Is midwifery malpractice an issue of reproductive freedom?

Compliance Concepts on Chalkboard

Australian midwife Martina Görner boasted on Facebook:

What a homebirth full of unexpected surprises , literally one after the other!! ‍♀️ Mum gave birth to her sweet little baby boy in water and then we thought the placenta was about to come… But as it turned out, there was another baby boy about to make his entrance into the world!! What a super hero mum Brooke is. What an amazing birth!! ✨ The twins are identical twins and were born this morning ☀️ @ 08.03 & 08.07 weighing 2350 and 2200gr. Mum ‍♀️ and babies are doing really well. Big congratulations to everyone!! #homebirth #waterbirth #midwife #melbourne #naturalbirth #twins #tenmoons #twinhomebirth @ Melbourne, Victoria, Australia

Amended post:

An Ambulance was called following the birth of the twins to transfer to hospital. The twins arrived premature (at 35 weeks). One of the twins experience respiratory difficulties. Both twins were transferred by Ambulance to hospital.

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A competent practitioner would never have boasted about such a massive screw-up but it’s par for the course in the world of homebirth. The midwife violated standards of her profession and no one died. She thinks that makes her amazing.

If you wish to hold a license from a professional board, you must follow the rules.

Her professional board [Australian Health Practitioner Regulation Agency] suspects — not surprisingly — it makes her incompetent and has suspended her practice pending investigation.

According to the Melbourne Homebirth Association:

Recently, Martina Görner from Ten Moons Midwifery in Melbourne attended an accidental twin homebirth, the story of which has been circulated on social media in the last couple of weeks. The mother and the babies were happy and well, however after the mother took the babies in to the hospital for a check up, Martina was reported to AHPRA by the hospital staff.

On 29/10 Martina’s offices were visited by “AHPRA investigations and security personnel, who wanted to immediately collect medical files, clinic computer and clinic mobiles” in relation to the birth.
Martina’s experience is not uncommon. Almost half of Australia’s privately practicing midwives have been reported to AHPRA, and the vast majority of notifications come from hospital staff, not from their clients. AHPRA, NMBA and most hospitals continue to struggle to understand that birthing women retain the rights to make choices in relation to their own care, even where those choices fall outside the guidelines.
Martina has a hearing before AHPRA / NMBA at 1pm on Wednesday 7th November, to determine whether she will have her registration suspended, and she has been required to give an undertaking that she will not practice as a midwife ahead of this hearing.

A petition organised by Bridget Muhrer of the Ten Moons Mothers Group has received over 10k signatures in less than 24 hours. The group is organising a flash mob protest outside AHPRA …

In other words, despite the fact that Görner violated multiple practice standards, homebirth advocates are supporting her.

Görner‘s registration has indeed been suspended and her supporters are furious. They seem to think this is an issue of reproductive freedom. It’s not; it’s an issue of professional competence. If you wish to hold a license from a professional board, you must follow the rules.

In and of itself, failure to diagnose twins is not malpractice. Prior to the advent of ultrasound, unexpected twins occurred in almost 30% of twin births. It is, however, malpractice to deliver a premature baby at home and that’s what Görner did. It’s not her only violation of professional standards.

Görner‘s boasts about her own practice indicate additional failures.

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91% of patients declined the glucose tolerance test.

99% declined group B strep testing.

87.5% declined Rhogam during pregnancy

85% declined neonatal Vitamin K

Even though these are foolish, potentially deadly choices, women have the right to make these choices … but ONLY if they are properly informed since these are violations of professional standards. The fact that Görner is boasting about these statistics suggests that she doesn’t see these choices as risky and potentially deadly, but it is NOT up to a provider to decide whether or not she likes practice standards.

Moreover, if the provider doesn’t know the scientific facts about these choices, she can’t possibly be providing informed consent. It doesn’t matter whether or not she and her patients share the same mistaken beliefs about these interventions. Counseling a patient in a healthcare setting mandates providing them with accurate information and making sure they understand it. That requires counseling by someone who is conversant with the scientific rationale behind each recommendation. Failure to provide such counseling is malpractice.

Professional standards are guard rails on professional practice. They are not discretionary. Patients can refuse them but providers can’t tell patients they aren’t necessary if that’s not what the science shows. If you want to carry a license, you must follow the rules for licensure whether you like them or not. There’s a reason for that: public safety. A midwife who routinely violates the standards of her profession puts the public at risk.

  • P.Cogale

    It makes me wonder whether had not one of the twins had respiratory stuff going on whether they would’ve gone to the hospital at all. 35 weeks and they probably would’ve gotten away without it if it wasn’t for that – ie supply line or expressed breast milk top ups (donor milk if necessary) if they weren’t quite strong enough to breastfeed effectively.

    Also at 35 weeks – you’re not 36/37 weeks and it being ‘acceptable’ to homebirth so that should’ve been a transfer in itself. Sure mom probably refused but then the midwife took the risk of her registration by staying.

    The missed twins – possible of course but you have to wonder.

    • Daleth

      >The missed twins – possible of course but you have to wonder.

      Yeah, no. That’s not a thing in this day and age. Even CPM’s have freaking MEASURING TAPES to check fundal height and STETHOSCOPES to notice the presence of multiple heartbeats.

      And remember, these are the people who talk so much about mom’s intuition. Didn’t mom intuit that there were two babies in there?

      “Missed twins” is homebirth code for “decided to keep this massive risk factor secret so the midwife wouldn’t get in trouble.”

      • Azuran

        Pfff, why would they even measure and bother using the stethoscope? Those are intervention, and intervention causes more intervention and you end up with a c-section.
        Better to not measure anything, because if you do measurements, they might not be normal. And you don’t want anything to be abnormal.

  • Petticoat Philosopher

    Ummm…I’m not a doctor but I don’t think babies should be bright blue? How did they look at that scene and think “Great photo op!” before realizing that a hospital transfer was needed???

    • Daleth

      My thought too.

    • Mel

      My son managed bright blue a few times.

      Thanks to his premature birth and resulting BPD, I became quite skilled at using his skin tone as an estimate of his blood O2 saturation during his NICU stay and a few reflux choking episodes at home. The colors as I remember them were bright pink for 100-90, brick red for 90-80, purple-red at 80-75, purple-blue below 70, mottled blue to around 60 and blueberry blue appeared at 50 or so. 50% is also where he’d start to noticeably lose muscle tone – and I don’t like how that kid’s head looks in either picture.

      The following twin looks like Spawn at about 50% sat in the picture right after birth. When he looked like that, I had a nurse next to me messing around with his vent or oxygen in the NICU and was doing back-blows while my husband jacked up the oxygen and was starting to call 911 at home. (At home, Spawn’s monitor just hit 50% when he coughed and began to scream as my husband was grabbing his phone to dial 911. Best sound of my life.)

      In a lot of ways, the photo with the mom in bed scares me more. That’s not a baby who is oxygenating well – but no one seems to have prioritized that above moving Mom out of the bathtub to somewhere more comfortable. I mean, the following twin’s hands are really blue and both babies look cold.

      • Ozlsn

        Neither twin looks particularly well in either photo. Yeah body heat is good, but so is wrapping the baby to keep warm. I hadn’t even realised the second photo was in a different place – too busy looking at the baby’s skin tone.
        I keep thinking that surely a midwife with an ICU nursing background would want supplemental oxygen on hand, right? Just in case you needed it? And a sats monitor? It’s not like they’re heavy items.
        I also can’t get over the difference between “going in for a check up” and “experienced respiratory difficulties”. Ambulances don’t transfer for check ups.

        • mabelcruet

          But…but…skin to skin. NOTHING can interrupt skin-to-skin, that’s the most important part of birth, when all the twinkly mama magic gets transferred to the baby and they become instantly immune because the microbiome is established, if skin-to-skin is delayed, epigenetics will happen!!!

          (sarcasm, hopefully obvious).

          Those babies don’t look right at all. I hope they got warmed up and oxygenated pretty damn quickly after that photo, otherwise that’s pictorial evidence of the utter crapness of that midwife.

          • lsn

            “if skin-to-skin is delayed, epigenetics will happen!!!”

            You owe me a new keyboard, I did a total coffee spit/choke with laughter over that.

  • Sara

    I call liar on the intact perineum number. Sounds impossible to me.

    • Ozlsn

      I call bullshit on the 100% 5 minute APGAR of 9 frankly. I don’t trust her stats at all.

      • Mel

        I’m quite skeptical that the following twin made a 9 at 5 minutes.

        • AnnaPDE

          It’s not like there is reliable evidence to any of her claims — it’s all just her saying so. And there’s a photo showing a bluish baby plus the confirmed aftermath.

      • Ravens Starr

        If the baby isn’t bright pink and vocal I don’t think a 9 APGAR is possible

    • Ozlsn

      I just realised that her 78% intact perineum equates to 31.2 women. What happened to the other 0.8 woman?

      • Merrie

        31 women would be 77.5% so maybe she rounded.

  • Amazed

    My God. After this, she’s still not being freaking investigated?!…

  • RudyTooty

    Holy Shit.

    Yeah. No. That woman should not be practicing anything.
    Especially when she is gleefully broadcasting her profound ignorance via social media.
    OMG. No.

    Great piece.

  • MainlyMom

    My stepkids were surprise twins born at home. CPM of course, even though my husband begged the mom and midwife to get an ultrasound. Fortunately the kids are ok, tho the second born one was hypoxic. He struggles more with school and behavior, and i have to keep beating back the suspicion that maybe its partly brain injury. It just makes me so freaking angry that no one cared they could have died.

    • RudyTooty

      “No one cared that they could have died.”

      Right – these not-caring people really have no business providing any sort of health care or medical services to anyone.

      Because they don’t care.

      I’m sorry about this.

    • Daleth

      i have to keep beating back the suspicion that maybe its partly brain injury.

      Why beat it back? It would be a weird coincidence, wouldn’t it, for him to have been hypoxic at birth, and to now have problems that can result from being hypoxic at birth, but for those problems to NOT have been caused by hypoxia in his case.

      • MainlyMom

        Beating it back is because there’s nothing i can do about it now. Plus i cant prove it, so it just gets me riled up for no reason.

  • nata

    the petition and the birth announcement post that I saw on facebook circulating among my UK friends did not mention the fact babies were 35 weeks. They claim that the midwife is punished just for supporting maternal choice to go without scans.

  • What scares me is the “we attended 40 births this year”. Good lord, I did that in less than a month! For more than 40 years…they think they are experienced??

    And note that almost no one was low-risk.

    Insane.

    • fiftyfifty1

      I’m confused as to why you say that almost no one was low risk. The patient panel actually seems pretty low risk to me. Almost half of the mothers had a previous successful vaginal birth. Low rate of breech, low rate of twins, very low rate of previous CS, low rate of preemies. It seems to me that this actually is a much lower risk panel than any OB has. I mean she then took this low risk panel and had them do risky things like refuse tests etc, but the underlying risk profile of the panel was low.

  • Platos_Redhaired_Stepchild

    The craziest thing is none of these women would get into the cab that had a driver with had 2 or 3 deaths under their belts or even if 2 or 3 passengers had to be transferred to hospital after a “ride” with them….yet, they let these incompetent fools do whatever with their own bodies and babies.

    • RudyTooty

      Midwives are not so open about disclosing the deaths that occur under their care. They’ve very shifty about it, if they admit it at all.

      [I’m referring to CPMs and lay midwives … eh, and probably some homebirth CNMs too… that I know personally. They’re candid with other midwives about the deaths they’ve attended – less so with their clients.]

  • demodocus

    My mother gave birth to triplets in the hospital. The first two had been long dead. The third was born alive, after they’d wheeled her into the hall and given her something for being hysterical, from what I’ve been told.. This was the 70s, though, and all-natural triplets aren’t exactly common. 40 years later and it’s just weird for anyone in a developed nation, supposedly having prenatal care, to be caught unawares.

    • These women not only refuse ultrasound, the midwife is so incompetent that she can’t tell from fundal height + dates that multiple pregnancy is likely. I bet she doesn’t even know what Leopold’s Maneuvers ARE.

      BTW, even in the 70s, it was unusual to miss a multiple pregnancy.

      • Azuran

        Knowing midwives, its even possible that she knew and either didnt tell the mother or they both agreed to hide it so the mother wouldnt be risked out of her dream home birth.

        • Daleth

          Knowing midwives, its even possible that she knew and either didnt tell the mother or they both agreed to hide it so the mother wouldnt be risked out of her dream home birth.

          Yes, and I don’t think that’s just “even possible.” I think it’s the most likely explanation. You’ll almost never hear a home birth midwife admit that she knew the mother was expecting twins, because in most places it’s illegal for a licensed midwife to knowingly plan to attend a home birth of multiples. Usually home birth midwives are not allowed to attend multiple births or premature births — and multiples are usually premature, so it’s a double whammy violation on the midwife’s part.

          So it’s really incredible how many home birth midwives are “surprised” to discover that mom was having twins…

          • sapphiremind

            Especially because you need providers for both babies as well.

      • demodocus

        They suspected multiples, but not triplets.

        • I have only been involved with ONE instance of spontaneously conceived triplets in my entire career. The mother was 40 years old when she lost her virginity on her wedding night, and her husband was so ill during the honeymoon (“Montezuma’s Revenge”) that they didn’t have sex again until she realized her period was late. With no special treatment beyond bedrest, she delivered three babies at 38 weeks, each weighing close to 8 lbs (vaginally!)

          Her husband told us later he was afraid to even breathe on his wife again.

          But of course I’v Been involved with quite a few triplets with IVF, even though Israel has a good record of fine-tuning fertility treatment to avoid high-number multiples.

          • Cristina

            Haha, if I was the wife, I’d be afraid for him to breathe on me too! I know a family where pregnancy #3 turned out to be identical triplets.

          • demodocus

            Mom was weird like that. My brother was the sole survivor of triplets too; Mom miscarried the girls. And then there are the twins. They’re about to turn 22.

      • fiftyfifty1

        Even if she does know what Leopold’s Maneuvers are she probably refuses to do them and calls it a form of “groping” or something.

      • Mel

        My mom didn’t know she was having twins until twelve hours before we were born. I’ll have to ask what cued the OB in at 29 weeks…..

  • Anna

    The HB midwives all cling onto the same pieces of “research” as evidence. Sara Wickhams vit K book, Sarah Buckleys nonsense against ultrasound and Gloria Lemays claims about gestational diabetes being “a diagnosis in search of a disease”. Now Rachel Reed has published a book on how bad inductions are they’ll all use that as proof 42plus weeks is safer than being induced. So they all say the Mothers are “informed” but no-one has told them any of the risks or possible bad outcomes. Because noone died they dont understand what the big deal is.

    • RudyTooty

      Yeah – but it’s not true that no one died.
      People do die – they just conceal that truth and decide that death is an acceptable outcome for their clients…. after they provided their deceptive “informed consent.”

      • Anna

        Yep, the midwives know and some of the higher level advocates are aware of some or most of the deaths but the average minion level homebirther has no idea.

  • Madtowngirl

    91% of clients refused GTT, but 2 had gestational diabetes, supposedly diet controlled. I have diet controlled gestational diabetes, and I have to monitor my blood sugars very closely. I wonder 1) how many women had it and weren’t diagnosed and 2) if the 2 women were properly monitoring their sugars. Spoiler: uncontrolled GD isn’t just bad for your baby, it’s bad for you! Isn’t GD supposed to be something that gets risked out by proper midwives? Why is she bragging about this? Uuuuuugh.

    • Cristina

      I had surprise GD (negative screen but sugar in urine when my water broke). My baby was born 8 lbs 6 oz at 35 weeks and was immediately whisked to the NICU after I was sectioned (breech). It took nearly 24 hours to stabilize his blood sugar! I’m so glad I gave birth somewhere where they 1) diagnosed it, and 2) treated it! Not screening for it doesn’t mean it doesn’t exist!

    • I am sure they were just uncontrolled diabetics. You don’t feel ill with diabetes, you know.

  • Ozlsn

    I’m kind of curious about her 100% excellence rating from only 19/40 clients. Did the rest not rate her? Did but didn’t rate her highly?
    Also was heartened to see how many comments on her statistics facebook page were basically ssying she was engaging in malpractice.

  • mabelcruet

    If she couldn’t even tell it was a twin pregnancy until the babies were born, I’m not sure I’d trust her judgement that the twins are identical or not.

    • Sarah

      I’m not sure I’d even trust her to accurately count how many actually came out.

      • mabelcruet

        Having said that, I just reported a placenta sent to me after a twin pregnancy-in hospital, delivered by proper midwives. Male and female twins. Clinical history ‘Conjoined placenta-conjoined twins???’ Given that the twins were different sex, and each were weighed and measured separately, I think they can safely be diagnosed as non-conjoined twins. It struck me as rather odd that someone didn’t know a fused placenta was an absolutely normal and very common variant of a dichorionic twin placenta.

      • Mel

        “I’m sorry, ma’am. You didn’t have triplets. You had a singleton. I got confused and counted your Old English Sheepdogs as babies. I mean, there were only four organisms in the room before you gave birth and then there were seven when I counted again. It’s tricky, but I think the dogs came in through the open door to the bedroom. My bad.”