American College of Domiciliary Midwives
3889 Middlefield Road
Palo Alto, CA 94303
650 / 328-8491
March 7, 2002
The Canton Repository
500 market Avenue
Canton, OH 44701
330 / 580-8300; 454-5745 ~ fax
Letter to the Editor letters@cantonrep.com
Akron Beacon Journal
Voice of the People
PO 640
Akron, OH 44309-0640
330 / 996-3000; fax
Letters to the editor vop@thebeasonjournal.com
I am writing about the inappropriate
criminal prosecution of Mennonite Midwife Freida Miller
- a clear case of “No good deed goes unpunished!”
I am a former Labor and Delivery Room
nurse and currently the director of the American College of Domiciliary
Midwives, a professional organization representing community-based
midwifery. Personally I am a Mennonite midwife living in California who
has provided maternity care for the last 20 years under the religious
exemptions clause of our state’s medical practice act. I am also
licensed under our state’s direct-entry midwifery law and practice
lawfully under the authority of both provisions.
Scientifically speaking, skilled
midwives are the safest and most appropriate provider of maternity
services for healthy women with normal pregnancies. The safety of
home-based care with an experienced midwife is equal to hospital birth for
low and moderate-risk mothers. The safest form of midwifery is that which
is well articulate with obstetrical services and the safest form of
obstetrics is that which is well integrated with midwifery principles and
practice. State laws should support a
complementary and cooperative relationship between doctors and midwives.
The criminalizaton of community-based midwifery is always based on
political strategies of organized medicine and not any credible scientific
evidence. Frivolous prosecutions of midwives are detrimental to the
practical well being of mothers and babies.
I am frequently called upon to review
midwifery cases for attorneys to determine if the midwife’s care was
safe and effective. It is my expert opinion that Frieda Miller is to be
commended for: (a) carrying oxytocin
-- i.e., Pitocin – a safe emergency drug to control uterine
bleeding; (b) astutely recognizing the necessity for its use in serious
postpartum bleeding; (c) being brave and honest enough to inform the ER
physician that the mother had already received a dose of this emergency
drug, thus alerting him to the seriousness of the situation. In regard to
a “community” standard of care by direct-entry midwives in the US,
this was perfect midwifery management – A+ care.
This inexpensive emergency drug (about
50 cents) could have prevented the death of the wife of the 17th
century Indian Maharajah, Shah Jahan. She died of the complications of
postpartum hemorrhage after giving birth to her ninth child. The
world-famous mausoleum at Agra, India – the Taj Mahal -- was
built in her memory by her grieving husband between 1632-1645. It was his
wife’s bad luck (and that of her 9 orphaned children) to give birth
before the discovery of this safe, inexpensive, life-saving drug in 1952
and the expertise and bravery of midwives such as Freida Miller to carry
and properly administer it when necessary. Let us not permit the Taj Mahal
to symbolize the needless sacrifice of childbearing women to either
ignorance or base political motives.
The “Freida
Miller” Law
Oxytocin / Pitocin should be available
to every childbearing woman, regardless of where she gives birth (home,
hospital or ambulance) or the status of the caregiver who attends her
birth (religious practitioner, midwife, doctor or EMT). Perhaps the Ohio
legislature could be moved to introduce a bill authorizing the emergency
use of oxytocin by all first responders, to be known as the “Freida
Miller Law” – in honor of Freida’s commendable actions and the
considerable contribution of her case to the public’s understanding of
how important it is to make this life-saving emergency drug widely
available. Parke-Davis, the pharmaceutical company who manufactures it,
might be happy to get on that bandwagon.
Safety of the Drug and the Treatment
It is important to understand that
Pitocin, when administered in a postpartum situation (i.e., after the baby
is born) is one of the safest drugs in the world, in fact safer
than aspirin as, unlike aspirin, it is impossible to be allergic to
oxytocin. Pitocin is only medicinally effective on the pregnant uterus and
in a normal dose (1-3 ampules) has virtually no side effects,
contra-inductions or allergic reactions and is never an “over-dose”.
The only medicinal effect it has in this minimal dose, in addition
to stimulating the uterus to contract, is to be mildly
“anti-diuretic”, that is to conserve or retain body fluids and blood
volume. This is in the interest of a mother who has bled excessively.
Emergency Exemptions Clause
The emergency use of this safe and
non-addictive drug by Frieda Miller not only protected the life of the
mother but also the well being of her newborn baby and all other children
in her family from the extreme and long-lasting distress of being
orphaned. Also sever postpartum hemorrhage can cause permanent damage to
the pituitary gland, causing Sheehan’s syndrome which, among
other disease processes, makes it impossible to produce breast milk.
The basic purpose of medical practice
legislation is consumer safety. Any application of these laws should be
consistent with (and not contradictory to) the well being of the public.
For that reason, medical practice acts normally include an “emergency
exemptions clause” that exempts laypersons from the technical
requirements of regulated medical practice in a bona fide emergency. This
is usually defined as a medical emergency occurring when no physician
is present.
Functionally such “first responders”
are restricted to actions made in an attempt to save a life, prevent
permanent damage or extreme suffering and are within the technical ability
and resources of the emergency responder. In war, natural disaster or
accidents, lay rescuers perform all sorts of “medical” and even
surgical interventions, such as an emergency tracheotomy on someone with
an obstructed airway. As a counselor at a wilderness camp for kids, I was
issued a pre-filled hypodermic syringe with epinephrine to use in case an
allergic child was stung by a bee. There is ample precedent for the
emergency use of anti-hemorrhagic emergency drugs.
In Freida Miller’s case, she
appropriately administered a safe, single-purpose emergency drug that did
not require her to either “diagnosis” between a variety of non-obvious
medical conditions (tell the difference between a heart disease versus
acute indigestion) or make choices between an array of different drugs (to
give an antibiotics versus an antacid) or choose between various doses of
the right drug. Pitocin comes in a 1 cc amp and you give one amp and
repeat if necessary. Postpartum hemorrhage is a “clear and present
danger”, a well-known complication of childbirth, of the same category
of evident emergency as someone not breathing, suffering from
anaphylactic shock, a sever asthma attack or arterial bleeding from an
accident. It makes no sense to treat maternity emergencies differently
than other medical emergencies that are protected by these well-founded
legal principles.
An
Experienced Midwife is an Educated Observer
with Emergency Response Capacity
A midwife is by the nature of her role a
‘first responder”. As a religious practitioner, I always carried this
drug. Not to do so would have been, for me at least, a violation of
conscience and of my religious values. The Golden Rule counsels us “do
unto others as you would have others do unto you”.
Were it my daughter and my unborn or newborn grandchild, I’d want
her midwife to carry and use emergency supplies and equipment.
To criminalize the use of emergency
drugs is to purposefully make childbirth unnecessarily dangerous. If the
problem is the law, then the law needs to be changed, as it must be kept
in mind that the basic purpose of medical practice legislation is consumer
safety, not as a political tool for promoting a medical monopoly.
Enforcing medical practice laws in a manner contradictory to common sense
and the well being of the public is indeed to permit the Taj Mahal to
symbolize the needless sacrifice of childbearing women to either ignorance
and/or base political motives. This is not in the interest of childbearing
families or a civil society. I
hope to see this unfortunate case have a fortunate outcome – perhaps
some version of “Frieda’s Law” -- a triumph of reason, compassion
and just plain common sense in the interest of healthy mothers, happy
babies and a stable society.
My Professional Background:
Prior to becoming a religious
practitioner of midwifery in 1981, I was an L&D nurse over the course
of approximately 17 years. In the 40 years that I have been attending
births in both homes and hospital in the role of nurse or midwife, I have
been present at approximately 3500 births. Over the last 2 decades I have
amassed a unique library of historical, legal and legislative resources
and frequently provide information on the historical and contemporary
practice of midwifery to lawyers, the state medical board and our
legislators. Many of these documents can be read or downloaded from our
web site (www.collegeofmidwives.org).
I was a consultant to the legislator who authored a
recent amendment to the Licensed Midwifery Practice Act. I am the liaison
between the ACDM and the Medical Board of California and have also been an
expert witness for the defense in a criminal and administrative case. I
was named by my peers to be an “exemplary” practitioner of midwifery
and was a contributor to a study on the exemplary practice of midwifery
published in the Journal of Nurse Midwifery. Guidelines for the safe and
effective practice of midwifery are posted on the ACDM web site, entitled
“Characteristics of Clinical Competency”
~ URL http://www.collegeofmidwives.org/college_of_midiwves01/CharClinicalComp%2001.htm
Warm Regards,
Faith Gibson, LM, CPM
Executive Director, ACDM; California College of Midwives
650 / 328-8491 info@collegeofmidwives.org
URL ~ www.collegeofmidwives.org
A copy of this letter is post on the College of
Midwives web site under the “Breaking
News” subdirectory
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