July 4, 2012
How to Avoid a Homebirth Disaster, Part 2
When I wrote How to Avoid a Home Birth Disaster, I didn’t plan on writing a “Part 2” but the more research I did about Rebecca Fielding’s case, it became obvious that writing a Part 2 would be necessary.
I want to preface my comments by revealing that I’m the granddaughter (3 generations removed) of two 19th century midwives. One delivered babies on a Virginia plantation and the other delivered half of her community until her death in 1936. I have the utmost respect for midwives because it was a midwife from Belize and not my colleagues who taught me the art of delivering my first baby. The record of Evelyn Muhlhan is unfortunately a cautionary tale for pregnant moms who opt to deliver at home.
In the Matter of Evelyn D. Muhlhan, License No. R060032, between July 2008 and September 2011, several complaints were brought before the Maryland Board of Nursing. The law (Code of Maryland Regulations 10.27.05.01(6)states that midwives must have a collaborating physician to cover them documented in a collaborative plan also known as an “Agreement.” Each year the agreement must be updated and submitted to the Board. The Board invoked an emergency suspension for Mulhan’s license for the following reasons:
- On June 7, 2008, she performed a vaginal home delivery on a patient who had a previous c-section, Factor V-Leiden deficiency and maternal obesity. Factor V deficiency predisposes patients to blood clots. The baby had to be brought to the emergency room because it was unresponsive, had meconium and was blue. The patient weighed 295 pounds. A physician was not consulted. Fortunately, the baby lived.
- On April 14, 2010, she used Pitocin in the patient’s muscle although it’s only supposed to be given in the vein. She used an antiseptic solution to treat Group B Strep as opposed to Penicillin which is the standard of care. The patient pushed for 3 hours, Muhlhan did an episiotomy, the baby did not deliver, so she repaired the episiotomy and then sent the patient to the hospital where an emergency c-section was done. The baby was born with brain injuries.
Muhlhan also attempted to deliver an 11-pound baby at home, had a patient who ultimately ruptured her uterus and manually removed another patient’s placenta that ended in a life-threatening postpartum hemorrhage.
So what’s the message? You must, I repeat, you must investigate people in whose hands you place your life. And this applies to physicians as well. Hospitals are imperfect institutions. It is the provider who will and should protect you from those imperfections based on their skill and advocacy. Homebirths will not be for everyone. There are health conditions that simply prevent this from happening.
We are moving towards promoting quality within healthcare as opposed to procedures and money. But we are far from getting there as yet. Each one of us must do our part to protect the integrity of our lives, our babies’ lives and heal our fractured healthcare system.
July 2, 2012
Do You Know How to Avoid a Homebirth Disaster?
A Maryland jury made history by awarding Enso Martinez and Rebecca Fielding $55 million dollars but there are no winners in this tragedy. Enso Martinez Jr. has irreversible brain damage and Johns Hopkins Hospital will spend resources that could be used for research for direct patient care, to defend their care of Fielding.
Home birth in the U.S. has increased by 20% in part, because of Ricki Lake’s documentary, The Business of Being Born. Women want to have their babies at home despite the admonishment and warnings from the American College of Obstetricians and Gynecologists. To all pregnant moms who want to have their babies at home, I get it. I truly do. You want a comfortable intimate environment to have what you deem is a “natural event” without “unnecessary intervention.” You want to be like the celebrities who have had successful home deliveries. But here’s the problem: your home is not equipped to deal with emergencies and they DO occur. Just ask celebrity mom Christine Turlington Burns, who experienced a postpartum hemorrhage and had to be rushed to the hospital in order to save her life. Obstetrics is a specialty of the unexpected. You MUST be prepared for emergencies.
Fielding entered Johns Hopkins Hospital because the baby was “stuck.” The midwife couldn’t deliver the baby because it was either too large or she couldn’t manage a shoulder dystocia. According a blogger, Dr. Amy Tuteur, Midwife Evelyn Muhlhan’s license was suspended by the State of Maryland because of five homebirth disasters including Fielding’s delivery.
An ambulance brought Fielding to a hospital where she allegedly waits for over 2 hours for blood test results. A c. section is delayed. A baby has brain damage. Take home message?
- Know your midwife’s professional record. Does she have malpractice suits? Has she been sanctioned by the state medical board for negligence?
- Meet your midwife’s ob-gyn back-up. The Smart Mother’s Guide to a Better Pregnancy discusses this in detail. At the first sign of trouble, Muhlhan should have contacted her ob backup. If she didn’t have one, she was begging for trouble.
- Have a PERSONAL copy of your prenatal chart with you and your back-up hospital or birthing center should have a copy as well. This is standard prenatal procedures. Having a homebirth doesn’t change that. Your prenatal record contains all of the important information including blood type and blood count. No one, I repeat NO ONE, is going to bring you into the operating room without knowing your blood type unless you are hemorrhaging to death. Had Fielding had a copy of her prenatal record, she might not have encountered the delay.
If you’re going to have a homebirth, then please take the necessary precautions. An ounce of prevention is always worth more than a pound of cure.
June 30, 2009
In Search of Integrity
There should be a litmus test for ethics and integrity so that the landscape of our country could look vastly different. There would be no healthcare crisis, no financial collapse, no housing foreclosures or unnecessary deaths because of pain medication addiction. The misfits seeking positions of power would be duly eliminated before they created havoc.
The death of Michael Jackson documented an ever expanding reality that gives me great pain: some doctors will do anything for the pursuit of money, even at the expense of human life.
During the course of my medical career, I have witnessed and have had to report colleagues who have crossed the line for the sake of their bank accounts. The colleague who supplied his cocaine habit by doing unnecessary surgery and fraudulent Medicaid billing. The physician who paid his cronies on a per-patient-basis and turned a public funded healthcare facility into a money making factory. The “deals” made by colleagues that violate conflicts of interests. Hippocrates is probably rolling over in his grave.
I will not write fictitious sick notes, fraudulent disability claims, fill prescriptions for people without a medical chart and am fiercely protective of my DEA license. My medical degree is not for sale. There are times when I have not been the most popular physician among my colleagues but at least I can sleep at night. I wonder if the physicians of Heath Ledger, Anna Nicole Smith and Michael Jackson can do the same.
The seduction of money comes with a heavy price. Just ask Michael Millikan, Ivan Boesky, or perhaps, the clients of Bernie Madoff. Dr. Deepak Chopra had the courage to say “no” to Michael Jackson, despite his celebrity. I only wish more of my colleagues would have the decency to do the same.
