An Untenable Situation
Originally published August 19, 2011
I received word yesterday, that a midwife in California, Katie McCall, had been convicted of a felony count of practicing medicine without a license. All midwives I know,because of their tenuous legal status in many states, fear prosecution. I personally will be moving to Virginia sometime in the future so I might pursue my studies and practice midwifery in a state that has liberal midwifery laws.
The brief L.A. Times article detailing Katie’s conviction says that investigators found Katie guilty of negligence and that she was a danger to the public. http://latimesblogs.latimes.com/lanow/2011/08/la-midwife-convicted.html
I began looking into what exactly had happened here. I was disturbed and wanted to understand- had this woman, due to ignorance and incredible hubris put a mother and baby at incredible risk?
First, let’s meet Katie. Here’s her current bio. Since 2007 when the incident she was convicted for occurred, Katie has become a Certified Professional Midwife and has received her license to practice midwifery from the very Board of Medicine that was supporting her prosecution. According Katie’s midwifery group birthsanctuary.com
Katie attended USC for her general education and then went on to study with the American Academy of Husband Coached Childbirth to become a certified childbirth educator. Shortly thereafter, she certified as a birth doula (labor assistant) with the Association of Labor Assistants and Childbirth Educators. Katie was also mentored through a pregnancy and birth support business called The Birth Connection in Glendale, CA, which Katie later purchased and expanded to include a 1500 square foot education facility, retail store and birthing center. She enrolled in midwifery school and apprenticed with the midwives who ran the birth center as well as with midwives who attended homebirths. She sold her business to pursue her midwifery education full time in 2006 and passed her midwifery (NARM) exam to become a Certified Professional Midwife in 2008.
Katie has received supplementary education in lactation to become a lactation educator, vaginal birth after cesarean support, support of sexual abuse survivors, aromatherapy and is neonatal and CPR certified. She has assisted over 500 couples through childbirth education and has attended over 450 births as of the end of 2009. As a Southern California native, she has a wide range of experience, serving mothers from diverse backgrounds. She believes her job is one of empoweringwomen to develop their own trust and connection with their bodies and their babies during their own unique journey into motherhood. If she has learned anything through her experience with birth, it is that every birth is as different as the women who are laboring.
Now this bio demonstrates that Katie is a respected member of her midwifery community and that in spite of being arrested and undergoing a criminal investigation, Katie continued in her commitment to women and their babies.
According to the L.A. Times article listed above, Katie was investigated through the Board of Medicine’s (BoM) ‘Operation Safe Medicine’(OSM). In their July 2009 newsletter,the BoM states that the purpose of ‘Operation Safe Medicine’ is to “investigate complaints of unlicensed activity received from health care consumers, and also to work with other regulatory and law enforcement agencies to find unlicensed facilities.” http://www.mbc.ca.gov/publications/newsletter_2009_07.pdf
When reading the article, you realize OSM was intended to bust people posing as surgeons and doing boob jobs on unsuspecting women or stopping charlatans from shooting people up with eucalyptus oil in the swap-meet bathroom. Is OSM really charged with investigating a homebirth in which ALL emergencies were handled with the utmost skill and from which ALL parties emerged healthy and whole?
As a member of a Yahoo group of student midwives & midwives who have been in practice for less than 3 years, I have been in active discussion about Katie’s conviction with women from all over the country including a personal friend of Katie’s who elaborated on the situation. {In my original post, I quoted exactly what Katie’s friend shared on the Yahoo group. I was later informed that it is against the rules of my forum to share discussions from the group. I have edited out Katie’s friends comments. The following is a summary of what was shared}.
Let’s look at the facts here- Katie offered her services to a woman who had chosen a home birth for her child. She, as astudent, knew she must have a senior midwife present with her during the client’s delivery and correctly called for her preceptor when the client went into labor. Unfortunately, the preceptor was attending another birth and was unable to come. So Katie recommended- as she is supposed to according to California law- that the client go to the hospital. The client refused to be transferred to the hospital. Katie left the room and began attempting to contact other Certified Professional Midwives who might come and assist her with the birth.
Meanwhile, the mother, her doula and whoever else might have been there labored in a separate room- unattended. The baby crowned and the head was born- all without Katie’s presence. This was now an unattended birth at home. If the mother had been expecting Katie to be her midwife, Katie would have been in the room when the baby’s head was being born.
And here’s where the situation gets sticky. The baby’s head begins to retract against the perineum- like a turtle head, the head seems to be trying to pull back up inside the mother’s body. This is the classic sign of shoulder dystocia. Shoulder dystocia is one of those rare birth complications that is a get-the-baby-out-NOW-or-the-baby-will-die situation.
Katie is a midwife at heart so she jumps in and starts doing all the tricks midwives know to resolve this situation. And the baby is born healthy. At some point during this life and death drama, 911 is dialed and the paramedics arrive. During the client’s immediate postpartum, it is discovered that she is bleeding uncontrollably. The paramedic doesn’t know what to do so Katie- stepping in as a good Samaritan- successfully stops the bleeding.
Katie- not intending to assist in the delivery at all once it is clear senior midwives are not available, but also unable to leave a laboring mother alone during the birth of her child- has used her skills and training to save not one, but TWO lives.
So how does OSM get involved? According to Katie’s friend, the doula present at the birth mentioned to some midwives- who weren’t there- what had happened and the midwives reported Katie to OSM.
My feelings about this whole situation- the initial report, the investigation and the conviction are almost overwhelming to me.
Why- WHY- would midwives who were not present at the time of the delivery accept a doula’s take on the situation to the point that they would call in OSM? There were TWO emergencies and TWO skillfully rendered responses that saved TWO lives! Yes- Katie should have been supervised that day- she TRIED to be supervised that day. But her training system failed her and the CLIENT decided to stay at home no matter what. Katie honored her wishes even as she tried to find a senior midwife to assist. How is Katie responsible for her client’s decision? How did these outsider midwives think the situation SHOULD have been handled? Should Katie have abandoned her client? If she had the baby SURELY would have died and the mother may have died as well!
Why did the BoM send OSM after Katie? Katie’s practice in no way resembles the cosmetic surgery hucksters and back-alley immigrant ‘clinics’ that OSM usually investigates. It wasn’t even the health care consumer that made the complaint (apparently, Katie’s client was very satisfied at having her and her baby’s lives saved). Does the BoM- the group who oversees and licenses California midwives- really believe that midwifery practice is on par with “an individual who permanently branded a victim using the wrong device, instead of removing the tattoo”? This feels like a BoM witch hunt- a student successfully handles two emergencies likely saving two lives and yet we will accuse her of a FELONY because of an act of God that resulted in her being without a supervisor when the emergencies took place.
And the conviction? Katie’s friend mentioned above shared that she believes there is a basic misunderstanding of homebirth and midwifery training in this country. You see, homebirth isn’t just a location- it’s a mindset, a philosophy, a lifestyle. Homebirth is about respecting women’s wishes as long as the mother and the baby are healthy. Katie’s client CHOSE to stay home regardless of the administrative difficulties of not having a senior midwife present. Katie’s client CHOSE to have an unassisted birth while Katie desperately searched for back-up. Katie CHOSE to remain close by in case her client had difficulty; that is the heart of midwifery- being WITH women as they deliver their babies on their terms.
And that’s the real untenable situation here, folks. As bad as it is that Katie was crushed between her client’s wishes and California law, it’s worse that we live in a country where our rights concerning child birth have been stripped from us. We take it as a huge victory if a hospital is ‘friendly’ toward what we want for our deliveries. We think it’s a step forward that the law ‘allows’ us to have our babies at home with skilled attendants. We act as if they have done us a big favor by being flexible and open-minded, by taking our wishes into account and doing what they can to make our desires possible. But this thinking is completely backward.
As long as any BoM, as long as ACOG, as long as ANY ENTITY believes it has a right to have veto powers over how we choose to birth our children, this situation will continue. Midwives who wish to serve women wanting an out-of-hospital birth will continue to be harassed and judged by a group whose standards and paternalistic, hierarchical expectations DO NOT APPLY in a homebirth setting. Women who desire medical autonomy during a hospital delivery will continue to have their bodies and their babies assaulted because the ‘law’ or ‘policy’ says that’s just the way things are- we know what’s best for you. We’re the experts.
The untenable situation is that someone other than the client in this story believed they have a right to decide what kind of delivery, what kind of attendant and what kind of setting was best for her.That is the crux of the untenable child birth crisis in this country.
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