American College of Domiciliary
Midwives
3889 Middlefield Road
Palo Alto, CA 94303
650 / 328-8491
March 7, 2002
Dave Knowlton, Attorney
Kennedy, Cicconetti, Knowlton and Buytendyk, LPA
558 North Market St
Wooster, OH 44691
330 / 262-7555
Fax 264-5739
Cell 347-1048
RE: Mennonite Midwife Freida Miller
- a clear case of ”No good deed goes unpunished!”
Dear Mr. Knowlton,
I am responding to a letter I received
via email asking for assistance in the inappropriate criminal
prosecution of Mennonite Midwife Freida Miller. As a lawfully practicing
Mennonite midwife in California, I was arrested in 1991 and prosecuted
over the course of 21 months. According to a radio news report at the time
of my arrest, the prosecution was an attempt by the Medical Board to
nullify the religious exemptions clause as applied to childbirth. After an
appropriate defense, the case against me was dismissed in 1993 based on
the legal reality of California law --
that it is lawful for any layperson to assist a woman during
normal childbirth, therefore it made little sense to prosecute a
midwife for doing so. In the course of our final hearing, the DA also
formally acknowledged the validity of my midwifery practice under our
state’s religious exemptions clause.
As is usual with high-profile midwifery
prosecution cases of this sort (i.e. no bad outcome, no obvious fault by
the midwife), there was midwifery legislation pending in our state
legislature when I was arrested -- the 6th attempt by
California non-nurse midwives to pass a licensing law to legalize and
protect the practice of direct-entry, non-medical (traditional) midwifery.
These criminal prosecutions consistently provide the medical community
with a media event that it uses to speak disparagingly of midwives while
insisting that homebirth is uniformly dangerous and hospital birth
uniformly safe (disinformation Xs 2). Midwife prosecution provides a much
appreciated opportunity by organized medicine to use the on-going
newspaper coverage (by nature a negative portrayal of midwifery) as
“proof” that their opposition to the passage of a community-based
midwifery law is purely in the interest of consumer safety (“Trust
me, I’m a doctor!”).
On the same day that a midwifery
licensing law was introduced in the Virginia state house (Jan 26, 1998), a
midwife and her assistant were arrested on manslaughter charges after the
amniotic fluid embolism (i.e. unpreventable) death of a mother at home
some 2 years prior. This case was the topic of a 10-day series of
“yellow” investigative journalism in an area newspaper that was picked
up by one of the syndicated news services and given county-wide exposure.
It was later revealed that the OB-coroner who charged that the midwife was
criminally negligent was also the wife of the prosecuting DA. When this
case came to trial the prosecution had to admit that there was no credible
foundation for a manslaughter charge and it was dropped. In Jan 2000, ten
days after midwives in California filled a bill to remove the “poison
pill” provision from our direct-entry licensing law, a licensed midwife
was extradited from Hawaii on a case that was several years old and
prosecuted on manslaughter charges, accompanied by a firestorm of media
coverage. When the case went to court the prosecutor admitted that the
baby’s death was unrelated to the care provided by the midwife and she
was put on probation for a minor violation of the licensing law.
The shtick here is that every newspaper
article and TV news show about these prosecutions immediately dropped down
into (usually negative) coverage of the pending legislation and every
article about the pending legislation immediately shift into a report
on-going criminal prosecution in a way that cast aspirations on any
legitimate practice of non-nurse, non-institutional midwifery.
Frieda is in a long line of these political strategies to block any
legal practice of home-based care and/or to make such practice
unnaturally and unnecessarily risky. By preventing midwives (who are
by nature “first responders”) from carrying or using the appropriate
emergency supplies and equipment, in particular, oxytocin to control
maternal bleeding and oxygen to properly resuscitate a newborn that
doesn’t breathe spontaneously, they are assured of more “bad press”.
When the inevitable homebirth mother bleeds excessively or her baby has a
breathing problem, this predictable situation is used by medical
politicians as yet another opportunity to point to midwifery as
horrifically dangerous and “should be made (or kept) illegal”.
Freida’s case is another salvo of the
“Hundred Years War” by organized medicine against community-based
midwifery. Surly by now you know that, scientifically speaking, midwives
are the most appropriate and safest caregivers for healthy women with
normal pregnancies. 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.
The dismissal of the criminal case
against me in 1993 came about in part because I did extensive research on
our state’s medical practice act in order to better understand the
statutory foundation for defining midwifery as an illegal practice of
medicine. In turned out that there was no statutory foundation,
only the Bowland Decision by our state’s supreme court, which
relied heavily on a perverted interpretation of Roe V Wade. When
this information was communicated to the DA, he replied by saying “Yea,
I know. I called up those guys at the Medical Board and told them if they
wanted me to keep prosecuting midwives they were going to have to get some
new legislation passed.” Within
60 days of his admission of the political nature of this prosecution, the
case against me was dismissed without any additional legal motions by the
defense. Six weeks later the midwife-sponsored midwifery legislation that
had been pending was gutted at the request of the California Medical
Association and language crafted by the CMA was introduced. Their version
eliminated the “hold blameless for care not rendered clause” and
replaced it with mandatory physician supervision, exchanging physician
immunity from the torts of the midwife to that of unnatural, unnecessary
vicarious liability. A “midwifery law that was designed to fail” was
born (a quote by senior counsel of the Medical Board of California)
Our fatally flawed bill -- the Licensed
Midwifery Practice Act – was passed in 1993. Needless to say, no
California physician is willing or able to provide the mandated
supervision and so for 9 nine years LMs in California have been
technically unable to comply with our licensing law. I now practice under
both licensure and, for families from our church, under the religious
exemptions clause. Families ask for care under the RelExClause because
they trust God more than allopathic medicine and anticipate using prayer
and other forms of their faith to rely on in relationship to pregnancy and
birth. Also this permits the mother to decline the standard tests,
interventions and restrictions that apply to licensed midwives (for
instance, no high parity motherd – more than 6 former births)
After two years of criminal prosecution
and the legal research it necessitated, I have become an “idiot
savant” on these topics. I have remained active in the legal and
political aspects of midwifery practice nationally and in California. I
know that is somewhat unusual for Mennonites but our family is no longer
“old order”, not since leaving Kitchner (original name was
“Berlin”) Ontario in 1915 and moving to the US side of the Detroit
River. Currently I am the executive director of the American College of
Domiciliary Midwives, a professional organization representing
community-based midwifery.
In my opinion, Frieda Miller is to be
commended for: (a) carrying oxytocin
-- i.e., Pitocin
(b) astutely recognizing the necessity for its use in a serious postpartum
hemorrhage
(c) being brave and honest enough to inform the ER physician that the
mother had already received one or two amps of this drug, thus alerting
him to the seriousness of the situation In regard to a “community” standard of care by midwives
in the US, this was the perfect midwifery management.
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. This drug is only medicinally effective on the pregnant uterus
and in a normal dose (1-3 cc’s) has virtually no side effects,
contra-inductions, 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. That is in the interest of the mother who has bled excessively.
One or two amps of this inexpensive drug
(about 50 cents per dose) could have prevented the postpartum death of the
favorite wife of the 17th century Indian Maharajah, Shah Jahan.
His wife died of the complications of postpartum hemorrhage after
giving birth to her ninth child. The
Taj Mahal is a mausoleum at Agra, India built in her memory by her
grieving husband between 1632-1645. It was her bad luck (and that of her 9
orphaned children) to give birth before the discovery of this safe,
inexpensive, life saving emergency drug and the expertise and bravery of
midwives such as Freida to carry and properly administer it when
necessary.
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
should she have blend to death. Also
sever postpartum hemorrhage can damage the pituitary gland, causing
Sheehan’s syndrome which, among other disease processes, makes it
permanently impossible to produce breast milk.
Normally medical practice acts 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 ability of the
emergency responder. In war, natural disaster or accidents, lay rescuers
performed all sorts of “medical” and even surgical interventions such
as an emergency tracheotomy on someone with an obstructed airway.
Somewhere back East a paramedic crew performed a Cesarean in the ambulance
on a pregnant woman who was clearly dying of a brain hemorrhage. As a
counselor at a wilderness camp for kids, I was “issued” a pre-filled
syringe with epinephrine to use in case an allergic child was stung by a
bee. There is amply precedent for the emergency use of anti-hemorrhagic
emergency drugs.
In Freida Miller’s case, she
appropriately administered a single-purpose emergency drug that did not
require her to either “diagnosis” between a variety of non-obvious
medical conditions (heart disease versus asthma attack?) or make choices
between an array of different drugs (penicillin or Cripro??)
or varying doses of the right drug. 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. A midwife is by the nature of her role a
‘first responder”. As a religious practitioner, I always carried this
drug as I firmly believed that not to do so would be unethical and a
violation of my religious beliefs, for example, the Golden Rule or “do
unto others as you would have others do unto you”.
Were it my daughter and my unborn or newborn grandchild, I’d want
the midwife to carry and use emergency supplies and equipment.
The Freida Miller Law”
Oxytocin/Pitocin should be available to
every childbearing woman, regardless of where she gives birth (home,
hospital or paramedic ambulance) or the status of the caregiver (religious
practitioner, midwife, doctor or EMT) who attends her birth. Perhaps the
Ohio legislature could be moved to introduce a bill authorizing the
emergency use of oxytocin by all caregivers, 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 make this life-saving emergency drug widely available.
Parke-Davis, the pharmaceutical company who manufactures it, might be
happy to get on that bandwagon. I
shall certainly suggest such a thing in my letters to the newspapers in
your region.
My 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. During the almost 2 years of
criminal prosecution I did extensive legal research on the history of
midwifery and medical politics and the California medical practice acts,
especially as it addressed (or failed to address) the practice of
midwifery. 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.
If I may be of assistance please feel
free to contact me via phone, pager or email.
Warm Regards,
Faith Gibson, LM, CPM
Executive Director, ACDM; California College of Midwives
650 / 328-8491 info@collegeofmidwives.org
URL ~ www.collegeofmidwives.org
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