Thursday, March 11, 2010

One of my Favorite Midwives Lost Lawsuit

Four years ago I started charting on Fertility Friend so that later in 2006 we could start trying to have another baby.  All those month of charting and chatting on the FF message boards taught me a lot.  My eyes were opened to what I really wanted for my birth.  In August of 2006 I found out that I was pregnant with my second child who is not almost 3 years old.  For that pregnancy I decided to use the Midwives thru Methodist Health Systems here in Omaha bc I wanted to have a natural, intervention free birth.  Just a few months later I split up with the father of my children.  The midwives, Jenda Stauffer, CeCe Norton, and Marilyn Lowe were absolutely amazing.  They helped me in ways I know my former OB would not have been able to.  Between the 4 of us we came up with a plan on how to handle any situations that might arise during the delivery if my ex chose to be present (things were extremely tense between us.)  This meant so much to me and helped me so much in having the labor experience of my dreams (definite topic of a later blog). 

Fast forward to March 11, 2011.  I am was reading a summary of post on the Nebraska Friends of Midwives yahoo group.  I see a post about a local midwife losing a lawsuit.  Imagine my shock and horror when I read it and see that its Marilyn Lowe!  I found the comments made by the attorney of the parents to be ignorant, biased and personally abhorrent.  Here is a link to the story:

After reading the story I immediately got online and looked into Shoulder Dystocia.  Here are some facts I found on an information website done by Dr. Henry Lerner.  His website is the worlds leading source for information on Shoulder Dystocia.

Shoulder dystocia happens in 1% of all in the US that is 40,000 cases per year (approximately 4million babies were born in 2007, the last year I could find stats for).

20% of babies with shoulder Dystocia will suffer some sort of injury either temporary or permanent.

Brachial Plexus damage will happen in 10% of all shoulder dystocia deliveries. (The brachial plexus is a network of nerves that conducts signals from the spinal cord, which is housed in the spinal canal of the vertebral column (or spine), to the shoulder, arm and hand.)

Brachial Plexus damage can happen without shoulder dystocia.  It happens in both vaginal births where there is no dystocia, and in c-section births.

Babies with shoulder dystocia must be delivered fully as quickly as possible to avoid fetal asphixiation.  This is because once the head is delivered the umbilical cord is compressed between the babies body and the mothers birth canal.  This significantly decreases or completely cuts off blood flow between mother and baby. 

Between 200 and 400 babies will have permanent brachial plexus injuries each year in the US.

 A study done in 1988 found that the amount of experience a doctor or midwife has delivering babies has no affect on injuries to the fetus resulting from shoulder dystocia.

A number of different studies all found that it is extremely difficult to accurately predict which babies will have shoulder dystocia.

ACOG says this about shoulder dystocia:
         Most cases cannot be predicted or prevented because there are no accurate methods to identify which fetuses will develop the condition.
         Ultrasonic measurement to estimate macrosomia has limited accuracy. (Macrosomia is a baby weighing over 4000 grams or 8 pounds 13 ounces)
         Planned c-sections based on suspected macrosomia is not a reasonable strategy. (One study showed that 1000 unneeded c-sections would take place to prevent 1 case of shoulder dystocia resulting in brachial plexus injury.)

On his website Dr. Lerner says "This automatic assignment of responsibility to an OB or Midwife for brachial plexus injury whenever shoulder dystocia occurs is inappropriate and not supported by literature."

I found this information very interesting and it made me feel even more strongly that Marilyn Lowe should not be held liable in this case.  I feel so strongly that I plan to send a letter to the editor.  The following is a rough draft, awaiting some major editing by friends before I actually send it...

Three years ago when I was pregnant with my second child I was a patient of the Midwifery Team thru Methodist Health Systems.  I was going thru a very stressful and difficult time in my personal life and also a stressful, higher risk pregnancy.  I was leaving the midwives office after a normal prenatal visit with midwife, Jenda Stauffer.  As we were walking towards the lobby we ran into one of the other midwives, Marilyn Lowe.  We stopped to talk to her and Jenda told her some of the things I had going on and was worried about.  Marilyn asked me some questions and being 7 months pregnant, stressed and very emotional I started to cry.  Marilyn immediately gave me a hug. It was one of those hugs that make you feel better, like everything is going to be ok, like a hug a mother gives to a hurt child. That calmed me down and she helped me make a plan to deal with the situations I was worried about.  Two months later I gave birth to my second daughter.  It was the most amazing, calm, wonderful birth experience.  I credit that to the excellent care I received from the Methodist Midwives and the plan that Marilyn Lowe helped me make 2 months earlier.  Marilyn and the other midwives went about and beyond the expected standard of care and I cannot picture a time when they wouldn’t do everything they could to ensure the best possible birth outcome. 
Having a large baby is not, in itself, a high risk delivery.  Thousands of “big” babies are born each year in the United States and only 1% of deliveries are affected by Shoulder Dystocia.  Shoulder Dystocia is an emergency situation.  It is vital to deliver the shoulder and rest of the baby as soon as possible after the head is delivered.  Once the head is delivered the umbilical cord is compressed between the baby and the mother’s birth canal, significantly decreasing, or completely cutting off blood flow between mother and baby.  Death or serious brain damage can happen in as little as 5 minutes from the time the head is delivered until the rest of the baby is out.  The Brachial Plexus is a network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand.  Brachial Plexus injury is caused by damage to those nerves and happens in 10% of shoulder dystocia deliveries.  According to ACOG most cases of Shoulder Dystocia cannot be predicted and there is no accurate method to identify which fetuses will develop the condition.  Ultrasonic measurement to estimate macrosomia has limited accuracy and planned c-sections based on suspected macrosomia is not a reasonable strategy.  According to Dr. Henry Lerner, whose website is the world leading source of information on Shoulder Dystocia, Brachial Plexus injury can happen and be completely unrelated to Shoulder Dystocia and happen in both vaginal and cesarean deliveries where Shoulder Dystocia is not present.  He goes on to say “This automatic assignment of responsibility to an OB or Midwife for Brachial Plexus injury whenever Shoulder Dystocia occurs is inappropriate and not supported by literature.”  The Reilly’s should be happy that Marilyn Lowe acted calmly and quickly to deliver their baby and happy that for the most part he was healthy.  The statements made by the attorneys showed bias and ignorance and were not supported by fact.  Midwives in Nebraska consistently have lower c-section rates and more positive birth outcomes. Nebraskans would only benefit from having more midwives available to them for prenatal and maternity care.  
 The comments made by the families attorneys really rubbed me the wrong way and I truly believe that the family should be thankful that she acted quickly and saved the life of their baby.  I also really dont think that every case of brachial plexus injury results in a lawsuit that is covered by the media.  I do not think this story would have been covered if the family had lost or if an OB had lost.  I know that the amazing successful deliveries by midwives are not covered.  Midwives offer an exceptional level of prenatal care that is hard to find with an OB.  I truly believe the last line of my letter, that we can only benefit from more midwives being available to care for pregnant women.  


  1. Nicely written AJ. I think part of the problem is that nobody wants to admit that sometimes birth doesn't go perfectly and injuries and deaths happen. You can be as prepared as you can, have an excellent birth team, and be right next to an OR and still have a tragic outcome. Somehow people think hospital birth = 100% safe birth. And when something goes wrong, they want to blame someone. It's human nature I suppose, but I too agree that if this was an OB, it wouldn't be all over the news.

    I hope your letter gets published!!