Published: Sunday, July 25, 2010, 3:00 PM Updated: Monday, July 26, 2010, 2:49 PM
But when the big day arrived, in the midst of labor, Hermans began experiencing breathing difficulties. Her baby was breech -- positioned to emerge feet first -- increasing the risk. The midwife arranged for ambulance transport to Oregon Health & Science University, where an ob/gyn surgeon delivered a healthy baby boy by Cesarean section.
And that would have been that, except the surgeon and a nurse at OHSU filed a complaint about the midwife, Jesica Dolin, alleging she violated professional standards by attempting a breech delivery.
It was the beginning of an escalating conflict over the scope of practice of midwives in Oregon. Midwives assert they are qualified to care for women giving birth to twins and breech babies, or attempting vaginal birth after c-section. Doctors filing complaints with the Oregon Health Licensing Agency insist that such births are too risky to allow out of the hospital
In April and May of 2010, the Oregon Health Licensing Agency began investigating such complaints against five midwives. Like Dolin, all work for Andaluz Waterbirth Center in Portland, which is known for taking on breech and twin pregnancies, and women with a previous Cesarean.
Midwives say the complaints are baseless and meant to thwart competition from midwives and out-of-hospital birth centers.
"This is all harassment," said Roy Haber, the attorney retained by Andaluz, which on Friday announced a federal civil rights lawsuit against OHSU and the Oregon Health Licensing Agency. "They did not have cause to believe that any of these midwives had violated any standards," Haber said. The midwives aren't seeking damages, Haber said. The lawsuit will ask for an injunction ordering the state and OHSU to "cease intimidation and threats against midwives."
The licensing agency recently withdrew the investigations of five midwives, after Haber refused to hand over medical records. The licensing agency also withdrew the case against Dolin, who said the withdrawals show the complaints were without merit.
Officials with the state agency declined to comment on the allegations in the pending lawsuit or the investigations of Andaluz midwives. OHSU also declined to answer questions, but issued a written statement saying "OHSU fully respects and supports a family's right to choose the pregnancy and birthing options that best meet their needs and ensure the health and safety of the mother and child," and that its hospital-based certified nurse-midwives "are fully supported by, and work closely with, OHSU obstetrician-gynecologists."
Oregon law gives licensed midwives a relatively broad scope of practice. They are authorized to perform obstetric ultrasound, provide drugs, give oxygen and IV therapy, and administer local anesthetics and stitch wounds. They can give antibiotic eye drops to newborns, order lab work, and perform newborn metabolic screening. Haber said Oregon law unequivocally permits midwives to attend breech and twin births, and vaginal births after Caesarean in a home or birth center.
Safety remains a matter of fierce debate. Standards of practice vary widely from state to state, and studies are contradictory. In a report in February, University of Texas researchers who analyzed U.S. birth records from 2000 to 2004 concluded that the risk of infant death was twice as high in home birth compared with hospital birth.
But in two large Canadian studies last year, in Ontario and British Columbia, infants born at home fared just as well as those born in the hospital. Significantly, home-birth mothers experienced fewer complications. In the Ontario study, the rate of emergency c-sections was 5 percent among women who planned home births compared with 8 percent among those who started in the hospital. In the British Columbia study, women giving birth at home suffered less than half as many serious perineal tears, and about a third less postpartum hemorrhaging.
Hermans, who is pregnant again and planning a home birth with a midwife, said she can't understand why the OHSU surgeon and nurse filed a complaint about her case. She said women are capable of weighing the risks and benefits of home birth versus hospital birth, and that women should have the right to choose.
"The complaint misrepresented me and my birth," she said. "I was furious. They had no business doing that."
– Joe Rojas-Burke