Tag: Homebirth

My story…the short version

jmacmidwife

A pathologist, nephrologist, and urologist walk into a boardroom…

Though this sounds like the start of a joke, what happened next was hardly funny. These three doctors, who are on the Louisiana State Board of Medical Examiners (LSBME), decided to indefinitely suspend my midwifery license.

What Happened?

Nothing. Other than a normal homebirth, where an 11-pound baby was safely delivered, nothing happened. There were no injuries. The mom and baby were not transported to the hospital before,during or after the birth. In accordance with the law, this mother’s obstetrician stated five times in her medical record that she was low risk and healthy for a homebirth.

On Christmas Eve in 2014, as I was leaving to a holiday party, I received a certified letter.  It stated that the Louisiana State Board of Medical Examiners summarily suspended my midwifery license under the guise of protecting Louisiana citizens, from what I am not sure.  While the news of being unable to attend any further births put a damper on my holiday, it pales in comparison to the experience of one of my other clients. She gave birth three days later without a healthcare provider by her side because she could not find a midwife to replace me in that limited amount of time and the LSBME, with blatant regard for this woman and her baby’s safety, refused to allow me to continue care.

The next three months following my suspension consisted of being at the mercy of the LSBME.  The LSBME’s idea of following the law included lying, withholding evidence, and purposefully manipulating the rules and regulations. In the end, the LSBME accused me of deviating from midwifery standards of practice, exhibiting incompetence as determined by local midwifery standards, and fraud and deceit in connection with services rendered. None of these allegations are true.

The LSBME allowed a videographer, who attended the birth, to file a complaint against me.  Ironically, while the labor was caught on video the actual birth was not, yet I was still accused of not delivering a baby correctly. However, I did not know who filed the complaint or what the allegations were until the day before my adjudication.  Of course this allowed me no time to prepare for her coached and rehearsed untruthful testimony.  Not only did this single, childless videographer lack medical training, her complaint was based on untrue allegations.  Her dishonesty was propagated by a local midwife and obstetrician, who coincidentally opened a new birth center located five miles from my home. Can anyone say competition? I can.

The videographer, without the birth parents consent, showed the video to this competing midwife and obstetrician. Coincidentally this was the same obstetrician my client, the mother, was transferring care from when she decided to have a homebirth with me.  The videographer worked closely enough with the birth center that they exclusively listed her photography services on its website.

Healthcare providers should be petrified that a videographer/photographer was allowed to file a complaint against their license especially when no one was injured.  Though anyone should be allowed to make credible complaints against anyone’s license, the allegations should be truthful.  None of the videographer’s allegations were proven to be anything but her opinion. Had the LSBME consulted with a noncompeting midwife, the charges would have been dropped.  Instead, I was judged by three doctors (a pathologist, nephrologist, and urologist). They did not understand what was happening at this homebirth nor could they imagine what was normal because management of a homebirth is vastly different than a doctor-led hospital birth.

Likewise, the LSBME could have interviewed any of the other four adults present in the room during the birth. This included a nursing student and doula with more knowledge and experience with normal births than the videographer, which would have laid the videographer’s false allegations to rest. The parents testified on my behalf,explaining to the board that they were overjoyed with my careful, quality of care and would do the same birth all over again with me as a provider. The parents even asked me to attend the birth of their next child, but because my license is indefinitely suspended, I was unable to attend. This mom went on to have another 11-pound baby in a hospital setting, attended by another midwife without judgment on her license.

No one can control how a birth is perceived. It all depends on the persons’ perspective. The people with the most important perspective are the parents. They thought the birth was perfect, not at all traumatic as indicated by the LSBME. Homebirth is raw,natural, messy and organic.  It’s hardly the same as a hospital birth. So of course a nephrologist, urologist, and pathologist who have never seen an out-of-hospital birth might perceive the normal sights and sounds of a homebirth as traumatic. Nothing unlawful or malicious happened at this birth or post-partum.

The LSBME was the investigator, accuser, judge, and jury in my case. In fact, the Lead Investigator was also the Executive Director of the LSBME—further evidence of injustice and conflict of interest. The Executive Director’s behavior, widely-known to be abrasive, abusive, and hostile did not lend itself to any professional negotiating or understanding. Under her direction, the LSBME acted like a soap opera; she allegedly had an affair with an attorney who worked with the LSBME to prosecute its victims, then hired his niece as part of the investigative staff, as evidently nepotism doesn’t apply to Louisiana. You just can’t make this stuff up.

Additionally, I didn’t have adequate access to the testimony nor appropriate peers to sift through the false allegations. Even though no one was hurt, injured, died, and no transfer to a hospital occurred, my livelihood was stripped from me because of competition. There was no oversight to this board. It screams of antitrust. Louisiana law states that a board of midwives serving underneath the LSBME would oversee any midwifery complaints. However, that board of midwives was dismantled years previously, evidently due to budgetary constraints.

In Adam Crepelle’s article, Guest column: Louisiana licensing rules stifle free market, he noted that “by making it harder to enter a profession, licensing can also reduce employment opportunities and lower wages for excluded workers, and increase costs for consumers.” The report notes that licensing is particularly burdensome on those required to move for work,like military families. It also asserts licensing hits the poor the hardest because they are often unable to afford licensing’s training costs.Furthermore, the report concludes that “most research does not find that licensing improves quality or public health and safety.”

Also, according to Alden Abbott of the Heritage Foundation, “In recent years, however, there have been signs that the Fourteenth Amendment ‘rational basis’ test that applies to economic regulation may be applied more expansively by the courts when it comes to analyzing anti-competitive licensing restrictions and related affronts to one of the most basic civil rights of all: the right to earn a living.”

Off the record, I consulted several midwives who are expert witnesses in other states and they agreed that my case was biased and unfounded, but I could not utilize their testimony because the prosecution set the tone of the courtroom, whereby doctors were used to defend midwifery rules and regulations. This is something doctors cannot adequately do because, well, they are not midwives and do not understand what occurs at a homebirth. Midwifery rules and regulations, especially for autonomous, out-of-hospital midwives are, and uniquely designed for, complete,continuous independent care of low-risk, healthy mothers. The mother whose baby I delivered was low-risk and healthy, as indicated five times in her medical records by the obstetrician she was seeing during the pregnancy. The LSBME told me that this obstetrician was “wrong.”

Why didn’t I appeal the decision?

Unfortunately I didn’t have the available funds. This was my second client in Louisiana as a licensed midwife,so my income was minimal. My attorneys were flabbergasted at the railroading that occurred at my hearing. Initially, they thought these allegations would not amount to anything close to a suspension because license suspensions are usually only given when a practitioner does something horrific like operates on the wrong leg, practices under the influence of drugs or alcohol, or prescribes medications illegally, not during a birth where no one was hurt or injured.

The decision the LSBME made in my case was unprecedented. A regulatory board like the LSBME is responsible for “protecting the public from unsafe practitioners,” but clearly it overstepped its jurisdiction because it did not have any oversight. It took advantage of its intended purpose and instead applied irrational, unreasonable, arbitrary, and burdensome requirements to unduly limit my individual constitutional liberties. Due to institutional corruption, an appeal was looking unfavorable, and it would cost me an additional $30,000. Unable to get the upper hand and find additional funds, I had to cut my losses and regroup. Besides, my family needed me.

I spent the next two years helping to care for of my 86-year old grandmother, while my mother took care of her dying husband, all while going through a divorce. Additionally, I found out I have thyroid cancer. Last year, I attempted to find some gainful employment doing something, anything that would help me afford health insurance. I live in a ‘red state,’ so even Medicaid insurance would cost me hundreds every month. I applied to about 50 different jobs from department stores to libraries. I couldn’t get past the background check with a suspended license on my record,despite having had a midwifery license in Wisconsin that was never acted upon and had no lawsuits. I chose not to renew my Wisconsin license, as I did not live there. I was fortunate enough to maintain my skill set in midwifery by working as an assistant midwife and birth assistant, but the pay is not as steady nor much as it would be if I were an independent midwife.  I could not afford to keep paying my health insurance premium of nearly $700 a month.

I moved to Florida in the spring of 2018 to work at a birth center where I would have a more steady income as an office assistant and birth assistant. I took a second job house sitting so that I would have a place to stay. After realizing that my first application for midwifery licensure in Florida should not have been denied, I chose to reapply after completing the in-state requirements. But once again, the suspended license in Louisiana is somehow preventing the Department of Health in Florida from granting me a license, even a temporary one, in the underserved area where I live. Although Florida has a Council of Midwives who assist the Department of Health in making decisions regarding midwifery rules and regulations, the Council was not given the ability to have any input on my application. Likewise, if my allegations were true and I was adjudicated in Florida, my sanctions would be at most a fine of a few hundred dollars and a few months of probation compared to an indefinite suspension.

The stipulations required to lift my suspension and place me on probation include paying the LSBME nearly$18,000 in fees (which the LSBME didn’t calculate until 11/2017), going to the LSBME’s handpicked rehab in Mississippi, completing three courses, demonstrating my understanding of the Louisiana midwifery rules and regulations (which the LSBME will elaborate only after I go to rehab), and paying a $300 fine. According to an email from my compliance officer on November 13, 2017, the LSBME accepts cash or money orders only. They do not take credit cards, have payment plans, or will agree to community service in lieu of fines or fees.  However,in an email correspondence tonight with the new Director of Investigations, he stated that “the board has been willing to work with licensees in the past if money is the primary reason a person would not be able to comply with orders and sanctions of an administrative hearing.  Paying over an extended period of time has been granted in the past.” Clearly, the LSBME personnel lack consistency and understanding of LSBME policies, procedures, and options regarding payments.

Despite the fact that physical, mental, drugs, or alcohol were never an issue in my case, the LSBME is requiring me to go to one of five rehabs to prove it. Interestingly, two of the rehabs closest to me declined to admit me after viewing my court documents because I do not fit their criteria for admission. Coincidentally, after the Mississippi rehab Pine Grove consulted with my compliance officer at the LSBME,they decided I was a “perfect” candidate. There is abundant information on how Physician Health Programs (PHP) choose to utilize fraud, deceit, and fabrication to go above the law to commit crimes for these boards, whom conveniently give them immunity and a constant flow of “customers.” Furthermore, the LSBME continues to change its requirements. For example, it stated that I could take courses found on the Board of Nursing’s website, but months later were silent on whether those courses that I already completed were adequate.

In a contrary statement, the new Director of Investigations wrote in October of 2018 that he reviewed my file and found that “there is no mention or recommendation of a drug and alcohol treatment facility.  This is not a requirement of the Board and therefore you do not have to commit yourself to a drug and alcohol treatment center.  The Board does require a mental/physical evaluation by a physician or group of physicians who have been pre-approved in writing by the Board.  You must also have an evaluation showing that you have been deemed competent to resume the practice of midwifery.” This sounds confusing because it is. I have several emails from my compliance officer stating the opposite. These boards are notorious for (un)comically being Lucy constantly moving the football so that I, Charlie Brown, can’t kick it.

Likewise, in an even more frustrating turn of events, the new Director also stated in an email from October 2018 that my compliance officer could set up a payment plan for the almost $18,000 fee, but my compliance officer stated that I would have to get preapproval from the LSBME before she could set up a payment plan because she could not guarantee that the LSBME would accept a payment plan even though the Director of Investigations stated to do so. Also, now I am apparently supposed to find my own physician to conduct a mental evaluation but they will not tell me what I need to be evaluating. Once I find someone who I think can do the evaluation I am to have that person contact my compliance officer for specific instructions on what exactly needs to be evaluated. Sound shady? Yes, yes it is.

Why share this story now? Why didn’t I share it three years ago when it happened?

The Supreme Court has finally realized how out-of-control and cartel-like these state boards have become. In 2015, in North Carolina State Board of Dental Examiners v. FTC, the Supreme Court held that when a controlling number of state board members are market participants, the board must be “actively supervised” to be immune from antitrust law. States have three options for complying with this ruling. First, they can choose not to put a controlling number of active market participants on boards. Second, they can actively supervise boards where market participants make up a controlling number of members. Third, they can forgo state action immunity by not actively supervising boards and keeping a controlling number of market participants on boards. Without such changes, state boards may be subject to antitrust liability for actions that are deemed to be anticompetitive.

In May 2018, Louisiana Senator John Milkovich introduced a bill to the Louisiana legislature to provide oversight to actively supervise these corrupt boards, like the LSBME. The bill was approved and instituting its requirements have begun, albeit slowly.  Therefore, I finally feel like I have a chance to positively change my circumstances. Louisiana needs to nullify the absurd sanctions placed on me. Please join me in contacting the following agencies and complaining on my behalf at the injustice and the unreasonable restraint on competition violating federal antitrust law that occurred. *However, since this bill was just “dropped on them” as stated by the secretary of the House and Governmental Affairs Committee, at this time, she does not know what a formal complaint should include.  I will update this information as soon as their attorney returns my call.

In compliance with Act 2018-655, the board gives notice to its licensees and applicants of their opportunity to file a complaint about board actions and board procedures. You may submit such complaints to one or more of the following organizations:

  1. Louisiana State Board of Medical Examiners; 630 Camp Street, New Orleans, LA 70130; (504) 568-6820; lsbme@lsbme.la.gov
  2. Committee on House & Governmental Affairs; La House of Representatives; PO Box 444486, Baton Rouge, LA 70804; (225) 342-2403; h&ga@legis.la.gov
  3. Committee on Senate & Governmental Affairs; La Senate; PO Box 94183, Baton Rouge, LA 70804; (225) 342-9845; s&g@legis.la.gov

Conveniently, the media group Gatehouse recently published a series of articles pertaining to out-of-hospital midwifery. They complied a database of all midwives across the US. If we look at Louisiana’s active licensed midwives (and the five midwives who would still be practicing if their licenses were not acted upon) we will find shocking statistics—32% (8/25) have had their licenses acted upon in some capacity. This further underscores the restriction of trade and antitrust issues occurring there. Out of those 20 with active licenses, three have been acted upon by the LSBME for violations and are still practicing in some capacity, whether that is on probation or in a state of undocumented, involuntary suspension. These violations, which midwives carry on their record forever, stem from simple clerical errors to natural occurrences that no one can predict or prevent like stillbirth. Two midwives, including myself have their licenses suspended. One Naturopathic physician was also targeted by the LSBME and had her license to practice midwifery revoked. The data speak for itself: more midwives have inactive licenses in Louisiana than those actively working (26 with two of those licenses having been acted upon). This means that there are more midwives in Louisiana that have, for one reason or another, stopped practicing in Louisiana. Is this because Louisiana unfairly and unjustly monopolizes the practice of midwifery? We can imagine that these midwives who are not practicing anymore or have declined to renew their licenses were dissuaded to do so because of the unethical railroading that occurs there. We can assume they would still be working in the field of midwifery if this Board had oversight and any adherence to the spirit of the law. When 32% of the Louisiana midwives are targeted, no one can claim this field is not being restricted.

According to the NOLA.com article Under Fire from Opponents, Medical Examiners Bill Stripped of Key Provisions, the number of doctors having active licenses acted upon is around 30-50 per year according to Cecelia Mouton then Executive Director of the LSBME. A census in 2016 from the Federation of State Medical Boards states that there are 16,894 active licensed physicians in Louisiana. Louisiana has provided licensure for midwives since 1984. So if we compare the amount of midwives to doctors over the last 34 years and the irrespective disciplinary actions (taking an average of 40 per year for doctors),midwives licenses have been acted upon 32% vs doctors 8%. How is the LSBME not overstepping its administrative function? How is this not a restraint of trade?How is the LSBME able to adequately discipline midwives when it is obviously biased?

The LSBME has traumatized me.From investigators showing up at my house to hand deliver a subpoena to knocks on my door from the mail carrier delivering certified letters—I lived in a constant state of fear of how the LSBME would affect my life. I lost over 20 pounds in two months from the stress. The LSBME combed through social media to use posts against me, forcing me to delete or make private all social media support systems I had established. I was concerned that my husband could lose his job, since he worked for the state of Louisiana. I worried that my daughter would be bullied in school by the obstetrician’s children. I was concerned that a lien would be placed on my property so that I could not move until I paid the fees. No part of my life was untouched by the evilness of the LSBME.

I am an over-qualified, educated, competent midwife, who cannot practice because of a bogus adjudication. I have never lost a mother or baby. I have never had a lawsuit. In the last three years, I have taken over 300 hours of continuing educational units. That’s far beyond any required amount in any state. I would be a valuable asset to any state, city, and community. I have two degrees in the study of midwifery, in addition to a bachelor’s degree. I have completed a course as an EMT. I have several job opportunities awaiting me at birth centers in Florida, but I only need a license. My position as a college midwifery clinical coordinator was rescinded as soon as my license was suspended. I am a preceptor for midwifery students. While I have suffered emotionally, physically, financially, and mentally because of my suspension, ultimately it is consumers seeking midwifery services who have suffered by not having access to one. Likewise, students who need preceptors are suffering from not having one more choice. Therefore, the LSBME is not only hurting me, but also mothers, babies, and future midwives.

Although I have been very blessed in the opportunities I have been given and the kindness and gratitude of my friends and family, it is simply not enough to sustain any lifestyle, especially one where I also need medical care. Please help spread my story to attorneys, organizations, and writers so that I can get the word out on the unconstitutional and biased decision made by the Louisiana State Board of Medical Examiners. Please call and/or write to the LSBME, the LA House, and LA Senate and complain on my behalf towards the goal of nullifying these sanctions so that I do not need to pursue litigation in either state.  Please help me raise the funds I need to overcome all of this and once again provide safe, competent, quality midwifery care.

Thank you.  

Jacqueline Macaluso

10/22/2018

http://narm.org/

https://apps.lsbme.la.gov/disciplinary/DocViewer.aspx?decision=true&fID=115520

http://www.soundoffla.com/?p=1750

file:///C:/Users/Macaluso/Downloads/DH-MQA%205015%20(09.2015)%2064B24-8.002%20[REVISED%20post-adop’n].pdf

https://www.physicianrights.net/?r_done=1

https://ij.org/pillar/economic-liberty/

http://gatehousenews.com/failuretodeliver/explore-the-database/#midwives

https://harvardlawreview.org/2015/11/north-carolina-state-board-of-dental-examiners-v-ftc-2/

Senate Bill 286 attempts to rein in dictatorial actions of State Board of Medical Examiners, runaway investigators

https://aapsonline.org/louisiana-needs-to-rein-in-unaccountable-medical-board-states-aaps/

http://copylinemagazine.com/2016/05/18/louisiana-state-board-of-medical-examiners-accused-of-racism-in-firing-of-african-american-employees/

https://www.heritage.org/report/constitutional-constraints-federal-antitrust-law#_ftn46

https://www.theadvocate.com/baton_rouge/opinion/article_46e02ba4-5fee-11e6-9b9d-e754e5adc4b6.html

https://regproject.org/

http://static1.1.sqspcdn.com/static/f/624306/26552206/1442864215407/SLLC+NC+Dental+Board.pdf?token=WVQM%2FK4rEWquAxF4AXLEp53fwvM%3D

https://www.arkansasonline.com/news/2018/oct/06/lawsuit-seeks-to-lift-midwife-restricti-1/

Click to access 162-U-Pa-L-Rev-1093.pdf

https://www.ftc.gov/system/files/attachments/competition-policy-guidance/active_supervision_of_state_boards.pdf?utm_source=govdelivery

https://www.newsmax.com/janeorient/ct-lsbme-management-mri/2018/05/09/id/859361/

http://woundedhealersnc.net/

Physician Health Programs (PHPs) are not above the law; They just think they are

http://thepsychologytimes.com/2017/05/08/meaningful-oversight-task-team-recommends-supervision-for-boards/

http://jmronline.org/doi/abs/10.30770/2572-1852-102.4.7?code=fsmb-site

Click to access la.pdf

Click to access 2%20February%202016%20Minutes.pdf

https://www.nola.com/politics/index.ssf/2015/06/louisiana_medical_examiners_le.html

Click to access 2016census.pdf

The New Director of Investigations at the LSBME

jmacmidwife

Below is my email on 10/22/2018 to the new Director (Lawrence Cresswell) of the Louisiana State Board of Medical Examiners. He is replacing Cecilia Mouton. It is about time. 

Dr. Cresswell CCs my compliance officer, Esparonzia Spooner when he replies promptly also on 10/22/2018. The take home from this email exchange is that I do not have to go to a drug and alcohol facility for the unwarranted mental/physical exam. Likewise even thought my compliance officer said a year ago that I could not make payments on the egregious fees/fines, that Dr. C said I could. Finally, he said he would be happy to help facilitate any request I have for a Board decision. Yes, we shall see. It is surprising to me how helpful he is being. It is almost as if he realizes the unprecedented amount of injustice that has occurred. 

Dear Mr. Cresswell, 
Welcome to the LSBME. 
I am one of the unfortunate souls to have been railroaded by the corruptness of the board and Dr. Mouton in the past few years. I am wondering if you can be of help in nullifying my egregious sanctions that are keeping my license indefinitely suspended? I do not live in the state of Louisiana anymore and will never return. However, because of my unconstitutional adjudication dripping with antitrust issues, I am unable to make a living in the state of my choosing. As you will see in my file, I have never hurt nor injured anyone. I have followed all the rules and regulations. I am over-qualified. In the last three years, I have taken over 300 hours in continuing education in addition to completing yet another degree in midwifery studies. Without a job, I cannot pay the board its fees of almost $18,000 and the board will not allow me to make payments, use credit cards, nor substitute community service for payment. Likewise, I cannot commit myself to a drug and alcohol treatment facility of the board’s choosing in good conscience as I do not have a drug nor alcohol problem, not to mention the $5000 required to pay for the evaluation. Furthermore, the inability to complete one of my sanctions because the board will not tell me how to complete it, until after my unnecessary drug and alcohol evaluation, is beyond ridiculous. It is not legal for my livelihood to be tied to a board with no oversight. I do not see how the board can continue to deny a good citizen like myself the inability to earn a living in any field. I look forward to a review of my case and the rescinding of all sanctions. 
Thank you. JMac

Dr. C’s reply:

Thank you for my welcome to the LSBME.  I have reviewed your file and would like to offer the following suggestions.  The board has been willing to work with licensees in the past if money is the primary reason a person would not be able to comply with orders and sanctions of an administrative hearing.  Paying over an extended period of time has been granted in the past.  I would recommend that you make a formal request to the board in writing that can be submitted to the Board on your behalf for consideration.  During my review of your file, there is no mention or recommendation of a drug and alcohol treatment facility.  This is not a requirement of the Board and therefore you do not have to commit yourself to a drug and alcohol treatment center.  The Board does require a mental/physical evaluation by a physician or group of physicians who have been pre-approved in writing by the Board.  You must also have an evaluation showing that you have been deemed competent to resume the practice of midwifery.  In addition, education in the areas of Medical Record Keeping, Medical Ethics, and Evaluation and Identification of High Risk Pregnancies are required.  These courses must be approved in advance by the Board.  If you have taken these classes since your suspension, please submit proof of course completion.  After the completion of the above, it has been ordered that your license may be reinstated, however your license would be reinstated on probation. 
I do believe there is a path for you to move forward and a way to regain your license.  You stated that you have no intention to practice in the State of Louisiana.  If this is the case, I recommend including this in your formal written request for Board consideration.  As the Director of Investigations, I do not make administrative decisions pertaining to any individual licensee as this is a decision of the Board.  I would, however be happy to help facilitate any request you may have to the Board for a decision.   I hope this has been helpful.

Sincerely, 
Dr. Lawrence H. Cresswell III, DO, JD

Tight cord homebirth

jmacmidwife

In the middle of this licensure purgatory, life goes on. Births are still happening. I have no choice but to continue waking up at night, put on my big girl panties (or a depends undergarment sometimes) and go hold space for those babies to enter the world. Oh and I occasionally get paid for this too.

Tonight I head to a birth where one of my good friends is the licensed midwife. I arrive to find that I am not really needed as an assistant there are two students also in attendance. It is common for midwives to have students attend births they need the hands-on experience and we need to keep replenishing the pool considering the burnout is high in this field. Likewise, most of us believe that we want future generations to benefit from having midwives so we need to make more constantly. Students frequently have varying schedules as they are by definition students so we get used to working around tests, school, and other issues. Tonight was no different. It was actually nice to not have to concentrate as hard. We had four brains tonight, which means an easy night right? hahahahahahahahahahaha

My roommate had been patiently waiting for me to come home that day. I was going to pick up dinner, but for some reason, after watching this mother labor intensely in the bathtub, I hesitated. I don’t like calling this feeling intuition, but you could. To me it was just a hesitation, but an important one. About ten minutes before the birth, I decided that I was not going to leave until the baby was born even though I had been waiting nearly two hours thinking the baby would have arrived and I would be on my way.

First babies do all the hard work of “paving the road” so-to-speak. The mother’s pelvic ligaments and tissues get stretched and the body does an excellent job of remembering what birth looks like replicating it well provided huge changes haven’t been made. If the mom took up cross-fit during the pregnancy anything is game as far as muscle relaxation goes during second stage. That said, subsequent births are usually much faster and easier especially once the baby enters the vaginal canal. This baby had been down in the canal a while. Sometimes this is normal, sometimes not. Usually it can be caused from a crooked head, or a hand by the baby’s face, or the baby may be bigger than the previous ones.

This mom had an epidural with her first baby, but otherwise no red flags. her first baby was around 7 lbs. Seems normal for her and her partner’s small frames and ethnicity. As we move from the bathtub to the bed to assess progress of baby’s descent, the mom assumes a hands and knees position for the impending delivery. The midwife was on queen-size bed behind the mom and one student was beside her. The other student was behind them charting and keeping time. Its a good time to note that this charting student had mentioned earlier in the day that she has yet to see a true emergency. Sigh. She has been a student for over a year and every birth apparently has been routine and normal. Not that all emergencies can be predicted, because otherwise they wouldn’t be called emergencies.

Being at home, we can provide a vastly different environment than hospitals. Lights are usually off or dim, the air temperature is warmer, it smells like home or essential oils or whatever your support team puts in the oven. You are wearing what you want and relaxed. No one is touching you or yelling. Except during an emergency when we throw on the lights, and begin using what I call our midwife voices. We may ask the support team to help or leave room. You may not have your baby in the position you thought you would.

As I rounded the end of the bed focusing on the ever-so inching of the baby’s head out of the mother, I noticed it looked darker than normal. Hmmmm. Was this because of the parent’s ethnicity? or a perfusion issue? The sun had set providing just enough light through the windows to make out what was going on, but not enough to not cast doubt. I quickly hit my phone’s flashlight function and shined it on the baby’s head. Oh bleep.

I made eye contact with the midwife and we synced our thought processes. Sounds funny, but this happens often when you get used to working with the same midwives. We both knew what to do. We needed to move the mother if the baby couldn’t make the journey through the canal on its own. What was going on? The head had been born but it was losing color, meaning it was not being perfused by the cord anymore. While heart tones had been good right before crowning, this color was anything but. The midwife frantically searched behind the head for sometimes blocking the decent of the body. She couldn’t find a reason. Was it a shoulder or an arm? The student and I quickly got the mother into a runner’s start position. If it is a true shoulder hung up on the pubic bone (what most doctor’s are terrified of) this one move usually helps dislodge the shoulder as it is able to rotate around the pubic bone. The midwife was still encouraging the mother to push through the next contraction. The charting student had turned on the lights. Nothing budged. We continued to flip and move the mother over and on to her back to have better access to her pubic bone and the baby. With this change in position, the baby descended enough for the midwife to grab a hold of a tight cord. She said it twice. The student on the bed reached for the instruments to clamp and cut the cord on the perineum, something we don’t normally do unless in an emergency. Luckily, this little one began budging before the instruments were employed. With one strong surge from the mother and some traction from the midwife this baby was born. After further untangling this little guy, we just needed to stimulate him to breathe–normal for a stalled arrival. He was in his mother’s arms in minutes.

Why didn’t we call 911? Well, if after moving the mother we had not had any movement of the baby, we would have. But we are trained to handle these emergencies. We are trained to do as much as we can until we can’t anymore. We don’t give up until we get a baby out or transport, whichever comes first. We use our intuition, brains, and a combination of years of gene selection, evolution, physiology, physics, herbs, oils, and biology. It is only vary rarely that we use actual medicine. This is why midwifery is nothing like modern day obstetrics and I am glad it isn’t.

Reaching out to Attorneys

jmacmidwife

12/8/2017 I hope You are well. I’m still battling the Louisiana board of medical examiners. Sigh. My midwifery license was suspended two years ago. But I’m just now trying to figure out how to fix this. Of course LSBME is creating obstacles. 
They have ordered me to pay court fees totally over $17,000 and go to an inpatient three day ($3,000) psych evaluation. Idk if you remember but there was NO indication for a psych evaluation on my order or in my case. No drugs alcohol or mental health was an issue at any time in my life. The board won’t let me have an out patient psych evaluation. All the psychologists who I’ve spoken with say I have to have a diagnosis or reason for the psych evaluation or they can’t administer the correct tests. However Louisiana will not give me a diagnosis or reason for the psych exam other than stating the board order (see below) and it doesn’t have a reason. They are requiring I go to one of five choice which are all drug and alcohol treatment centers. Idk how they can require me to go to one of these when I don’t have a drug or alcohol problem. Never have. Is this legal? Can I appeal this? I don’t know how they can change the order or make it burdensome when there is no reason. How can I get treated for something that doesn’t exist and there isn’t any evidence for it? 
I would greatly appreciate your advice or info. 
Thank you for your time. JM

One practicing attorney has been particularly helpful and above all, kind. She continuously, when not busy with actual paying clients, offers wisdom and guidance. I could not have gotten this far without her help. I truly am indebted to people like her, whom I have never met, but care wholeheartedly and believe in fighting these horrific Boards. 

Last entry

jmacmidwife

I want to think that you will read this and that I will also write something as nice and flowery in a card that I give to you at graduation, but honestly, I can’t think that far ahead right now. It still seems surreal. I still have so much to do in a few weeks’ time.

So, on to the happy but sad part….Again, keep in mind that verbalizing is not my thing– If the tears rolling down my cheeks could talk right now; I think they would say how much I appreciate all that you have done to help get me through this program. I can still remember quite vividly how you went to that bar with me the night or so before I left for Florida. You were asking why I wanted to leave and why one midwife and not the other and maybe had I lost my mind? I was on track to completing all births– to being done and had little guarantee of doing that, if I went anywhere else.  I had few sane reasons to want to go to Florida or at least no good reason to give you except for this is what is supposed to happen—this is what the universe wants me to experience next.  As I searched your face for confirmation—it was comforting to see an expression of understanding, peace, and resolve.

It was so difficult, yet so appropriate that I left for Florida, but your assurance that everything would be alright with your trusty water bottle was all I needed to make it through each amazing day.  Like birth, you let me unfold on my own time. You trusted that the process would allow me to find my own way towards completing and accomplishing tasks.  I don’t know if I would have been able to get through this semester without holding that knowledge close and knowing you were only a phone call away.  While it may have taken a few days to get you to see my perspective on some things, lol, you always were there to guide me no matter how hard or long or difficult I made getting there. I hope the next bunch of students is as equally appreciative, thankful, and awestruck by your guidance, support, time, energy, and dedication to creating midwives. I am truly grateful for your love and support in this adventure. Thank you.

Midwifery psycho babble

jmacmidwife

You learn something at every birth and (un)fortunately sometimes the universe gives us lessons that we need to learn—perhaps we don’t want to learn them or think we have learned them good enough, but there they are again. So, I guess it was inevitable that I go back into a hospital and face the music. I used to think doctors walked on water.  I never imagined they were these egotistical, righteous beasts.   Heck, when I was younger, I wanted to be one.

 It only took about 2 good years of doulaing for me to come to the conclusion that they had elevated themselves to God-like status and liked it, which by the way, is fine with me, until it affects me or the people who I am hired by.  The more I read, the more I believed in birthing naturally, the more I felt the hospital was unjustified in its decisions.  It was not me who could stop them. I could only inform and educate parents on the benefits and risks of doing certain procedures or interventions on the spectrum.  However, some mothers wanted an advocate in the hospital—a voice—while theirs was in labor land.  This advocacy was not unjustified or unsolicited. It was a reflection of the parents’ wishes already agreed upon weeks before when the birth plan was approved and placed in the chart. However, this voice was not to be tolerated in labor. How dare someone try to voice reason when reason was not necessary according to the physician? 

I like to give parents an example of how messed up this whole birthing process in the hospital can be. I use an example of my husband’s outpatient shoulder surgery.  A few days before the surgery, we meet with the physician who goes over the entire procedure and answers all questions.  The surgeon wants to meet your support people so he can give you information regarding care after surgery.  He is polite, unpretentious, and respectful of where you are coming from.  He gets out models and x-rays and essentially provides proof of why he is doing what he is doing. He shows us the tools he is using and how recovery will look down to the sutures he puts in. There is no stone left unturned. He does not want you to leave with an uncertainty whatsoever.  The day of the surgery, every team member who is present in the surgery comes to pre-op and explains what their role is and essentially gets your consent.  Fast forward to a hospital birth where in most hospitals a third of all women will have major abdominal surgery and all they get is one sheet of paper to read and sign stating informed consent—no other info is given.  It’s an abomination to women’s healthcare.

Recently I attended a birth, not really as a doula, although the parents introduced me as one. My midwife introduced me to the doctor as her student so it was more like—here is a person who has been supporting these parents throughout their pregnancy and since the mom is no longer a home birth candidate, now this person is supporting her in the hospital, but she is not trying to save these parents from the abominations that occur in here. We understood that we were here because we needed help from the hospital and agreed to let go of our aspirations for a natural birth. Membranes had been ruptured for many days and we needed Pitocin to get things going. Natural induction methods had already been employed.

 It was only a matter of time before I found myself wishing I had been at an erupting volcano or sinking ship rather than be in that room. My face must’ve revealed my true inner feelings and my lack of enthusiasm for the hospital policies was palpable. It’s not that I was surprised at my behavior, don’t get me wrong, I had acted like this before, but this time I expected to act less childish and more professional because I was older and wiser? However, in the face of hypocrisy and disrespect, I can only clam up and shake my head.  Nothing had changed. Not me, not my ability to play the role of facilitator in the hospital. I outwardly admitted that I could do nothing for these parents. I didn’t want to further jeopardize the midwife’s relationship with her backing physician. I was just praying it would be over soon. I should have said to the doctor that the parents may be needed more explaining of what the choices were, but honestly, I didn’t think I could have spoken nice to them at that moment. If I haven’t been in the hospital that is friendliest to homebirthers and had the backup physician working with the parents—I would have expected the behavior from the hospital staff, but this was different. I wasn’t a doula coming in guns ablazing. I was a midwife—not a colleague or anywhere near equal to him, but a collaborating member of a healthcare system. 

So, here I thought, with more experience and education and coming in with a different attitude that my experience would be different, but no.  Unfortunately this leaves a bad taste in my mouth for my return to Louisiana. I want to be the type of midwife who is able to go into the hospitals with her clients and interact professionally and civilly with the staff. I don’t want to drop them at the door and wish them luck, but I am concerned. Perhaps this is just who I am and I need to accept that I am not good at this and won’t be good at this. Can that be a choice to say I won’t work at it? I just feel that every time I interact in a negative way it does more damage to the relationship with the staff and future encounters. What a sucky place to be. It’s not that I don’t value having healthcare available when we need it. I appreciate it and am so thankful that we have a relatively clean place to go in an emergency where proper medically trained personnel are waiting to do their jobs.  Many places on Earth aren’t so lucky, but I am not going to hump the legs of the doctors just so they treat me or my clients differently. No. I won’t do it. Now, if they happen to get to a place over a few years or months of interacting and feeling comfortable with my ability to catch issues and/or consult then super, but I cannot see myself going out of my way to kiss their butts. I have already decided that I will inform my clients of my relationship or lack thereof with the medical community and if they are not happy with it, then they need to find another provider. I have to be comfortable with my abilities and that is something I just cannot provide right now. I wish I could, but I physically cannot.

Birth takes forever sometimes

jmacmidwife

No one truly understands what it entails. Everyone just watched the Business of Being Born and voila is calling a midwife. Sure they understand that the interventions are different, but the biggest lesson I received from this birth was knowing that the expectation to manage the birth is still there, no matter where they are laboring. These women still don’t want to own their births, they just want to be handled, told what to do, in a way that makes it appear that they are empowered and given choices. Ok, I have to repeal that empowerment comment because I don’t even know if that piece is there.

For many moms, I believe birth isn’t defining them, their character, their future, their image of themselves as mothers and that is ok with them—however mind blowing that is for me! So, huge step in understanding what women want. This mom had been in off and on labor for three days. Yes, I said days.  For my idealistic brain, this mom was savoring her labor, going through the process of birth and unfolding it as it should be for her. Did she want this 3-day labor-no? Did she give a shit who unfolded it-no? She just wanted to tell her FB friends at the end of the day that she had a homebirth.

So, it was like day 2 or something that this mom said to me—I feel pain in my back. Well, hunny. News flash—labor is painful. It was like she was surprised that it was hurting and kept wanted to have her mom, also a chiropractor, adjust her. Fine, you know, I am sure relaxing her made it much more tolerable, but we have to work with the pain not make it go away. Huge lesson. Make sure moms understand and accept this. She was like shocked. It was weird. Next, this baby wasn’t descending. UGH. She was spending lots of time resting and not enough time walking. I wish I would have hired her a doula. I was wasting so much of my time and energy doulaing for her when her DH and mother wanted to sleep. That is not my job—ok—not all the time, especially when you are in what I consider prodromal labor. The good thing to come out of all this was that I had the opportunity to do plenty of vaginal exams. YAY for internal exams. I think I am finally getting the hang of finding these elusive cervixes. I can’t really tell how effaced moms are, but I am sure that will come in time.

My fearless leader finally got bossy with Ada and started stretching her cervix. We made her get out of the tub and walk around, do squats, etc. Nothing seemed to help. During one vaginal exam, I felt a huge caput, which was cool to feel and we later found out it was a combo caput/hematoma. This baby was about 0 station the entire first stage. It would not descend for anything. So, pushing this cervix out of the way was incredibly hard. I think I broke a sweat and made my fingers sore in about three minutes of attempting to hold it back. The midwife said I have to get over this fear of holding these back. It isn’t a fear, it is just a dislike, a huge disservice to my inner hippie, but she will forgive me. Next time for a lip, I think I might pancake flip mom on all sides–through like 8 contractions. Or else I would knee chest her to get that cervix better positioned on the head because reducing the cervix is no fun, but that is the thing I needed to get— mom didn’t care and I don’t have to like it—I am here to serve her in the best way possible within my SOP and rules and regs and within her ideal of a good birth. She truly didn’t care and I wasn’t hurting her like I could make myself imagine I was hurting her if I said hold back the cervix. Like I said, at the end of the day if she had every trick thrown at her in the book, that was fine, she just didn’t want a section. We trusted the process but she only wanted to trust it for so long.

However, I always have to over process right? So, I am thinking of this other couple I doulaed for in the hospital about 5 years ago. I wanted to help the mama and give her all my gadgets and comfort tools and she had to jolt the over-zealousness out of me literally. She said—look—I didn’t hire you to do stuff to me—I hired you to be here and believe in me and trust this process. So, it’s that approach I took, but —that was in your doula lifetime—you are a midwife—completely different. Different approach, totally—I HAVE to manage these births—duh—that is what these are—manages. Dare I say that I hate it? Not midwifery, but the idea of having to manage this outcome when I want these mamas to be slow dancing across a field of daisies and own this process yet surrender at the same time and out slides a baby. Clearly my vision is flawed. My spirit is shaken. Has midwifery really gotten to this point or has it always been here and I just didn’t realize it? Will I still be able to have these doula-type clients or will I be forced to control this process that I pretend is as normal as sneezing? WOW. The midwife did ask me what I wanted to do with this mom—and I had to face my inner love child and tell her—no this mom is not going to sit in the birth pool and have the water birth she envisioned. You are not going to tuck her in bed and hope to God that after she wakes on the 4th night of contractions she will finally get somewhere cervical change-wise.  No, I couldn’t do what I wanted to do; I had to do what needed to be done– AND THAT WAS OK!!! So, this pity party for the midwife-self that I thought I was becoming needs to wrap up and move on. My idealist world will be better played out in someone else’s head. 

Ada, it turned out, had broken her tailbone as a child—why the F this is not one of our questions when taking histories is beside me?! We needed to get her off her bottom and heart tones were worse on the birth stool, so we flipped her.  Mom was working so hard that we gave her blow by, but I wish I had put the adult mask on the end because the mom and FOB were doing a shitty job at holding. She was purple pushing. She looked like she had been beat up. The midwife was arguing with me that I had never pushed a 10 pound kid out so I didn’t understand how to push. WTF? ok.

Which brings me to a good point. Midwives are stubborn, strong women, but if you cannot take criticism please do not become a midwife.

New revelations?

jmacmidwife

I have to preface this entry with– it seems I learn something after almost every contraction. It is amazing. I am so thankful to be here with a midwife who wants to teach and wants me to get it. I appreciate her time and patience greatly.

OK, new birth, New revelation. I am coming to terms with the fact that I am being faced with whatever I need to learn or at least that is how I am coping with it. It isn’t really that bad. It is just these primips!!! A few things. I don’t think we are educating them enough. While yes, this one –I’ll name her Ada—knew about induction methods and wanted a waterbirth. Plus she wants to be a doula and is a massage therapist and chiropractor– a great base for knowing her body and understanding natural practices.

A cornerstone to midwifery care is knowing your clients. While yes, I knew all this cool stuff about Ada and a little about her birth plan—I don’t know until later that she really doesn’t care THAT much about the homebirth that I have in mind for ALL my clients. I have to stop projecting my vision of a quick, beautiful, elegant birth goddess under moonlight in a babbling brook birth onto them. I don’t know where I get this random vision or ideal, but it isn’t for everyone, heck, I have no idea if any mom I meet will ever really want what I want for them. That is lesson one: move on from your ideals. It isn’t about me. Learn who your clients are and know them. While yes, they are in love with the idea of a homebirth, they are not in love with the idea of a 4-day painful, hands-off, non-interventive, midwife sleeping on couch, ineffective contractions, blah, blah, blah. GET WITH THE PROGRAM—these people just want to avoid a section!!! Ok, that might be a little simplistic, but I have to make it that simple sometimes for my brain to wrap itself around this monumental discovery. I hate to say it—but Kombaya is so yesterday.  It’s becoming trendy just to say you had a homebirth.

I should rename this blog– the death of a midwife

jmacmidwife
  1. In what ways do you think this experience might affect you as an individual? In what ways do you think this experience is affecting you as a student midwife?

This experience has made me much more confident in myself. I have never been so outgoing on purpose. Being able to interact with a variety of clients has enabled me to appreciate all of them and really look forward to hopefully working with many different types of people.

I found that I feel comfortable in a clinic setting, but get the benefit of being part of homebirth families.  It is almost the best of both worlds, but I can see how working with affluent families has its perks. Rarely would you have to concern yourself with STIs or hepatitis. You don’t have to be concerned with drug withdrawal or worrying about the wellbeing of the baby when you leave. Plus you get paid pretty well usually.

I never thought I could be this happy doing something I consider work. This has also taught me that I want to pursue more education, maybe not right away, but eventually. I think I will get my MPH or CNM. I don’t know what will happen with healthcare, but it seems like as less OBs are born, more NP, PA, CNM and other supportive nursing personnel will take over the role of prenatals, postpartum and maybe even normal low-risk births. I think if I want to get a piece of the pie, I need to get more letters behind my name.

Just like making a cake

jmacmidwife

UGH. These labs are going to be the death of me or primips—I can’t decide.  So, I have to thank those who opened my mind and gave me a chance. Looking back a year ago, when I was interviewing with the midwife in Minnesota, I thought I had a fairly good foundation for midwifery. No, I didn’t. It is glaringly obvious to me now why she didn’t like me or think I would be worth having around. Heck, I can’t believe anyone found me worthy. Maybe I was a warm body? It’s not that I think midwifery is rocket science by any stretch, but you do need to think quickly and know your shit. You may only use this info a handful of times in your career, but you need to know it, be able to recall it with incredible deftness and confidence. Foresight is incredibly important. Yet, it is kind of like making a cake, you have basically the same ingredients every time, you know about how long it should take depending on conditions and well you check it every so often knowing that every time you open the oven door you may be causing more problems, but your cake should overcome. So, you set up your area –get your plate where you will frost the cake ready and the wire rack where the cake will cool. You have your supplies washed and ready to go and even have in the back of your mind where the fire extinguisher and extra flour are kept in case of a blaze.