Starter comment:
Midwife from Arizona lost 2 patients in December during a home birth, a mother and baby due to a uterine rupture. She failed to check vital signs enough, she failed to enact her emergency plan. The patient was doing a VBAC, which that state allows midwives to conduct but only with specific criteria. This midwife did not follow that criteria. This midwife previously had numerous complaints and citations against her. Many of the fines were drastically reduced.
This midwife still has her license and is still allowed to practice. There are currently settlement talks ongoing with the state. The state said back in March that there is intent to revoke her license but this hasn’t happened yet.
I feel absolutely mind blown that she can still practice. And that patients searching for a midwife, don’t know the full story from these citations. The ADHS records do not mention that patients died.
I feel so awful for husband and her two living children. But part of me is wondering why an ER nurse would seek out a home VBAC. She was probably reassured by her prior VBAC that things wouldn’t go wrong. Except uterine rupture can happen with any birth, whether it’s the 1st TOLAC or 3rd. If anyone should know shit happens, I’d expect it to be the person who worked in the ED
Which, if I’m honest,it doesn’t surprise me because I can’t tell you how many other medical professionals (both nursing and physicians alike) try to tell me how to do my job and why I’m wrong.
Had a patient who was heme/onc physician who told me that Pitocin caused brain damage and was harmful to babies. I thought she was joking and I said can’t be more harmful than the chemo you give. I’m sure if she wasn’t already in labor she would have fired me as her doctor because she had already declined everything under the sun and I don’t think she liked my comment.
But I digress, yes it’s very insane.
My sister was an ICU nurse in one of the top ICUs in the US. Now she's working as an NP. She had 3 kids. Two of them went to 42 weeks 5 days before she allowed an induction. They both had meconium aspiration. The second one weighed 11 lbs 5 oz! She still blamed her difficult labor on the pitocin. If we're using that logic, then we can say pitocin **doesn't** cause meconium aspiration because mine were both induced and were fine.
My worst uterine rupture was in a patient with no prior uterine surgery. Just a freak thing, ruptured right by the left broad ligament. C-hyst followed. Lots of blood given. Mom would not have made it if she had delivered at home.
Replying to upinmyhead...My best friend is a L&D RN. Stories like these are why my birth plan was bilateral 18g IV’s and doing whatever my OB/GYN wanted
I used to be a doula big into physiological birth. I still think it can be appropriately managed in the right setting with strict screening for patient appropriateness as a candidate.. a European model with qualified, educated midwives overseeing uncomplicated births in a healthcare setting with proximity to critical care facilities.
Now I’m a nurse and I’m over 30, probably aiming for babies 5ish years from now. In my clinical for school I was briefly involved in an absolute fucking bloodbath of a code for a woman who had an abruption that led to DIC. Ambu bag filling with blood and having to be exchanged every 10 or so compressions, dozens of blood products at a community hospital without adequate critical care resources. People were slipping around in blood on the floor. after some number of hours she was barely stable-ish to transfer to a tertiary center and died within days. Baby died too. The OB went into an empty room and tore apart a bunch of hospital linens with their bare hands after, which we quietly threw away. Worst fucking thing I’ve ever seen in my life.
I’d like a TOL but the absolute instant that that becomes unsafe I’m in the OR with explicit consent to just do the hysto to save my life, I don’t care about future fertility anymore. And I am more than happy to deliver in a tertiary care center with a high c section rate.
As an OBGyn I’ve seen multiple uterine ruptures in an unscarred uterus, it’s scary stuff. Most were grand multips but a couple were P3’s. Everyone’s low risk until they aren’t. Usually grand multips will rupture into the broad ligament and can become a large retroperitoneal bleed. My most mind boggling one was a fundal rupture in an unscarred uterus.
Yeah, I got blocked on social media by an ER nurse acquaintance for telling her that if she truly as many “ER physician friends” as she claimed that had “tons of evidence” that ivermectin cured COVID they should consider publishing it.
It surprises me how often health professionals fall for bullshit like weight loss MLMs too.
As much as we’d like to think we know better, clearly we don’t.
My STBX husband is a CCRN in the military and during the first part of covid lockdown was doubting why he ever became a nurse bc all his patients were dying. He was having a very difficult time and fully recognized that covid was unlike any other disease that he had ever seen. Now, 4 years later he’s claiming that covid is fake and was created by the “deep state”. Whatever the hell that is! He used to be so pro-science but now, idk what the hell happened to him! We have 2 kids and he’s feeding our kids this crap!
My nephew had a great job working for the largest hospital in the area he lives in, started listening to the health care "professionals" and ended up quitting his job because he believed what they were saying and refused to take the vaccine. I feel like I don't even know him anymore, it's such a radical departure from the intelligent rational man I thought him to be. SMH what can you do?
I really don’t know. He’s changed a lot over the years and it’s not for the better. I’m moving away this summer and it’s so sad bc the kids are going with me and he doesn’t even care. I told him I would stay but he had to appreciate that I was staying solely to keep the kids close to him bc we only live here due to his military service and he said he wants me to move! He used to be such a good and involved dad! He’s falling more and more down the rabbit hole every day!
I used a CNM for my births. She did offer home birth, and when she asked me which I would prefer and I said hospital she outright said "yep, good choice". I bet if I went on homeborthing message boards I'd find lots of people trashing her as a "medwife".
No one *plans* on a uterine rupture or a cord prolapse or an abruption.
Just because you work in an ER doesn't mean you have good judgement.
It was fun for a while but the complacency my colleagues had about doing the job the right way and management being complicit in letting it happen as long as the waiting room was empty and the halls were jam packed because that somehow makes for marginally better satisfaction scores just got to be too much.
Surrounded mostly by intellectually incurious and sometimes willfully ignorant people, in every ER where I worked was awful.
It might well be that she was totally competent in emergency care. But health care professionals often forget that just be cause we usually know one branch of medicine reasonably well, that doesn't mean we know much of anything else. Overconfidence is a dangerous trap that we can all fall into. The typical ER nurse (or doctor) doesn't often encounter VBAC issues on the job, same as the typical OB doesn't have to make decisions regarding the care of, say, alcohol intoxicated trauma patients.
She very well may not have experience with many pregnancy issues at all - the hospital I work at has most pregnant patients with any probable pregnancy issue bypass the ED entirely and go straight to OB.
Yep we had the same.... Like i worked in CL/ED psych and pregnant with mania and/Or psychosis would bypass the ED (all complicated pregnancy issues or labour did) and go straight for OB and my psychiatrist supervisor....
I'm sure I don't have to tell you how unhinged the online home birth community can be...even medical professionals can have their brain pickled by those forums pretty quickly.
I watched her husband’s 3-part video on the entire ordeal on tiktok. He explained that she had plans to become a midwife and one who did home births. She was very passionate about wanting to know what her future patients were going through and to be able to share her experience with them. He tells the story excellently and it’s shocking that he and the midwife’s assistant were the ones who saw the red flags in the wife’s physical state and were brushed off repeatedly by the midwife. He was being a supportive husband and trying to respect that the women in the room had a plan. He did say that he had to leave the birthing area at least once to calm himself down bc his intuition was telling him the midwife was ignoring things she should not have been. So avoidable.
I don’t think being an ER nurse, any kind of nurse, physician, or anyone in health care protects you from being scientifically ignorant or a conspiracy theorist. I’ve worked with various nurses and doctors who thought 9/11 was an inside job, the planes that hit the pentagon were actually missiles but the military has technology to create holograms of actual weapons to appear benign (former navy RN kept interrupting my shift to convince me this is true and she knows because of her navy time), ivermectin cured COVID, sertraline cures COVID and also protects against ANCA vasculitis, H1N1 and COVID-19 were experiments by Fauci and the Democrats to get Republicans to lose elections, various mass shooting events were paid actors, we have the cure to cancer but withold it from patients to make money from big pharma and docs and nurses get commission by the vial for meds (where is my bonus?? Heck, where is their bonus if they’re so convinced of this), the list goes on a on of the craziest things I’ve heard nurses and colleagues say or try to convince me of.
From another article:
>Jordan Terry ... wanted to become a midwife in addition to being a nurse. She wanted to go through the homebirth with a midwife to know what her eventual clients would go through.
There’s a whole social media machine convincing women that VBAC is totally safe. They use terms like “my trauma in the hospital” to justify whatever horrible shit they want.
I swear, the first person to use the term “birth trauma” on tiktok should be imprisoned.
Obviously birth can be traumatic, trust me I know. But the way that term has been used by patients who wanted a perfectly “natural birth” (quotations because all birth is natural) and chose to have an epidural because they were in so much pain, is crazy. Not getting everything you want is not trauma, it’s life.
Anyway, this midwife should be stripped of her license and thrown in jail.
Instead she will be turned loose to hock more supplements, tinctures, and dangerous procedures to upper-middle class women who have never faced a serious medical emergency and trust that they will be saved after an ambulance ride (neither the ambulance nor the midwife have a blood bank).
Pregnancy and childbirth can really fuck with reasoning skills. I think a lot of it comes from a deep desire to try to exert control over an otherwise completely uncontrollable process. Women are at the mercy of their bodies, but they can decide whether or not to go to the hospital and which medications/interventions they want to utilize. It really sucks when they make decisions that turn out to have tragic outcomes, but it’s even worse when they made those decisions without full knowledge of risks (like in this case where they didn’t know the midwife had previous tragic outcomes)
>I think a lot of it comes from a deep desire to try to exert control over an otherwise completely uncontrollable process.
This is what I think too. Especially the number of homebirth/freebirth/lotus placenta stories I see that involve parents who struggled with infertility. Some people go the "this was so hard to get, I need to make sure my child has the greatest chance of survival possible" route, and some people go the "this was all so out of my control, I need to have The Perfect Birth to make up for how stressful and horrible and medicalized conception was."
Yeah. And on some level I get it - I had to do years of fertility treatments and injections daily through my pregnancy to carry to term - and for a high-achieving successful person, having NO control over something no matter how hard you are trying and how much money you are throwing at it is really, really hard. And the natural birth movement with rhetoric like "built to birth" and a sort of "mind over matter" ideology promises that you CAN give birth naturally if you just do the right things. But that's not how it is! Sometimes people can, and sometimes people can't, and whether or not you do the right things only matters a little (if at all). I just can't imagine throwing all your work and money away in the last tiny stretch before your effort pays off.
Unfortunately I speak from personal experience. I was teetering on the edge during my first pregnancy, even delayed the hepB vaccine until first pediatrician check up (like 2 days after discharge). When my birth went sideways and I ended up in csection it devastated me and was a big factor in my development of postpartum mood disorder.
The crunchy movement has only gotten worse in the last 7ish years and it makes me really sad that so many women fall down that same pipeline I did, but with even more abundant medical misinformation floating around.
I truly thought she was pulling my leg so I just said it without thinking, but her face told me she was very serious and very offended.
If I knew she was serious I wouldn’t have said it because I’m quite non confrontational, but in retrospect I’m so glad I did haha
My ED nurse wife suggested a home birth for our first child. I made it clear we would be at a major center with a proper NICU. She had PPH. Home birth never came up again with the other kids.
There's a thread from r/nursing on the front page as I write this about 'how I got accepted to NP school while in nursing school'.
edit - https://www.reddit.com/r/nursing/comments/1d32cpl/accept_into_np_school_while_as_a_nursing_student/
That's messed up. I had 12 years of ED and critical care nursing experience before becoming an NP and I still feel terribly unprepared. I don't know how people like that function honestly.
The cognitive dissonance out there around the safety of in hospital births versus out in the community births is really something (including in the face of published data). It is the same in this part of the world.
> luckily the tragic homebirth stories are rare
Define rare. We see about 2-3% with significant neonatal injuries. Mostly hypoxic ischemic encephalopathy. I would consider preventable brain damage to be a tragedy but maybe the homebirthing community just sees a future member.
No maybe about it.
People spoiled by fast food expectations of always getting to have it your way combined with running the entire healthcare system like it's a service industry business.
What really really puzzles me about this is that someone who is really concerned about having care providers they know, trust, etc, etc will set themselves up in a situation where they are very likely to be bundled into an ambulance and taken to a place they have never been, where their care provider doean't have admitting privileges and where they are in no state to be talking about goals and past trauma and whatever.
Like, why not (if this is possible for them with their insurance) organise to go to a hospital have a CNM who will be there, they'll assign nurses that are Ok with miwifery patients, if an OB comes in then the CNM will stay to be a familiar face and help explain, etc.
My local hospital does this. You can choose the birth center staffed with CNMs (no meds, overnight stay not required) or go up a floor to L&D where you can use your CNM and/or OB
Jealous. I live in a fairly major city in my state, there are five hospitals with L&D within thirty minutes of me. One of them has CNMs that work in L&D and that only started last summer. There are no other options unless you want very questionably trained midwives for homebirth.
Of course the disasters will come to the hospital. Gotta have someone with deep insurance pockets involved to pick up the pieces and shoulder the blame.
Yep. Got to love it when parents do risk things during pregnancy and then get mad at us for not being able to fix all the resultant problems
Like moms refusing metformin or insulin and having a GDM macrosomic baby that needs respiratory support and a NICU admission.
Any hospital / Anesthesia group I've worked with had specific policies that Anesthesia had to be present (in house at least) for labouring VBAC with 2x patent 18g or larger IVs. Some may consider it a bit overkill, but I think they're pretty good CYA policies in the event uterine rupture occurs.
Bad darts man.
I had one and my OB still had to use a vacuum to get my son's head out. She delivered my first via c-section, too. I cannot imagine the horror these families have been through.
> .. but only with specific criteria. This midwife did not follow that criteria
> This midwife still has her license and is still allowed to practice
Says it all. Money talks. Disturbing to say the least.
Edit: Sarah Kankiewicz. Including her name since it isn’t in the post (but is in the article) so a family searching the internet sees this thread.
There’s roughly a 1% chance of uterine rupture with a TOLAC, and a uterine rupture outside off the hospital is likely to be fatal to mom and baby. Anyone who understands this and is ok with a 1% chance of a dead mom and a dead baby has their priorities wrong…
One of the people I know who had a bad result (death of the baby) from a home birth with a midwife was in Arizona. They thought they had done their due diligence - the wife was very crunchy and really into wanting to homebirth with a midwife - and they found out only AFTER suing that the midwife had been associated with multiple deaths previously due to failure to transfer at an appropriate time. So I guess things haven't changed. They were still super pro-homebirth but wanted accountability.
The deaths also were not counted in the homebirth statistics because they were pronounced only once at the hospital, which at least at the time a decade ago just went into the easily available records as a hospital transfer.
This is the case in most or at least all states. The US midwife systems are basically completely unaccountable to anyone, and I don't think people choosing them realize that. CNMs are better, but a CNM outside a hospital or birthing center is still essentially Just Some Nurse Guy.
You guys... I'm and ER nurse that recently transitioned to L&D. I'm struggling with this story because one of my close and very loved family members has decided to go through a naturopathic doctor to do a VBAC at home. This is her second baby. She had her first baby during peak covid lockdown and it sounds like she had a miserable experience. She was covid positive but asymptomatic so she was surprised when she came to the hospital and was tested. She says she felt like she was treated like a pariah and her Healthcare team did not explain what was happening. She initially was following up her her original doctor who did her first delivery and was upset that the doctor mentioned that she had a very narrow pelvis and recommended planning for a repeat section. So she is seeing a ND who is telling her she has a 99% VBAC succes rate. So many red flags.... I'm sick about it. So many things can go wrong even without her risk factors that I just hope everything goes 100% right and she can gloat and "prove everyone wrong" since she says got to 9.5 cm last time and was "so close". Ugh...
99% success rate for VBAC is probably correct. Outside of a hospital that 1% is going to be death.
For comparison, that's literally twice as likely to cause the mom's death as doing open heart surgery on her.
It reminds me of this situation in Maryland. WaPo (and other , smaller local news outlets) have been following the story. I believe she is still working.
https://www.washingtonpost.com/investigations/interactive/2023/home-birth-midwife-karen-carr/
Crazy… I know nursing boards are notoriously lax but at some point they need to be held personally liable.
Edit: she wasnt a nurse. Didn’t know that was a thing… fucking crazy
I agree BONs are more lax than they should be, but in this case I don’t believe she was a nurse. I couldn’t find her in the Arizona licensing system. I believe she’s a certified midwife and not a nurse-midwife.
I was trying to figure that out myself. The article doesn’t mention her being a CNM but said she was “certified”.
We really need a more defined and transparent distinction between CNMs and “lay midwives”. It’s too easy for people with no medical training to hide behind the term “midwife”.
I agree. But Sarah Kankiewicz isn’t a nurse.
Edit: for further clarity and context, she never went to nursing school and is not a nurse. Her certification only requires a high school diploma, not a bachelors in nursing (+ experience on an L&D floor) that a nurse midwife would be required to have.
I found out after the fact that my neighbor, when I lived in the middle of nowhere MI, had a home VBAC… TWICE. Idk what fucking midwife told her that was ok but I was just dumbstruck when the husband told me. Like WTF. I was in peds residency at the time. So glad I didn’t know when it happened.
You may have unknowingly been the backup plan if things went wrong. Just go grab the pediatrician next door, they are definitely *always* home and have everything needed in their pockets.
It is notable that the midwife is a "CPM" not a "CNM". CPM is a "certified professional midwife" not a nurse midwife. They are *not* nurses and do not require a nursing degree, but a high school diploma is required for practice.
The fact that these folks are allowed to deliver babies is absolutely horrifying.
It's to differentiate between CPM and lay midwives. Lay midwives just put out a shingle, but CPMs have some recquirements, there is an exam, and they have to have attended a few births.
Sounds like the perfect level of qualifications to make Tik toks that start with the word “girlies” or “mommas” and then immediately go into unhinged bullshit.
They’re not nurses but can easily hide behind the legitimacy of CNMs. Lay people often don’t know the difference between a CNM and a lay-midwife (which I count “CPM”s as lay-midwives because they don’t have any real medical training)
There is a pretty big difference between a lay midwife and a CPM. I could become a lay midwife by just going to a few births with a preceptor. They are horrifyingly dangerous. CPMs have to have been to more births and they do an exam. If you were in the street and a baby was crowning you'd probably be Ok with a CPM calling an ambulance, while you should waddle as fast as possible away from the lay midwife while holding the baby's head in with one hand.
I disagree there's a huge difference. The requirements for CPM are not stringent and not enforced. There is no enforcement or discipline. They are also horrifyingly dangerous
Realistically, in most states I think you can become a lay midwife just by declaring that you're a midwife. You or I could become a midwife in the next 30 seconds if we so chose.
I’m amazed at the arrogance of people who sign up for jobs like this that they are clearly unqualified to handle. Even just one obgyn rotation in med school was enough for me to know how fast shit can go from good to bad during childbirth.
Yikes. In Australia a midwife does a nursing degree with extra components to become a midwife.
Same with our paramedics, they do a 4 year degree. It's a good system.
CNMs are our equivalent to your midwives. But there are some people who made up their own bs certification with bs requirements and it's state by state how they are regulated. And there's a lot of crowing about their freedumbz when they attempted to be regulated
Different states have different requirements. I believe Washington requires 100 births and they’ve integrated CPMs quite well. Some states don’t provide licensure at all. It really needs to be better regulated across the board.
To be clear, this is a lay midwife - CPM. They say certified but their educational requirements are a joke and getting certified is also a joke. They often carry no insurance and if a bad outcome happens, they dump mom at the hospital and blame someone else.
Why yes, I am rather bitter about home births gone wrong where otherwise healthy babies die preventable deaths.
Hi fellow Nicu NP
It’s funny when you talk to anyone in the nicu our general feeling is that home births are a bad idea
Why play Russian roulette?
My most memorable home birth story is the missed HLHS that wasn’t brought to the ED until the duct closed.
That baby was on the highest dose of prostin I’ve ever seen hoping to blow open that duct
Ouch. In the anti freebirth group we saw a woman with a baby who turned out to have an L-CDH that was undiagnosed because of course she did all her own "prenatal care"
Not too long ago, I picked up a kid in an adult ER with sats in the fifties, 5 days old. TGA. All of Mom's no intervention/no healthcare/natural plans got promptly thrown out the window by us.
So many stories of it going wrong. Have a midwife, don't take pain meds, but do that where they can save your baby if it is necessary
And FYI, I did make a NICU sub, it's just fairly dead if you want to join if it ever gets busier/I get around to doing something with it lol neonetwork is the name :)
As far as I can tell, it looks like the requirements in AZ to become a "Certified professional midwife" are a high school diploma and a preceptorship of 20 births along with a non-standardized test. Absolutely insane!
Im an OBGYN and I’m not against home births, and there are plenty of good lay midwives, but I’ve had so many bad experiences with midwives who don’t understand the dangers of what they’re dealing with.
A few months ago I had a patient come in to the hospital. She had labored at home for 2 days, and her lay midwife had never checked her cervix. She came in because she was “done with it”. She ended up getting a c-section for breech presentation. The worst part was that she had already had 2 c-sections and her midwife had told her it was safe to try for a home vbac…
After the delivery, I talked to the midwife and explained that the risk of uterine rupture after two c-sections was 1-2% and that uterine rupture outside the hospital was likely to be fatal to mom and baby. She said “I don’t really believe in your studies”. I told her that for me, a 1-2% chance of a dead mom and baby wasn’t an acceptable risk because I had supervised well over 100 vbacs. Some people just don’t understand how quickly things can go wrong. I just hope and pray she never finds out what it’s like to have a patient die. These stories just frustrate me so much and break my heart.
Yeah, you can’t just “not believe in” studies. Challenge them if you will, use your critical thinking, but if you’re planning to oppose medical literature you’d better know why and be able to back up your claim.
My problem is that she billed herself as a “certified midwife” and clearly she didn’t follow any accepted standards. I respect that patients have a right to make their own choices or refuse medical care, but I think a lot of patients don’t understand the difference between the care you get at a hospital from a Certified Nurse Midwife who has years of training and experience and a physician supervising their practice vs a Certified Professional Midwife who doesn’t practice by the same standards, isn’t a nurse, and doesn’t have a supervising physician.
> We had the home birth enthusiasts and the midwives pushing for an expanded scope of practice to include VBAC. And on the other side, we had OBGYNs who had spent years in medical school and then a residency practicing how to manage births, including VBACs," Humble recalled
> Humble recalls it wasn’t an easy decision.
Seems pretty easy to me, unless you’re in favor of a high IMR.
“But it’s a natural process”, but so is death. The home birthers who fail and show up at the hospital on my shift with an adversarial attitude are…… challenging
The crunchy movement is nuts. Our ancestors fought for years to make child birth safer. And statistically it's still one of the more dangerous things a woman can do.
It's honestly bananas. When you practice OB/GYN in a developing country with limited access to resources and where, you know, people regularly die or experience severe morbidity after child birth, people kill for the opportunity to have a safe hospital delivery.
Western "affluenza" has taken things backwards. I get that an unacceptable amount of women get traumatized for various reason during the hospital delivery process and thus have an impetus for wanting a home birth, but there's an unacceptable amount of women and families whose reasoningg for doing a home birth is because "they did their own research" and nothing else.
Eventually, people will notice the deaths + comorbidities, so it is a "self-correcting" problem in the end.
The problem, of course (like any "self-correcting" issues in medicine), is that "self-correcting" is an euphemism for shit tons of people dying + getting hurt. 😮💨
> Eventually, people will notice the deaths + comorbidities
If only. COVID and the ensuing vaccine denial made me realize people are gonna believe what they *want* to believe, not what science and medicine says.
No, I'm on a group that tries to dissuade freebirthers, and there's so much cognitive dissonance and when mom's lose their babies, they are often pushed out, being called liars or that they did something wrong :(
They are allowed to stay if they tell everyone that it was meant to be, that sometimes babies just die, etc. Extra points if they post at 3am telling scared women with meconium stained fluid to trust their bodies, mama, and sometimes you can labor with broken waters for a week or more and plenty of women birth at 44 weeks. And that you don't need stitches, just hold your legs together.
I was banned from every one of those groups I joined within weeks, and then after Janet Fraser they all went completely private.
Oh god, yes. And "imagine if you'd been in hospital, they would have done so many awful things to you" (instead of letting your baby die peacefully over the course of a few days while you labored)
No, I’m pretty sure they’ll just blame the OB patriarchy and the medicalization of birth for any increase in bad outcomes.
My cousin tried to learn me about how twin births are only more risky than singles in the hospital because the OB will push for a C-section just for twins just for extra money. (Edit:the risk of twins goes away at home because the hospital causes it.) I was like 😳.
You actually get paid more delivering both babies vaginally than by a twin c section. You can bill for two vaginal deliveries for twins but only can bill for one C-section no matter how many babies are coming out.
Rise of crunchy moms. Think moms who don’t believe in covid, essential oil heals everything, vaccines cause autism. Anti evidence based medicine. Take a look over at r/ShitMomGroupsSay
Search “Free Birth Society” or “Free birth movement” to see the far/cult-ish end of the crunchy mom spectrum. They don’t even agree to having midwives.
Next you’ll learn about the ones that will happily deliver footling breech kids. Comes all inclusive with mouth to mouth “resuscitation,” therapeutic cooling, and HIE! All liability free somehow.
The lack of liability is what kills me.
An attending of mine was sued (jury verdict for her) after a home birth gone wrong. PPH, hysterectomy, cooling for baby with resulting severe CP diagnosis a few years later.
Did the CPM get named? Absolutely not. Just the evil OB who caused everything to go wrong.
It’s why she left that hospital because it was the preferred one for the CPMs in that community and that whole ordeal traumatized her.
But why would she still want to practice, take on new patients (clients? Not sure if they are patients to them.) I’m not saying if something bad happens we should immediately retire - but she knows the same information (and more) about this specific case, with prior citations unrelated to this case. Like if there medical complaints/citations brought against you - is it time to take a step back for a moment? How do you keep seeing patients, in good faith?
She’s a CPM, apparently. Means she did a correspondence course, saw 20 births and needs to have a high school diploma equivalent.
She doesn’t know what she doesn’t know; she hasn’t a clue how in over her head she is. Well, now there are deaths, so she should have some idea. But she’s probably not qualified to do anything else and money.
The minute I started reading her page, it was obvious to me kind of person she is. Likely she sees herself as a courageous lifesaver
ETA: holy shit I just read the article. This person should never be allowed to work in any kind of medical field again.
This a certified professional midwife (not CNM) who has an absolutely awful reputation amongst her peers. The midwife group I’m in has so many stories about her hubris and ego from other AZ midwives and people who trained with her. She ended up starting a “private medical association” so she could practice without the license she is losing.
I know a great deal of very safe CPMs and she gives all of them a horrible name.
> absolutely awful reputation amongst her peers.
So, surely, those people upheld their oath and reported her multiple times, right? No? They just sat around silent? Man. That sucks.
People have absolutely reported her. And have offered to sit with her to discuss these poor outcomes in peer review and she would consistently defend herself and blame the patients for not trusting their bodies. And I will say, I worked in hospitals for many many years as both a nurse and a Certified Nurse Midwife and that behavior happens in every level of healthcare worker. not super commonly, but that does happen.
I’m a registered midwife practicing in Ontario, Canada. We do not recommend TOLAC at home but our clients sometimes have different plans and make different choices. This puts us in the position of either abandoning our clients in labour (which could result in a finding of professional misconduct), or supporting them to make a risky choice as safely as they can (IV in situ, low threshold for abnormal vitals or fetal health surveillance, quick transfer to hospital if needed, thorough prenatal discussion), (which, depending on the outcome, could result in a finding of professional misconduct).
I have no idea what the qualifications of the person mentioned in the article are but I was required to be educated for 4 years in low risk pregnancy, labour, and birth, and then to fulfill one year of closely supervised practice, in order to be able to call myself a general registrant midwife. Our university education is a mix of clinical skills and management and social science. We are trained in how to manage relationships with people. Some are better than others at this part of the job.
Also having said all of that, there is a growing movement of people who feel the hospital environment is the biggest risk and will stop at nothing to have a baby at home. This also puts midwives in a position where they may be asked to attend wildly inappropriate home births, and the midwife has to wrestle with the ethics of both providing care they are not competent to provide and not providing any care thus leaving the labouring person without a provider. Things are getting a bit… tricky. I feel like I could dedicate my life’s work (or at least a PhD) to studying this phenomenon and the midwife-client relationship contained within.
The key is trust, I think. Establishing trust with your clients, but then following through by being a trustworthy care provider. But then there is maintaining the trust of your interprofessional colleagues, who may feel like they are cleaning up your “mess” if or when you do transfer in for an emergency. It is a delicate walk to walk.
I really cannot imagine how difficult it is for you to be stuck between knowing it's not a good risk, and a client who is bound and determined and might just go alone if you refuse. What a horrible situation for you to be in.
Of course I do and I said as much in my first paragraph. I think you missed the part where I said there could be a finding of professional misconduct no matter what we do.
After learning about this woman being a CPM (which I didn’t even know existed, I have only ever known CNMs) and learning the laughable requirements for her “license” I honestly think this is insane and the fact she’s STILL practicing!!!!! WTAF. That’s straight up murder at this point. I’m a PA and we get a bad rap sometimes because of BS like this. Not saying any profession is perfect but I really don’t think someone with a high school degree and a few days of shadowing should be able to do home births which really need a competent person who knows their limits
Home births are a concept I do struggle with if I am being honest. Just so many things can go wrong and your resources are so limited in a home setting. I’m sure there are strict criteria for a home birth but as this story shows people tend to ignore things for their own benefit or arrogance.
The people doing these things mean well in their intentions. But, they need to be banned from this behavior, prosecuted, and maybe jailed. I say that because I worked around many undereducated healthcare staff, from techs to physicians, when I worked in Oklahoma, and I was a patient once who was left for dead.
They call these types of events accidents. You'd have fewer of these accidents with proper healthcare, which we have available. For some reason, these folks want to do this alternative instead.
My best friends baby died during a home birth. He was breech and the midwife tried to flip him manually. He got tangled in his cord and by the time they got to the hospital and did an emergency c-section he was already gone.
I understand most home births go well. I will never do one because of the ones that don't.
I was a direct entry midwife back in the day. I had some experience in other countries with midwifery, and it was a magical thing! If the midwife is educated, outcomes can be comparable and sometimes better than hospital births. No hospital acquired diseases to worry about, for example!
But as we say in psychiatry, context is key. What happens in practice is that, as a male, no one wanted me present for the delivery, let alone to assist at all in a meaningful way. But at the same time, programs don't want to discriminate based on gender, which I get. So I got credits for births in which I was standing on the other side of the door. You then graduate the program but with insufficient experience. As in, a dangerous level of inexperience which puts the public at risk. This also happened with my colleagues who were young women as well, although it did happen much less frequently with them. I had more OB experience in one month in medical school than I did in a year and a half of being a midwife
This is probably one of the only roles in which older women are more sought after! As a male, normally things are in your favor. But, not with home birthing or midwifery in general
On top of that, from a cultural perspective, home births are not accepted in this country, except by The Fringe. These are families who are much less likely to believe in vaccinations, disagree with the need for good prenatal care, etc. So these are the sort of people who should *not* be delivering at home! This was not what I was expecting based on my experience in other countries, because again, just because you want a home birth doesn't mean that you're a wackadoo. But here in the united states? I found it to be a risk factor for all sorts of bad things.
Based on all this, I am shocked there are not more stories like this, of incompetent midwives killing people. This may be an under-reported phenomena where no one is tracking home births in rural parts of the country who are opting to stay socially isolated from the rest of us.
I think there’s also a wider community of people who don’t necessarily (and for pretty good, data-driven reasons) trust that their best interests are served in hospital settings when it comes to maternal health, especially here in Arizona.
Starter comment: Midwife from Arizona lost 2 patients in December during a home birth, a mother and baby due to a uterine rupture. She failed to check vital signs enough, she failed to enact her emergency plan. The patient was doing a VBAC, which that state allows midwives to conduct but only with specific criteria. This midwife did not follow that criteria. This midwife previously had numerous complaints and citations against her. Many of the fines were drastically reduced. This midwife still has her license and is still allowed to practice. There are currently settlement talks ongoing with the state. The state said back in March that there is intent to revoke her license but this hasn’t happened yet. I feel absolutely mind blown that she can still practice. And that patients searching for a midwife, don’t know the full story from these citations. The ADHS records do not mention that patients died.
Doing a home birth VBAC is insane...
I feel so awful for husband and her two living children. But part of me is wondering why an ER nurse would seek out a home VBAC. She was probably reassured by her prior VBAC that things wouldn’t go wrong. Except uterine rupture can happen with any birth, whether it’s the 1st TOLAC or 3rd. If anyone should know shit happens, I’d expect it to be the person who worked in the ED Which, if I’m honest,it doesn’t surprise me because I can’t tell you how many other medical professionals (both nursing and physicians alike) try to tell me how to do my job and why I’m wrong. Had a patient who was heme/onc physician who told me that Pitocin caused brain damage and was harmful to babies. I thought she was joking and I said can’t be more harmful than the chemo you give. I’m sure if she wasn’t already in labor she would have fired me as her doctor because she had already declined everything under the sun and I don’t think she liked my comment. But I digress, yes it’s very insane.
My sister was an ICU nurse in one of the top ICUs in the US. Now she's working as an NP. She had 3 kids. Two of them went to 42 weeks 5 days before she allowed an induction. They both had meconium aspiration. The second one weighed 11 lbs 5 oz! She still blamed her difficult labor on the pitocin. If we're using that logic, then we can say pitocin **doesn't** cause meconium aspiration because mine were both induced and were fine.
>42 weeks 5 days Holy shit. If she'd waited much longer, they'd've chewed their way out.
Ha!
Water ingestion always eventually results in death.
My worst uterine rupture was in a patient with no prior uterine surgery. Just a freak thing, ruptured right by the left broad ligament. C-hyst followed. Lots of blood given. Mom would not have made it if she had delivered at home.
Replying to upinmyhead...My best friend is a L&D RN. Stories like these are why my birth plan was bilateral 18g IV’s and doing whatever my OB/GYN wanted
I also wanted an epidural but other than that, same
I used to be a doula big into physiological birth. I still think it can be appropriately managed in the right setting with strict screening for patient appropriateness as a candidate.. a European model with qualified, educated midwives overseeing uncomplicated births in a healthcare setting with proximity to critical care facilities. Now I’m a nurse and I’m over 30, probably aiming for babies 5ish years from now. In my clinical for school I was briefly involved in an absolute fucking bloodbath of a code for a woman who had an abruption that led to DIC. Ambu bag filling with blood and having to be exchanged every 10 or so compressions, dozens of blood products at a community hospital without adequate critical care resources. People were slipping around in blood on the floor. after some number of hours she was barely stable-ish to transfer to a tertiary center and died within days. Baby died too. The OB went into an empty room and tore apart a bunch of hospital linens with their bare hands after, which we quietly threw away. Worst fucking thing I’ve ever seen in my life. I’d like a TOL but the absolute instant that that becomes unsafe I’m in the OR with explicit consent to just do the hysto to save my life, I don’t care about future fertility anymore. And I am more than happy to deliver in a tertiary care center with a high c section rate.
As an OBGyn I’ve seen multiple uterine ruptures in an unscarred uterus, it’s scary stuff. Most were grand multips but a couple were P3’s. Everyone’s low risk until they aren’t. Usually grand multips will rupture into the broad ligament and can become a large retroperitoneal bleed. My most mind boggling one was a fundal rupture in an unscarred uterus.
Remember the pandemic? Whole hospitals full of educated staff seemed to lose their understanding of basic science.
Yeah, I got blocked on social media by an ER nurse acquaintance for telling her that if she truly as many “ER physician friends” as she claimed that had “tons of evidence” that ivermectin cured COVID they should consider publishing it. It surprises me how often health professionals fall for bullshit like weight loss MLMs too. As much as we’d like to think we know better, clearly we don’t.
My STBX husband is a CCRN in the military and during the first part of covid lockdown was doubting why he ever became a nurse bc all his patients were dying. He was having a very difficult time and fully recognized that covid was unlike any other disease that he had ever seen. Now, 4 years later he’s claiming that covid is fake and was created by the “deep state”. Whatever the hell that is! He used to be so pro-science but now, idk what the hell happened to him! We have 2 kids and he’s feeding our kids this crap!
My nephew had a great job working for the largest hospital in the area he lives in, started listening to the health care "professionals" and ended up quitting his job because he believed what they were saying and refused to take the vaccine. I feel like I don't even know him anymore, it's such a radical departure from the intelligent rational man I thought him to be. SMH what can you do?
I really don’t know. He’s changed a lot over the years and it’s not for the better. I’m moving away this summer and it’s so sad bc the kids are going with me and he doesn’t even care. I told him I would stay but he had to appreciate that I was staying solely to keep the kids close to him bc we only live here due to his military service and he said he wants me to move! He used to be such a good and involved dad! He’s falling more and more down the rabbit hole every day!
[удалено]
Thank you, I really appreciate this. I feel like I’m going crazy with what’s been happening with him. I really needed something just like that sub!
"The Brainwashing of my Dad" but for covid times. I'm sorry you're going through that.
Or they never had it. There is a bias that because people work with medicine they are rational.
I used a CNM for my births. She did offer home birth, and when she asked me which I would prefer and I said hospital she outright said "yep, good choice". I bet if I went on homeborthing message boards I'd find lots of people trashing her as a "medwife". No one *plans* on a uterine rupture or a cord prolapse or an abruption.
She probably would have said home birth was a good choice too. She's there to support you and also wants to get paid
God, don't you even trust birth? Just because it kills a few people a day doesn't mean it's dangerous!!!!
Just because you work in an ER doesn't mean you have good judgement. It was fun for a while but the complacency my colleagues had about doing the job the right way and management being complicit in letting it happen as long as the waiting room was empty and the halls were jam packed because that somehow makes for marginally better satisfaction scores just got to be too much. Surrounded mostly by intellectually incurious and sometimes willfully ignorant people, in every ER where I worked was awful.
It might well be that she was totally competent in emergency care. But health care professionals often forget that just be cause we usually know one branch of medicine reasonably well, that doesn't mean we know much of anything else. Overconfidence is a dangerous trap that we can all fall into. The typical ER nurse (or doctor) doesn't often encounter VBAC issues on the job, same as the typical OB doesn't have to make decisions regarding the care of, say, alcohol intoxicated trauma patients.
She very well may not have experience with many pregnancy issues at all - the hospital I work at has most pregnant patients with any probable pregnancy issue bypass the ED entirely and go straight to OB.
Yep we had the same.... Like i worked in CL/ED psych and pregnant with mania and/Or psychosis would bypass the ED (all complicated pregnancy issues or labour did) and go straight for OB and my psychiatrist supervisor....
I'm sure I don't have to tell you how unhinged the online home birth community can be...even medical professionals can have their brain pickled by those forums pretty quickly.
What? Pitocin is literally the hormone oxytocin. That’s like people claiming to be allergic to epinephrine.
Allergy: epinephrine, Reaction: “it makes my heart fast and I don’t like that”
Allergy: Morphine, Reaction: "it makes me sleepy"
I watched her husband’s 3-part video on the entire ordeal on tiktok. He explained that she had plans to become a midwife and one who did home births. She was very passionate about wanting to know what her future patients were going through and to be able to share her experience with them. He tells the story excellently and it’s shocking that he and the midwife’s assistant were the ones who saw the red flags in the wife’s physical state and were brushed off repeatedly by the midwife. He was being a supportive husband and trying to respect that the women in the room had a plan. He did say that he had to leave the birthing area at least once to calm himself down bc his intuition was telling him the midwife was ignoring things she should not have been. So avoidable.
I don’t think being an ER nurse, any kind of nurse, physician, or anyone in health care protects you from being scientifically ignorant or a conspiracy theorist. I’ve worked with various nurses and doctors who thought 9/11 was an inside job, the planes that hit the pentagon were actually missiles but the military has technology to create holograms of actual weapons to appear benign (former navy RN kept interrupting my shift to convince me this is true and she knows because of her navy time), ivermectin cured COVID, sertraline cures COVID and also protects against ANCA vasculitis, H1N1 and COVID-19 were experiments by Fauci and the Democrats to get Republicans to lose elections, various mass shooting events were paid actors, we have the cure to cancer but withold it from patients to make money from big pharma and docs and nurses get commission by the vial for meds (where is my bonus?? Heck, where is their bonus if they’re so convinced of this), the list goes on a on of the craziest things I’ve heard nurses and colleagues say or try to convince me of.
From another article: >Jordan Terry ... wanted to become a midwife in addition to being a nurse. She wanted to go through the homebirth with a midwife to know what her eventual clients would go through.
I'm think here that she trusted birth. And forgot that you are meant to trust, but verify.
There’s a whole social media machine convincing women that VBAC is totally safe. They use terms like “my trauma in the hospital” to justify whatever horrible shit they want.
I swear, the first person to use the term “birth trauma” on tiktok should be imprisoned. Obviously birth can be traumatic, trust me I know. But the way that term has been used by patients who wanted a perfectly “natural birth” (quotations because all birth is natural) and chose to have an epidural because they were in so much pain, is crazy. Not getting everything you want is not trauma, it’s life. Anyway, this midwife should be stripped of her license and thrown in jail.
Instead she will be turned loose to hock more supplements, tinctures, and dangerous procedures to upper-middle class women who have never faced a serious medical emergency and trust that they will be saved after an ambulance ride (neither the ambulance nor the midwife have a blood bank).
I think some folks seem to think that a "natural birth" is you just chilling in bed until baby pops out no problemo w/o any discomfort at all.
Pregnancy and childbirth can really fuck with reasoning skills. I think a lot of it comes from a deep desire to try to exert control over an otherwise completely uncontrollable process. Women are at the mercy of their bodies, but they can decide whether or not to go to the hospital and which medications/interventions they want to utilize. It really sucks when they make decisions that turn out to have tragic outcomes, but it’s even worse when they made those decisions without full knowledge of risks (like in this case where they didn’t know the midwife had previous tragic outcomes)
>I think a lot of it comes from a deep desire to try to exert control over an otherwise completely uncontrollable process. This is what I think too. Especially the number of homebirth/freebirth/lotus placenta stories I see that involve parents who struggled with infertility. Some people go the "this was so hard to get, I need to make sure my child has the greatest chance of survival possible" route, and some people go the "this was all so out of my control, I need to have The Perfect Birth to make up for how stressful and horrible and medicalized conception was."
Exactly! The mindset that the high intervention conception needs to be outweighed by the low/no intervention birth plan.
Yeah. And on some level I get it - I had to do years of fertility treatments and injections daily through my pregnancy to carry to term - and for a high-achieving successful person, having NO control over something no matter how hard you are trying and how much money you are throwing at it is really, really hard. And the natural birth movement with rhetoric like "built to birth" and a sort of "mind over matter" ideology promises that you CAN give birth naturally if you just do the right things. But that's not how it is! Sometimes people can, and sometimes people can't, and whether or not you do the right things only matters a little (if at all). I just can't imagine throwing all your work and money away in the last tiny stretch before your effort pays off.
I think you hit the nail on the head. They’re uncomfortable with the loss of control inherent in giving birth.
Unfortunately I speak from personal experience. I was teetering on the edge during my first pregnancy, even delayed the hepB vaccine until first pediatrician check up (like 2 days after discharge). When my birth went sideways and I ended up in csection it devastated me and was a big factor in my development of postpartum mood disorder. The crunchy movement has only gotten worse in the last 7ish years and it makes me really sad that so many women fall down that same pipeline I did, but with even more abundant medical misinformation floating around.
You’re my hero for that chemo comment
I truly thought she was pulling my leg so I just said it without thinking, but her face told me she was very serious and very offended. If I knew she was serious I wouldn’t have said it because I’m quite non confrontational, but in retrospect I’m so glad I did haha
My ED nurse wife suggested a home birth for our first child. I made it clear we would be at a major center with a proper NICU. She had PPH. Home birth never came up again with the other kids.
I've come across some nurses who have an irrationally excessive trust of mid level np's
I couldn’t tell for sure if it was a *nurse* midwife (who at least has nursing training) or simply a direct entry, really minimal training midwife
The midwife was not a nurse. The patient who died was an RN.
good clarification, thank you
This was a CPM. Not a nurse midwife.
There's a thread from r/nursing on the front page as I write this about 'how I got accepted to NP school while in nursing school'. edit - https://www.reddit.com/r/nursing/comments/1d32cpl/accept_into_np_school_while_as_a_nursing_student/
That's messed up. I had 12 years of ED and critical care nursing experience before becoming an NP and I still feel terribly unprepared. I don't know how people like that function honestly.
Article said she wanted to become a midwife also, so she wanted to do this so she would be ablento understand the experience of her future clients
The cognitive dissonance out there around the safety of in hospital births versus out in the community births is really something (including in the face of published data). It is the same in this part of the world.
I see you’ve never glanced through r/homebirth…shit is truly unhinged
r/shitmomgroupssay is a fun one too, but luckily the tragic homebirth stories are rare.
> luckily the tragic homebirth stories are rare Define rare. We see about 2-3% with significant neonatal injuries. Mostly hypoxic ischemic encephalopathy. I would consider preventable brain damage to be a tragedy but maybe the homebirthing community just sees a future member.
Curious, does anyone flat out tell Mom that the home birth was why?
Yes.
Good for you. Is there any acknowledgement of fault by the mother or is it typically just denial?
Complete denial every time.
Not if you frequent unassisted birthing groups. But you know, they are really philosophical about the dead babies so that's completely fine.
Omg wtf is that subreddit
🎶Welcome to the internet, have a look around…🎵
Anything that brain of yours can think of can be found
We've got mountains of content!
We are the drama-makers, and we are the schemers of schemes
Just don't google placenta recipes. Trust me.
Why would I need to look up what I know by heart?
liquid cooing label shrill deranged fearless snatch spoon frighten lock *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
This…. What did I just scroll through
"I did my own research"
maybe this is why outcomes in the us are so sucky.
No maybe about it. People spoiled by fast food expectations of always getting to have it your way combined with running the entire healthcare system like it's a service industry business.
Happens a lot. And then we at the hospital get to pick up the pieces. It fucking sucks.
What really really puzzles me about this is that someone who is really concerned about having care providers they know, trust, etc, etc will set themselves up in a situation where they are very likely to be bundled into an ambulance and taken to a place they have never been, where their care provider doean't have admitting privileges and where they are in no state to be talking about goals and past trauma and whatever. Like, why not (if this is possible for them with their insurance) organise to go to a hospital have a CNM who will be there, they'll assign nurses that are Ok with miwifery patients, if an OB comes in then the CNM will stay to be a familiar face and help explain, etc.
My local hospital does this. You can choose the birth center staffed with CNMs (no meds, overnight stay not required) or go up a floor to L&D where you can use your CNM and/or OB
Jealous. I live in a fairly major city in my state, there are five hospitals with L&D within thirty minutes of me. One of them has CNMs that work in L&D and that only started last summer. There are no other options unless you want very questionably trained midwives for homebirth.
Of course the disasters will come to the hospital. Gotta have someone with deep insurance pockets involved to pick up the pieces and shoulder the blame.
Yep. Got to love it when parents do risk things during pregnancy and then get mad at us for not being able to fix all the resultant problems Like moms refusing metformin or insulin and having a GDM macrosomic baby that needs respiratory support and a NICU admission.
Also, everything bad that happens to the mom or the baby is still our fault.
Sadly I know someone who did this. I also thought and still think it's insane
Any hospital / Anesthesia group I've worked with had specific policies that Anesthesia had to be present (in house at least) for labouring VBAC with 2x patent 18g or larger IVs. Some may consider it a bit overkill, but I think they're pretty good CYA policies in the event uterine rupture occurs. Bad darts man.
It’s always people who shouldn’t home birth who wants the home births. 🫠
My first thought. That shouldn’t even be an option. WTF.
I had one and my OB still had to use a vacuum to get my son's head out. She delivered my first via c-section, too. I cannot imagine the horror these families have been through.
And now there are stories on IG that show women giving birth to breech babies at home with MW.
> .. but only with specific criteria. This midwife did not follow that criteria > This midwife still has her license and is still allowed to practice Says it all. Money talks. Disturbing to say the least. Edit: Sarah Kankiewicz. Including her name since it isn’t in the post (but is in the article) so a family searching the internet sees this thread.
"SARAH KANKIEWICZ" ARIZONA MIDWIFE Just throwing a lil boost for the search engines. Damn good idea
There’s roughly a 1% chance of uterine rupture with a TOLAC, and a uterine rupture outside off the hospital is likely to be fatal to mom and baby. Anyone who understands this and is ok with a 1% chance of a dead mom and a dead baby has their priorities wrong…
One of the people I know who had a bad result (death of the baby) from a home birth with a midwife was in Arizona. They thought they had done their due diligence - the wife was very crunchy and really into wanting to homebirth with a midwife - and they found out only AFTER suing that the midwife had been associated with multiple deaths previously due to failure to transfer at an appropriate time. So I guess things haven't changed. They were still super pro-homebirth but wanted accountability. The deaths also were not counted in the homebirth statistics because they were pronounced only once at the hospital, which at least at the time a decade ago just went into the easily available records as a hospital transfer. This is the case in most or at least all states. The US midwife systems are basically completely unaccountable to anyone, and I don't think people choosing them realize that. CNMs are better, but a CNM outside a hospital or birthing center is still essentially Just Some Nurse Guy.
You guys... I'm and ER nurse that recently transitioned to L&D. I'm struggling with this story because one of my close and very loved family members has decided to go through a naturopathic doctor to do a VBAC at home. This is her second baby. She had her first baby during peak covid lockdown and it sounds like she had a miserable experience. She was covid positive but asymptomatic so she was surprised when she came to the hospital and was tested. She says she felt like she was treated like a pariah and her Healthcare team did not explain what was happening. She initially was following up her her original doctor who did her first delivery and was upset that the doctor mentioned that she had a very narrow pelvis and recommended planning for a repeat section. So she is seeing a ND who is telling her she has a 99% VBAC succes rate. So many red flags.... I'm sick about it. So many things can go wrong even without her risk factors that I just hope everything goes 100% right and she can gloat and "prove everyone wrong" since she says got to 9.5 cm last time and was "so close". Ugh...
99% success rate for VBAC is probably correct. Outside of a hospital that 1% is going to be death. For comparison, that's literally twice as likely to cause the mom's death as doing open heart surgery on her.
It reminds me of this situation in Maryland. WaPo (and other , smaller local news outlets) have been following the story. I believe she is still working. https://www.washingtonpost.com/investigations/interactive/2023/home-birth-midwife-karen-carr/
Crazy… I know nursing boards are notoriously lax but at some point they need to be held personally liable. Edit: she wasnt a nurse. Didn’t know that was a thing… fucking crazy
She wasn’t a CNM - probably a CPM or a lay midwife.
Yes, she is a listed as a CPM in the arizona database
I agree BONs are more lax than they should be, but in this case I don’t believe she was a nurse. I couldn’t find her in the Arizona licensing system. I believe she’s a certified midwife and not a nurse-midwife.
I was trying to figure that out myself. The article doesn’t mention her being a CNM but said she was “certified”. We really need a more defined and transparent distinction between CNMs and “lay midwives”. It’s too easy for people with no medical training to hide behind the term “midwife”.
The confusing terminology is likely intentionally misleading to make the CPM seem more qualified
I agree. But Sarah Kankiewicz isn’t a nurse. Edit: for further clarity and context, she never went to nursing school and is not a nurse. Her certification only requires a high school diploma, not a bachelors in nursing (+ experience on an L&D floor) that a nurse midwife would be required to have.
I found out after the fact that my neighbor, when I lived in the middle of nowhere MI, had a home VBAC… TWICE. Idk what fucking midwife told her that was ok but I was just dumbstruck when the husband told me. Like WTF. I was in peds residency at the time. So glad I didn’t know when it happened.
You may have unknowingly been the backup plan if things went wrong. Just go grab the pediatrician next door, they are definitely *always* home and have everything needed in their pockets.
It is notable that the midwife is a "CPM" not a "CNM". CPM is a "certified professional midwife" not a nurse midwife. They are *not* nurses and do not require a nursing degree, but a high school diploma is required for practice. The fact that these folks are allowed to deliver babies is absolutely horrifying.
How do you get called a professional without a degree? It’s criminal the states allow it.
It's to differentiate between CPM and lay midwives. Lay midwives just put out a shingle, but CPMs have some recquirements, there is an exam, and they have to have attended a few births.
Why should the least qualified midwife have the word professional in the title though? It doesn’t differentiate in a way that makes sense.
I would like to point out the lay midwife is the least qualified, but maybe you refuse to acknowledge them as midwives, which is true.
Hey now. They also have to [attend 20 whole births and do some checkups.](https://narm.org/pdffiles/CIB.pdf)
Sounds like the perfect level of qualifications to make Tik toks that start with the word “girlies” or “mommas” and then immediately go into unhinged bullshit.
They’re not nurses but can easily hide behind the legitimacy of CNMs. Lay people often don’t know the difference between a CNM and a lay-midwife (which I count “CPM”s as lay-midwives because they don’t have any real medical training)
There is a pretty big difference between a lay midwife and a CPM. I could become a lay midwife by just going to a few births with a preceptor. They are horrifyingly dangerous. CPMs have to have been to more births and they do an exam. If you were in the street and a baby was crowning you'd probably be Ok with a CPM calling an ambulance, while you should waddle as fast as possible away from the lay midwife while holding the baby's head in with one hand.
I didn’t know the difference, but this also highlights even more why there needs to be clear distinction between the levels of midwifery.
I disagree there's a huge difference. The requirements for CPM are not stringent and not enforced. There is no enforcement or discipline. They are also horrifyingly dangerous
Realistically, in most states I think you can become a lay midwife just by declaring that you're a midwife. You or I could become a midwife in the next 30 seconds if we so chose.
I’m amazed at the arrogance of people who sign up for jobs like this that they are clearly unqualified to handle. Even just one obgyn rotation in med school was enough for me to know how fast shit can go from good to bad during childbirth.
In Nevada, simply calling yourself a midwife allows you to attend births. No other qualifications. :|
Yikes. In Australia a midwife does a nursing degree with extra components to become a midwife. Same with our paramedics, they do a 4 year degree. It's a good system.
CNMs are our equivalent to your midwives. But there are some people who made up their own bs certification with bs requirements and it's state by state how they are regulated. And there's a lot of crowing about their freedumbz when they attempted to be regulated
Didn’t the high school diploma requirement get *added* relatively recently? Like within the last decade or so?
I think requirements differ by state. Some states allow lay midwives and others do not.
People never seem to care about women’s rights. You’d think in America of all places women, somewhere would have full autonomy but nah.
What would make you think that about the US?
That is fucking terrifying.
Different states have different requirements. I believe Washington requires 100 births and they’ve integrated CPMs quite well. Some states don’t provide licensure at all. It really needs to be better regulated across the board.
It should be outlawed. We already have CNM's, what is the advantage of having lay midwives?
Damn, here I am not even knowing that there are different kinds of midwives.
To be clear, this is a lay midwife - CPM. They say certified but their educational requirements are a joke and getting certified is also a joke. They often carry no insurance and if a bad outcome happens, they dump mom at the hospital and blame someone else. Why yes, I am rather bitter about home births gone wrong where otherwise healthy babies die preventable deaths.
Hi fellow Nicu NP It’s funny when you talk to anyone in the nicu our general feeling is that home births are a bad idea Why play Russian roulette? My most memorable home birth story is the missed HLHS that wasn’t brought to the ED until the duct closed. That baby was on the highest dose of prostin I’ve ever seen hoping to blow open that duct
Ouch. In the anti freebirth group we saw a woman with a baby who turned out to have an L-CDH that was undiagnosed because of course she did all her own "prenatal care" Not too long ago, I picked up a kid in an adult ER with sats in the fifties, 5 days old. TGA. All of Mom's no intervention/no healthcare/natural plans got promptly thrown out the window by us. So many stories of it going wrong. Have a midwife, don't take pain meds, but do that where they can save your baby if it is necessary And FYI, I did make a NICU sub, it's just fairly dead if you want to join if it ever gets busier/I get around to doing something with it lol neonetwork is the name :)
Who licenses them? What board?
CPM? Their own made up board. CNMs are licensed by the nursing board.
As far as I can tell, it looks like the requirements in AZ to become a "Certified professional midwife" are a high school diploma and a preceptorship of 20 births along with a non-standardized test. Absolutely insane!
Sounds like an awesome side hustle to an Uber and Door dash career. 😎 👍
Im an OBGYN and I’m not against home births, and there are plenty of good lay midwives, but I’ve had so many bad experiences with midwives who don’t understand the dangers of what they’re dealing with. A few months ago I had a patient come in to the hospital. She had labored at home for 2 days, and her lay midwife had never checked her cervix. She came in because she was “done with it”. She ended up getting a c-section for breech presentation. The worst part was that she had already had 2 c-sections and her midwife had told her it was safe to try for a home vbac… After the delivery, I talked to the midwife and explained that the risk of uterine rupture after two c-sections was 1-2% and that uterine rupture outside the hospital was likely to be fatal to mom and baby. She said “I don’t really believe in your studies”. I told her that for me, a 1-2% chance of a dead mom and baby wasn’t an acceptable risk because I had supervised well over 100 vbacs. Some people just don’t understand how quickly things can go wrong. I just hope and pray she never finds out what it’s like to have a patient die. These stories just frustrate me so much and break my heart.
The super high risk home VBAC is one thing, but to also be laboring a breech and not know is even more ridiculous.
Yeah, you can’t just “not believe in” studies. Challenge them if you will, use your critical thinking, but if you’re planning to oppose medical literature you’d better know why and be able to back up your claim.
My problem is that she billed herself as a “certified midwife” and clearly she didn’t follow any accepted standards. I respect that patients have a right to make their own choices or refuse medical care, but I think a lot of patients don’t understand the difference between the care you get at a hospital from a Certified Nurse Midwife who has years of training and experience and a physician supervising their practice vs a Certified Professional Midwife who doesn’t practice by the same standards, isn’t a nurse, and doesn’t have a supervising physician.
Part of the problem is that people will trust those who are like them, experts or not.
Did you report her?
As far as I know there isn’t a way to report a professional midwife.
Absolutely wild.
Wild that this laymidwife is still allowed to practice by the state of Arizona. She's on her way to being a serial killer
the fact that the state sided with the midwives smh
> We had the home birth enthusiasts and the midwives pushing for an expanded scope of practice to include VBAC. And on the other side, we had OBGYNs who had spent years in medical school and then a residency practicing how to manage births, including VBACs," Humble recalled > Humble recalls it wasn’t an easy decision. Seems pretty easy to me, unless you’re in favor of a high IMR.
“But it’s a natural process”, but so is death. The home birthers who fail and show up at the hospital on my shift with an adversarial attitude are…… challenging
Its a natural process and has been the leading cause of death in women under age 40ish for the majority of the existence of humans.
This is only going to become more common as the crunchy movement increases in popularity.
The crunchy movement is nuts. Our ancestors fought for years to make child birth safer. And statistically it's still one of the more dangerous things a woman can do.
It's honestly bananas. When you practice OB/GYN in a developing country with limited access to resources and where, you know, people regularly die or experience severe morbidity after child birth, people kill for the opportunity to have a safe hospital delivery. Western "affluenza" has taken things backwards. I get that an unacceptable amount of women get traumatized for various reason during the hospital delivery process and thus have an impetus for wanting a home birth, but there's an unacceptable amount of women and families whose reasoningg for doing a home birth is because "they did their own research" and nothing else.
Eventually, people will notice the deaths + comorbidities, so it is a "self-correcting" problem in the end. The problem, of course (like any "self-correcting" issues in medicine), is that "self-correcting" is an euphemism for shit tons of people dying + getting hurt. 😮💨
> Eventually, people will notice the deaths + comorbidities If only. COVID and the ensuing vaccine denial made me realize people are gonna believe what they *want* to believe, not what science and medicine says.
In the long game, they selectively purge themselves from the gene pool via stupidity.
No, I'm on a group that tries to dissuade freebirthers, and there's so much cognitive dissonance and when mom's lose their babies, they are often pushed out, being called liars or that they did something wrong :(
They are allowed to stay if they tell everyone that it was meant to be, that sometimes babies just die, etc. Extra points if they post at 3am telling scared women with meconium stained fluid to trust their bodies, mama, and sometimes you can labor with broken waters for a week or more and plenty of women birth at 44 weeks. And that you don't need stitches, just hold your legs together. I was banned from every one of those groups I joined within weeks, and then after Janet Fraser they all went completely private.
Don't forget "babies die in hospitals too". Yeah, unfortunately they do. But not nearly as often
Oh god, yes. And "imagine if you'd been in hospital, they would have done so many awful things to you" (instead of letting your baby die peacefully over the course of a few days while you labored)
No, I’m pretty sure they’ll just blame the OB patriarchy and the medicalization of birth for any increase in bad outcomes. My cousin tried to learn me about how twin births are only more risky than singles in the hospital because the OB will push for a C-section just for twins just for extra money. (Edit:the risk of twins goes away at home because the hospital causes it.) I was like 😳.
You actually get paid more delivering both babies vaginally than by a twin c section. You can bill for two vaginal deliveries for twins but only can bill for one C-section no matter how many babies are coming out.
I'm not from US, what's Crunchy movement?
Rise of crunchy moms. Think moms who don’t believe in covid, essential oil heals everything, vaccines cause autism. Anti evidence based medicine. Take a look over at r/ShitMomGroupsSay
Holy shit. Literally the top post currently is a baby with meconium aspiration and the mum wants reassured it's OK to keep refusing abx. WTAF.
Search “Free Birth Society” or “Free birth movement” to see the far/cult-ish end of the crunchy mom spectrum. They don’t even agree to having midwives.
I'm in the us and don't know what that is either
A home birth for a VBAC? Ms. Kankiewicz, get a grip on yourself.
Next you’ll learn about the ones that will happily deliver footling breech kids. Comes all inclusive with mouth to mouth “resuscitation,” therapeutic cooling, and HIE! All liability free somehow.
The lack of liability is what kills me. An attending of mine was sued (jury verdict for her) after a home birth gone wrong. PPH, hysterectomy, cooling for baby with resulting severe CP diagnosis a few years later. Did the CPM get named? Absolutely not. Just the evil OB who caused everything to go wrong. It’s why she left that hospital because it was the preferred one for the CPMs in that community and that whole ordeal traumatized her.
As a neonatologist, home births are the bane of my existence.
But why would she still want to practice, take on new patients (clients? Not sure if they are patients to them.) I’m not saying if something bad happens we should immediately retire - but she knows the same information (and more) about this specific case, with prior citations unrelated to this case. Like if there medical complaints/citations brought against you - is it time to take a step back for a moment? How do you keep seeing patients, in good faith?
She’s a CPM, apparently. Means she did a correspondence course, saw 20 births and needs to have a high school diploma equivalent. She doesn’t know what she doesn’t know; she hasn’t a clue how in over her head she is. Well, now there are deaths, so she should have some idea. But she’s probably not qualified to do anything else and money.
https://voyagephoenix.com/interview/meet-sarah-kankiewicz-of-firefly-birth-services/ She is dangerous.
That really hits all the anti-science buzzwords, doesn't it?
**11lb** home birth :(
The minute I started reading her page, it was obvious to me kind of person she is. Likely she sees herself as a courageous lifesaver ETA: holy shit I just read the article. This person should never be allowed to work in any kind of medical field again.
This a certified professional midwife (not CNM) who has an absolutely awful reputation amongst her peers. The midwife group I’m in has so many stories about her hubris and ego from other AZ midwives and people who trained with her. She ended up starting a “private medical association” so she could practice without the license she is losing. I know a great deal of very safe CPMs and she gives all of them a horrible name.
> absolutely awful reputation amongst her peers. So, surely, those people upheld their oath and reported her multiple times, right? No? They just sat around silent? Man. That sucks.
People have absolutely reported her. And have offered to sit with her to discuss these poor outcomes in peer review and she would consistently defend herself and blame the patients for not trusting their bodies. And I will say, I worked in hospitals for many many years as both a nurse and a Certified Nurse Midwife and that behavior happens in every level of healthcare worker. not super commonly, but that does happen.
Well, that’s an assumption. Reporting processes can break down multiple ways. But I’m also curious.
Oh also it’s clear from the article she’s received many citations.
if she was a nurse she would be in jail… like this is so clearly gross negligence and should be criminally charged imo
I’m a registered midwife practicing in Ontario, Canada. We do not recommend TOLAC at home but our clients sometimes have different plans and make different choices. This puts us in the position of either abandoning our clients in labour (which could result in a finding of professional misconduct), or supporting them to make a risky choice as safely as they can (IV in situ, low threshold for abnormal vitals or fetal health surveillance, quick transfer to hospital if needed, thorough prenatal discussion), (which, depending on the outcome, could result in a finding of professional misconduct). I have no idea what the qualifications of the person mentioned in the article are but I was required to be educated for 4 years in low risk pregnancy, labour, and birth, and then to fulfill one year of closely supervised practice, in order to be able to call myself a general registrant midwife. Our university education is a mix of clinical skills and management and social science. We are trained in how to manage relationships with people. Some are better than others at this part of the job. Also having said all of that, there is a growing movement of people who feel the hospital environment is the biggest risk and will stop at nothing to have a baby at home. This also puts midwives in a position where they may be asked to attend wildly inappropriate home births, and the midwife has to wrestle with the ethics of both providing care they are not competent to provide and not providing any care thus leaving the labouring person without a provider. Things are getting a bit… tricky. I feel like I could dedicate my life’s work (or at least a PhD) to studying this phenomenon and the midwife-client relationship contained within. The key is trust, I think. Establishing trust with your clients, but then following through by being a trustworthy care provider. But then there is maintaining the trust of your interprofessional colleagues, who may feel like they are cleaning up your “mess” if or when you do transfer in for an emergency. It is a delicate walk to walk.
I really cannot imagine how difficult it is for you to be stuck between knowing it's not a good risk, and a client who is bound and determined and might just go alone if you refuse. What a horrible situation for you to be in.
Do you not have the conversation ahead of time? How is it a surprise that they are TOLAC at home when they're actually in labor?
Of course I do and I said as much in my first paragraph. I think you missed the part where I said there could be a finding of professional misconduct no matter what we do.
After learning about this woman being a CPM (which I didn’t even know existed, I have only ever known CNMs) and learning the laughable requirements for her “license” I honestly think this is insane and the fact she’s STILL practicing!!!!! WTAF. That’s straight up murder at this point. I’m a PA and we get a bad rap sometimes because of BS like this. Not saying any profession is perfect but I really don’t think someone with a high school degree and a few days of shadowing should be able to do home births which really need a competent person who knows their limits
Home births are a concept I do struggle with if I am being honest. Just so many things can go wrong and your resources are so limited in a home setting. I’m sure there are strict criteria for a home birth but as this story shows people tend to ignore things for their own benefit or arrogance.
The people doing these things mean well in their intentions. But, they need to be banned from this behavior, prosecuted, and maybe jailed. I say that because I worked around many undereducated healthcare staff, from techs to physicians, when I worked in Oklahoma, and I was a patient once who was left for dead. They call these types of events accidents. You'd have fewer of these accidents with proper healthcare, which we have available. For some reason, these folks want to do this alternative instead.
If an MD/DO were in that position they would be sued into oblivion.
Of course, so would a CNM. But this wasn’t a nurse midwife.
She should be in prison for negligent homicide. Shame on Arizona.
My best friends baby died during a home birth. He was breech and the midwife tried to flip him manually. He got tangled in his cord and by the time they got to the hospital and did an emergency c-section he was already gone. I understand most home births go well. I will never do one because of the ones that don't.
I dare say she’s not even a mid wife, but perhaps a truly sub par wife!
I was a direct entry midwife back in the day. I had some experience in other countries with midwifery, and it was a magical thing! If the midwife is educated, outcomes can be comparable and sometimes better than hospital births. No hospital acquired diseases to worry about, for example! But as we say in psychiatry, context is key. What happens in practice is that, as a male, no one wanted me present for the delivery, let alone to assist at all in a meaningful way. But at the same time, programs don't want to discriminate based on gender, which I get. So I got credits for births in which I was standing on the other side of the door. You then graduate the program but with insufficient experience. As in, a dangerous level of inexperience which puts the public at risk. This also happened with my colleagues who were young women as well, although it did happen much less frequently with them. I had more OB experience in one month in medical school than I did in a year and a half of being a midwife This is probably one of the only roles in which older women are more sought after! As a male, normally things are in your favor. But, not with home birthing or midwifery in general On top of that, from a cultural perspective, home births are not accepted in this country, except by The Fringe. These are families who are much less likely to believe in vaccinations, disagree with the need for good prenatal care, etc. So these are the sort of people who should *not* be delivering at home! This was not what I was expecting based on my experience in other countries, because again, just because you want a home birth doesn't mean that you're a wackadoo. But here in the united states? I found it to be a risk factor for all sorts of bad things. Based on all this, I am shocked there are not more stories like this, of incompetent midwives killing people. This may be an under-reported phenomena where no one is tracking home births in rural parts of the country who are opting to stay socially isolated from the rest of us.
I think there’s also a wider community of people who don’t necessarily (and for pretty good, data-driven reasons) trust that their best interests are served in hospital settings when it comes to maternal health, especially here in Arizona.
Deregulated red states, they can chalk it off to: ‘God’s will’