Idaho Case Shows Midwife Tension With Hospitals

An experimental malaria vaccine once thought promising is turning out to be a disappointment, with a new study showing it is only about 30 percent effective at protecting infants from the killer disease.

An experimental malaria vaccine once thought promising is turning out to be a disappointment, with a new study showing it is only about 30 percent effective at protecting infants from the killer disease.

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"There were some questions about the length of labor," Deputy Chief Tracy Basterrechea told the AP.

On Oct. 11, 2010, a student midwife improperly cut an infant's umbilical cord, resulting in significant blood loss before the baby died. Jerusha Goodwin failed to provide medical personnel at St. Luke's Meridian Medical Center with relevant records, investigators wrote.

And on June 30, 2010, Coleen Goodwin delayed paramedics from entering The Baby Place for four minutes. When they were finally allowed in, Coleen Goodwin instructed them to drive past two nearby hospitals to St. Luke's in Boise, adding precious minutes to a journey that ended in the infant boy's death.

The mother, Rachel Rabey, said in an interview Coleen Goodwin whispered to her, "If we go to Meridian, they won't let me stay with you." Rabey said she was perplexed.

"I didn't care where I went, or if Coleen could stay with me," remembers Rabey, who recently had her third child, a girl, at St. Luke's in Boise. "All I cared about was getting to a hospital."

The Baby Place's web site does indicate negative feelings toward hospitals, with one employee writing in a testimonial to prospective clients that she began her midwife studies after a hospital birth where she felt "cheated out of the birth experience."

The Goodwins do have troubled relationships with doctors, said Alison Hunter Stucki, who planned her eighth child's delivery at The Baby Place in 2007 but was forced by complications to transfer to nearby St. Luke's Meridian Medical Center.

Stucki said her family witnessed hostile doctors force Coleen Goodwin from the delivery room.

Still, Stucki, an ardent Baby Place supporter, doesn't believe those experiences led Goodwin to endanger women or their babies.

"What I've experienced is nothing but professionalism," said Stucki, who gave birth to her ninth baby at The Baby Place in 2009. "I do believe the doctors are upset with her. Every baby she delivers in her birthing center is one baby they don't get."

In addition to the three babies that died, the Goodwins were hit by a separate 2010 lawsuit, filed by the parents of a baby that suffered permanent brain damage. Last week, the midwives agreed to pay $5 million to Adam and Victoria Nielson, the couple that sued.

The Nielson's attorney, Eric Rossman in Boise, said he pursued the case pro bono because he couldn't "in good conscience dismiss the case as long as they continue to practice in this facility."

Objective measures of Idaho's midwife-doctor relationships — and their impacts on babies — are difficult to come by, because the state doesn't keep comprehensive records of the outcomes of midwife-assisted births requiring hospital transports.

A private effort, the Idaho Perinatal Project run by St. Luke's, documented 138 instances between 2005 and 2011 where mothers who planned a home birth were transported to a hospital.

Though its records are also incomplete — reporting is voluntary; there are no reports for 2012 — they do point to the trauma that accompanies a planned out-of-hospital birth where something goes wrong. There were at least nine cases where infants died at or before arriving at the hospital and several instances of birth asphyxia, fractures, post-partum hemorrhage and unexpected twins.

For many doctors who don't see the cases of successful home births, these tense interactions add to already deep misgivings about midwifery.

"There were also 34 cases which had no infant outcome listed," said Dr. Scott Snyder, medical director of St. Luke's Newborn Intensive Care Units. "The data is not an overestimation of what we're seeing. It's an underestimation."

Snyder does believe standards set by Idaho's midwife licensing that took effect in 2010 have fostered communication between most midwives and doctors, despite problems investigators found at The Baby Place. Midwives now visit St. Luke's, attending some staff meetings. Doctors' appreciation for midwives' services has grown, he said.

Snyder is also hopeful when the Idaho Legislature reviews the state's midwife rules in 2014, when the existing licensing law expires, they'll make it mandatory for midwives and doctors to track outcomes of transfers.