I am an RN with two years of sporadic experience in Labor and Delivery. My brother's wife, (SIL), pregnant with their third child opted to have a home birth with a Certified Midwife, (MW) because she was turned away by her OB due to lack of maternity Insurance. They were planning to pay cash and that was unacceptable for this Obstetrician. (7 years earlier, this particular physician delivered my nieces, (twins), vaginally.)
This pregnancy started out perfectly. Ultra sounds revealed a placenta that was close to the cervical opening but in time, as the uterus grew, the placenta moved and was no longer a potential complication…or so the MW stated.
The nightmare occurred during the last 6 hours.
MY SIL had "Bright Red or FRANK BLOOD" at 12 midnight, in the toilet upon urinating. This is typically an emergent sign which signals something is wrong. (It is also a cardinal sign for placenta abruption.) The midwife came at 12:30 AM, May 17th, 2010. The MW saw the blood in the toilet because my SIL saved it for her.
So, to recap, the midwife was told about the blood at 12 midnight and saw the blood at 12:30 AM. She opted to call a physician that she said was a part of her "backup plan". This backup plan (which turned out to be worthless), is outlined on her website and was talked about extensively at a meeting held with those planning to attend the birth. The OB that supervised the MW’s practice would step in and take over the case IF any emergent situation arose. She also described an affiliation with a hospital that her clients would be taken to, if necessary, where this particular physician would oversee the care of the mom and baby.
I heard every word because I was there.
The OB who was her “backup” did not answer the call. She called a second physician that was "on call" and the MW said that he told her to “observe the patient”.
The contractions started coming one after the other along with extreme pain which my SIL spoke to the MW about. (This is another cardinal symptom of placenta abruption.) The intervention made at that time was to put her in the hot tub. The MW monitored the fetal heart tones with a Doppler and by 3:15 AM, the fetal heart rate had dropped and stayed in the 60's and then 50's.
At this point, the MW told my SIL to get out of the tub for her babies sake...they had to get to a hospital. Naked and wet, with a blanket put around my SIL, my brother, under unspeakable pressure, proceeded to drive to the closest hospital. The MW called them at that time and asked if an OB was on staff. She was told “no” and advised to take my SIL to Memorial Hermann which was another 15 plus minutes away. The drive took at least 30 minutes.
It was clear to my brother that no one in the ER was expecting them. He ran in and got the wheel chair and then went back to the car to get his wife. She delivered shortly after arrival and the Dr. (who was a new OB) was on the scene and ended up taking over the care of my SIL and her baby.
He cut a very large episiotomy in order to accommodate the size of the baby and “get him out”. He, the baby was not breathing and in severe distress upon delivery. Resuscitation procedures began for the infant and he was taken to the nursery. The MW said to my brother, that the baby was fine. “She had seen bluer babies then this.”
I arrived at the hospital about 4:10 AM to see my SIL, legs in stirrups, white as snow, bleeding, with two physicians trying to get the bleeding to stop. Blood covered the delivery room. Nurses were in chaos. Both MDs were VERY concerned.
My SIL was taken to the OR. The MW with her asst. MW remained with my brother and me reiterating that this birth was dedicated to “The Lord “from the beginning and “it would be fine”. The primary MW proceeded to talk about her frustrations regarding the “first physician”. Her concern was focused on the episiotomy that he had performed. (The MW thought that he had “butchered my SIL and she had to tell him to stop cutting in order for him to stop”. It turned out to be a 4th degree episiotomy which has been healing well since the delivery.)
The two physicians WERE NOT able to stop the bleeding...plus there were no blood products at the lab. This is at 4:30 AM. About 6:15 AM, my SIL had a Hgb. of 3 and a temp of 91.4 F. She was still in the OR.
Both physicians came out one at a time, again and again. They told us that they did not think that my SIL would survive. They said she was bleeding from everywhere and was in DIC.
The MW and her asst, MW, left at some point after the Dr.’s projected outcome for my SIL and remained in the waiting room. My brother and I sat together on the floor outside of the OR. We prayed, cried, talked about his children being w/o their mom, and planned a funeral, kept our mother updated (who was taking care of his twins). It was hell!
Blood products were hung once received by the lab…around 6:30 AM. A total of 51 units of various blood products were infused and my SIL was taken to ICU where she, my brother and I remained for several days. She survived. She was moved to the floor and discharged home on Sunday afternoon. No residual physical damage has been noted so far. The emotional toll however, is and has been enormous especially given the following events that they are now facing.
(My nephew, Sam, apgarred at 3, 3, 6, and after 20 minutes, 8. Later that morning, 5/18, my brother and I were told by the physician who was on call for the nursery / NICU, that the baby was stable.)
The baby began to seize early morning, May 19th. My brother told me the medical personnel were starting an alternative IV. I thought if he was “stable”, why would he need another IV? I went to the NICU and the new Dr. who took over the care told me that the baby was seizing last night and he was being transported to Memorial Hermann, downtown Houston Medical Center to the NICU. The explanation was that the infant needed an EEG and further evaluation.
I rode with the baby to the Houston Medical Center via ambulance while my brother stayed with his wife. The infant was taken to the NICU, level 3 nursery. I was greeted by the receptionist at the front desk who had me wait for 20 minutes until I could see a nurse manager and find out what was happening.
(I refer to the receptionist now as the Gestapo because of her extremely poor social skills. In my opinion, she is in dire need of training and supervision when it comes to dealing with families and patients that are tired, vulnerable, and in tremendous distress!)
Finally, I was allowed to be with the baby per the Nurse Manager, Tyra. She was a ray of sunshine in comparison to my initial contact at the NICU with the receptionist.
I spoke with Dr’s, Nurse Practitioners, and staff nurses throughout my stay. I had the freedom to go in and out of the NICU day and night. The nursing staff from the time I arrived, to the time I left Friday evening, was amazing! Dr. Carbehol, Betina, NP, the EEG tech, and Jen at the Ronald McDonald house where I stayed for 3 days, were outstanding. Their efforts to include me as a team member, accommodate my needs, serve, and answer the ongoing questions in order to educate me, made this nightmare for my family, and me, a bit more bearable.
To summarize my nephew’s status, the EEG, (electroencephalogram) taken within 24 hours revealed that his entire brain had been affected by the lack of oxygen due to the loss of blood that he had sustained. A MRI was completed and read one week after admission and clearly delineated that there was global brain damage which ultimately validated the results from the EEG.
Our family now waits to see what the baby will recover an hour / a day at a time.
We celebrated when he finally had his first wet diaper because that meant no more urine catheter! His kidneys were working and there was no need for long term dialysis. He could pee!
We celebrated when his pupils constricted (even though they were sluggish), when exposed to light via an ophthalmoscope because that meant he was not brain dead. There was a response.
We were happy to hear that the sedation medication, Phenobarbital and Ativan, were maintained at adequate levels in order to keep the brain from seizing. It was critical to have the brain rest so it could recover and heal to whatever extent he was capable of. (Seizures can be very hard to control.)
We were so glad to have him taken off the respiratory equipment (CPAP) days after the incident because given time, he was able to take deep enough breaths to satisfy his blood oxygen levels. He could breathe on his own!
Today, he actually looks at Mom, Dad and his sisters. He sucked Dad’s finger laced with sugar yesterday during a visit. Unfortunately, he is still at the NICU, away from home, because he is not able to feed from a breast or bottle. His gag reflex is weak which means he can’t swallow without choking.
We are waiting and praying for this to return or my nephew will have to be fed by a tube…in his mouth, nose, or directly, surgically placed in his stomach. (GTUBE).
I have come to understand from other parents and medically trained practitioners who have walked this path that this is how it will go for the duration of his life. One celebration at a time with each step of recovery from the trauma he endured during his birth.
In conclusion, my nephew has been diagnosed with SEVERE ENCEPHALOPATHY due to a HYPOXIC, ISCHEMIC, EVENT or HIE. He is going on 3 weeks of age.
The primary MW is a trainer of midwife interns and plans to open a birthing center in Katy, Texas within the next few months. She claims 17 years of experience delivering babies, pre nursing coursework (that was never completed), a certification from NARM and a license to practice midwifery in the state of Texas. Her “stated record” is next to perfection with only 4 babies going to the hospital. All outcomes were great.
(Except now, given the experience with my nephew and his mother.)
The Primary MW has met with my SIL this past week. The MW is convinced that she has done the right thing and made all the correct decisions. Her thinking is that if she referred my SIL to the hospital initially when the blood was first observed at 12:00 AM, the “outlying hospital that they would have gone to most likely would have done a C-section and my SIL would have bled to death”.
The truth is that the placenta was abrupting or pulling away from the uterine wall which is an emergency situation! My SIL needed to be taken to a hospital immediately...at 12:00 AM! This was the first indication that the delivery was not normal.
The second cardinal warning of abruption was the pain. MY SIL told the MWs that she could not take the pain. (I am sure that the pain level that my SIL complained of WAS NOT congruent with the dilation stage of her cervix. Her pain level was intolerable and both MWs ignored this.)
The third sign which accompanied the second sign / pain was that the uterus was having a continuous contraction. The uterus was not resting in between contractions. THIS IS NOT NORMAL!
The intervention, given all the symptoms mentioned above, was to place my SIL in a hot tub and monitor the fetal heart rate via Doppler. By 3 PM, the fetal heart tones were in the 60’s and then 50’s. My nephew was dying and this is what finally motivated this MW and her Asst. to go to a hospital.
Neither midwife knew what was happening when the signs of an emergent delivery started!!! They were both clueless and way out of the scope of their practice outlined by the TX Dept. of State Health Services. Both midwives were planning to perform a delivery without a Physician, Hospital or “emergency backup” plan in place. Two lives, approaching death rapidly, were in their hands and they chose to wait until the last minutes prior to getting medical help.
I am furious and very sad for my nephew who will never have a normal life due to the negligence and ignorance displayed by these Midwives.
This did not have to happen. It could have been prevented!
If a registered nurse, physician or hospital practiced medicine with negligence of this caliber, they would be paying tremendous consequences…not to mention the potential for losing their professional licensure!
FYI: The primary MW, who has been paid $3000.00 in cash for her services (which is her fee per birth), does approximately 4 home births per month. That totals $150,000.00 per year. There has been no refund to date.
Candice SanPietro
PS - Kathy Rude opened up "Katy Birth Center", Katy TX with two other nurse midwives in December 2010. They all continue supporting Home Births and do not post anything regarding Sam's Story on their web site. The only stories posted are the ones that sell "Home Birthing" not the ones that depict the risks and devastated families.
Kathy Rude was found guilty regarding her negligence with Sam and his mom, Tina by the TX State Board of Midwifery and was given 6 months of probation. That means they require her to submit a total of 10 reports on various births she attends and have another midwife accompany her at all births...for 6 months. (#2 at a birth is much safer then #1 which is how it should be).
http://www.dshs.state.tx.us/midwife/mw enforce.shtm
Thats it!!!! No fines, fees or suspension. No mandated apology to the family...or Sam. And of course, no obligation to share her negligence with the public.
