When I was working in the ER a medical student was “helping out” in triage, and spent 45 minutes taking a H&P without starting any treatment or letting the Drs or nurses know he was seeing a patient whose presenting complaint was “central crushing chest pain”.

            He got as far as “Mr X, a man complaining of central crushing chest pain who has a previous hx of angina” before all hell (and much, much swearing) broke loose.

            It was a teachable moment once the patient was in the cath lab. While it was happening, not so much. Medical students:IQs of geniuses, common sense of house plants.

          • araikwao

            Fortunately they are teaching us that “minutes = myocardium”. Gosh I hope I am never that med student though!!

    • Montserrat Blanco

      In my field of expertise: resident calls while I am sleeping, I hear “bleeding”, jump out of bed, run up the stairs and enter the room in less than two minutes. While running up the stairs get the clinical history details and make up a plan. Plan is started in less than three minutes from the call.

      This without considering that the resident is already putting into action while calling me.

      Either that or facing a jury…some months after loosing my Job.

      Bleeding can not always be stopped but it is an emergency!!!

      • The Computer Ate My Nym

        First rule of blood:blood goes round and round. It’s supposed to be in the body, not all over the floor. If it’s all over the floor, there’s a problem.

        • Trixie

          That’s when you firmly command the woman to stop hemorrhaging, right?

          • prolifefeminist

            …because it’s always her fault.

          • The Computer Ate My Nym

            Sure. And if that doesn’t work then you go to cinnamon and homeopathic shepard’s purse.

            Either that or go with the evil medical model and use c-section, tamponade, and blood product replacement. And then suddenly it may no longer be God’s will that the baby and/or mother die. God’s funny that way.

          • CognitiveDissonaceHurts

            Have you heard of the fantasy that a woman can just command herself to stop hemorrhaging and her body will respond?

        • KarenJJ

          Well that’s what sucking on cinnamon candy and blowing on the woman is meant to fix.

      • stenvenywrites

        But, but … but when do you tell the resident how proud you are of her? Don’t you care about her self-esteem?

    • Deborah

      Even if the resident and attending were the most negligent on the planet, you’d still probably wind up with a live baby and mom because the L&D nurses would call their charge, who would either then directly call the attending or go over the attending’s head (head of department). Plus the strip would give it away.

      • Medwife

        Ha. Let alone “the TOLAC is bleeding”. An attending would have to be having a stroke not to haul ass hearing that.

    • attitude devant

      Remember that under ACOG standards the OB must be in house. I have taught in a residency program. We had to be physically present in the building 24/7.

  • The Bofa on the Sofa

    I have been told that the plan for the peer review of Gina Phillips is that she will be reviewed by other midwives who are there to have their own cases reviewed.

    Hey, it’s true “peer” review – incompetent midwives being evaluated by incompetent midwives.

    Clearly her peers.

    • Zornorph

      It would have been nice when I was a kid and got in trouble to face judgement from other naughty children and not my Dad.

  • seriously

    Wow, looks like you need to do some serious fact checking.

    • Elizabeth A

      Which facts, of those presented, do you dispute?

      • seriously

        Its not my story to tell. If someone involved wants to share their story on this blog, that is their prerogative. I’m just urging people to not take this blog as fact. If I had a blog and were presenting things as facts, I’d probably try to do so with some form of ethics.

        Also, people delete Dr Amy’s questions because she is a vicious troll, using other people’s tragedies as fodder for her website. If she were someone who actually cared or was trying to change things by informing people, instead of browbeating them for being stupid, she’d probably be taken more seriously.

        • Guestll

          Right, so what are you doing to stop the preventable deaths and injuries of babies at homebirth?

        • Elizabeth A

          I’ve been very polite and caring in a lot of conversations about homebirth. No one takes me seriously. Gentleness doesn’t appear to be a working strategy here.

          I’m not all that interested in getting into it about whose story a homebirth death is to tell. But the story of a peer review of a homebirth death is an item of general public interest, which ought to be conducted publicly, and commented on in the same way.

          • prolifefeminist

            Well said, Elizabeth.

            The family’s loss is personal and private. But because these midwives offer their services to the public, a review of their involvement in this death is everyone’s business. Women currently in the care of these midwives, or who may hire them in the future, deserve to know if the midwives caused this baby’s death. After all, it is their JOB to be on the lookout for trouble and transport to the hospital quickly if there are warning signs. If they failed to do that – if they failed to do their JOB – they should be held accountable.

        • http://kumquatwriter.wordpress.com/ Kumquatwriter

          So, you don’t actually have any information whatsoever and your disingenuous opinion is “Dr. Amy is meen.”

          Helpful, that. And not in the slightest concerned about the continually growing number of tiny graves. And let me guess – all the strangers crying and mourning these totally unnecessary deaths are just haters, right?

        • The Computer Ate My Nym

          You have made at least 3 comments on this web site, each attacking Dr. Tuteur and implying that you have knowledge of the case that proves her presentation of the data to be false. Yet you never, despite being repeatedly asked to do so, made any statements about which facts are wrong or made any attempt to correct the misstatements. In terms of “trolling”, I’d say you meet the definition better than Dr. Tuteur. If you have something relevant to say about this case, why don’t you say it?

        • Amy

          Where did she call James’s mother stupid? Oh, that’s right. She didn’t.

          She’s calling the attending midwives incompetent, because that’s the only word to describe a practitioner who fails to recognize serious symptoms and then discourages the patient from getting any treatment for said serious symptoms.

          And I don’t know what you call sharing information with people if not “informing people.”

        • prolifefeminist

          “If she were someone who actually cared or was trying to change things by informing people…”

          Well, Dr. Amy and this blog informed me when I was pregnant three years ago. This blog changed my mind about attempting another HBAC, a decision which probably saved my son’s life. I take her seriously, and I’m damned glad I did when I was pregnant too.

        • anne

          “If she were someone who actually cared or was trying to change things by informing people”

          Dr. Amy cares enough about women that she actually went to college, went to medical school, went through residency, practiced as an OB/GYN, wrote a book, and taught other doctors on the care of pregnant and laboring women. And she respects women enough to tell them the truth as unpleasant as it may be and to leave comments up on her blog that can be downright abusive.

          That’s a helluva lot more than midwives do.

        • Amazed

          Oh, you take her very seriously, seriously, don’t you? Otherwise, you wouldn’t be here.

          I am going back to work with the lovely image of your heartless trollish vicious money-grabbing self shaking in your boots.

          Wonderful.

        • anion

          I guess the word “allegedly” is some sort of incomprehensible collection of letters to you, far beyond your capacity to understand? (As is the word “reportedly,” it seems. And “troll.”)

        • Jessica S.

          Translation: Dr. Amy doesn’t inform people according to my narrow perimeters. Your comment is the opposite of reality.

        • Mishimoo

          “If someone involved wants to share their story on this blog, that is their prerogative.”

          You’d completely support their choice to share though, right? You definitely wouldn’t invalidate both their decision and their story by claiming that they’re blaming others in their grief, or some other such nonsense?

    • The Bofa on the Sofa

      Well, she tried. But her questions got deleted.

      I gotta say, it’s really funny.

      1) Amy hears about it, and goes to the midwives’ to ask about it
      2) They delete her questions instead of answering them
      3) Trolls jump in and tell Amy she needs to do some fact checking

    • Guestll

      So it’s not your story to tell, it’s not your role to provide clarification, it’s only your job to condemn and vilify. Got it.

  • Zornorph

    What would they be able to do to her, anyway? Could they take away her CPM tag even if they wanted to? Do they actually have the ability to stop her from attending births? Or is the most they could do be to tell her she was a naughty girl and not to do it again?

    • Houston Mom

      They can suspend her for a while and could stop her from further practice, theoretically:

      http://www.dshs.state.tx.us/midwife/mw_enforce.shtm

      • LadyLuck777

        The good thing is that at if you scroll down you will see that at least some of these midwives are being sanctioned for failure to transfer in a timely manner.

        • Houston Mom

          The bad thing is that punishments seem to be probated pretty often. Scroll down to Kathy Rude. See what she got for killing a little boy during an abruption. You can google her and find a family member’s description of the baby’s death.

          • Houston Mom

            Sorry the poor little guy survived for quite a while. http://christianmidwife.webs.com/ Dr. Amy has written about Sam previously.

          • LadyLuck777

            I did google it. Thanks. And holy crap. It stuns me how anyone can read that and not feel impassioned to change how things are done – especially a politician.

          • guest

            That may be the worst thing i have ever read. http://christianmidwife.webs.com “Sam’s Story.”

          • Jacob Wrestled (Danielle G.)

            I just read this link. Heartbreaking and maddening.

          • Thankfulmom

            That was horrifying.

          • Jessica S.

            Heartbreaking. That woman should not be allowed anywhere NEAR another person in terms of providing health care.

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        And if she wants to carry on, nonetheless, who’s to stop her? What law is she breaking and what are the penalties?

        • The Bofa on the Sofa

          I was going to say that they could give her the stink-eye, but knowing how midwives work, they wouldn’t. They would “support” her.

          • KarenJJ

            Well for Lisa Barrett she had a fine of $20,000 (AUD) plus court costs (which were I think around the $100,000 mark). I still think her fine is incredibly cheap for what she did. I know someone that was involved in price fixing a good decade ago and was personally fined $50,000 (company had to pay further again and a few other managers also had personal fines).

            So there’s some starting numbers for the midwifery peer review board. Just need to ensure that bankruptcy doesn’t get you out of paying the fine and that there are criminal actions for non-payment.

        • Houston Mom

          There are just monetary penalties it seems after scrolling through the rules, no mention of criminal penalties, not even for continuing to practice after being told to stop.

      • The Computer Ate My Nym

        Looking at the list of midwives with judgements against them I’m struck by a couple of things:
        1. Many have more than one violation, separated in time. So they keep practicing after what is likely a gross violation of standard of care.
        2. How minimal the penalties are. A 6 month probated suspension and $500 fine for a case that resulted in a baby dying (F.B.)? Not impressive as a penalty for bad treatment.
        3. Most or all of the penalties that were serious (surrender or revocation of license) seem to have occurred in the early 2000s. Are the penalties decreasing over time?

        • Mel

          Additional scary bit: I read through the penalties part of the Texas Midwifery Board Midwife Rules. Those midwives who had $500 dollar fines for messing with records or failure to turn in birth certificates promptly – it was either their THIRD time messing up OR they refused to fix the problem after being informed by the Board (pg 27)

          (2)
          for intentional alteration or falsification of client records or reports, other
          than birth or death certificates, or misrepresentation of facts:

          (A)
          for the first offense, an administrative penalty not to exceed $100;

          (B)
          for a second offense, an administrative penalty not to exceed $200; and

          (C)
          for subsequent offenses, an administrative penalty not to exceed $500 per
          offense, with each day of a continuing violation constituting a separate
          violation.