MIDWIFERY
The Florida Council for Licensed Midwifery “is a loosely run playroom,” said Wilkerson, the Tampa obstetriciangynecologist. “I think the public is ignorant to what they’re getting with a licensed midwife. It has gone on for way too long.”
The council operates under the Florida Department of Health and assists the agency with developing rules and addressing complaints. Although physicians sit on the board, midwives serve as both the chair and vice chair.
Required to convene three times a year via conference calls, the group meets with no regularity. In 2017, the board met on Sept. 13, Sept. 25 and Oct. 23. Their next meeting was more than a year later, on Nov. 16.
In the past decade, Florida formally pursued discipline in just 36 of the 170 midwifery complaints — at least 10 involving fatal incidents. It revoked only one license during that time, although six other midwives voluntarily surrendered theirs after facing allegations.
During that same time period, the Florida Department of Health counted 66 full-term stillbirths at home or in a freestanding birth center. An additional 19 fullterm babies died during or within a month of an out-of-hospital delivery assisted by midwives, CDC data show.
But for years, it was voluntary for midwives to submit annual reports counting fetal deaths and hospital transfers, according to a GateHouse Media review of the reports. Some of those that are submitted were incomplete or inaccurate, the analysis showed.
Florida passed a law this year requiring better tracking of hospital transfers and adverse incidents from attempted and completed out-ofhospital deliveries.
“The bill we passed is not going to solve this problem in and of itself,” said Sen. Dana Young, R-Tampa, who chaired the Health Policy Committee and sponsored the legislation. “But it does require that these birthing centers staffed by licensed midwives must do what hospitals already are doing, which is reporting adverse incidents.”
Kama Monroe, executive director of Florida’s Council of Licensed Midwifery, declined interview requests but answered questions via email in August. She defended the state’s oversight of midwives and the home-birth industry.
“Licensed midwives are medical professionals and the department regulates and investigates their work using the same methods we use for every other medical professional,” Monroe wrote. “This has been true since we began regulating the profession in 1982 and Midwife Taryn Goodwin checks the vital signs of newborn Chloe Davis, born to Caleb and Carolyn Davis on Aug. 14 in Mustang, Oklahoma. remains true today.”
••• Oregon revoked just two direct-entry midwife licenses in the past decade despite investigating at least nine incidents in which a baby died, according to a review of disciplinary records.
One of them involved licensed midwife Jennifer Gallardo, who didn’t call 911 despite several warning signs that a vaginal birth after a caesarean baby was in trouble during a 2010 home birth, according to the state records.
At one point during the difficult labor, the midwife failed to distinguish the difference between the baby’s heart rate and that of its mother.
Gallardo “admitted that she questioned whether these were fetal heart tones at the time, and thought the baby was either fine or dead,” state records show. The midwife “did not call 911 to transfer to care to EMS, did not document discussion of need to transport with client, nor is there a signature from client refusing transport to the hospital during this time.”
The complaint counted more than 50 violations of Oregon statutes and regulations leading to the baby’s death.
Gallardo, who had four prior disciplinary actions in Oregon — one stemming from a fetal death — was ordered this time to participate in a peer review and receive direct supervision for her next five clients. Her current license status is active.
The chairwoman of Oregon’s Board of Direct Entry Midwifery, Colleen Forbes, declined to comment on the disciplinary process, saying it’s a confidential proceeding. She further declined to offer general insights into how the board makes decisions to protect the public’s safety or hold
midwives accountable.
“We do an excellent job of keeping the public safe,” said Forbes, a licensed, certified professional midwife based in Eugene. “But this is certainly not information for the media.”
Not everyone agrees the board does a good job.
“The board exists to protect the midwives,” said Martha Reilly, chief of women’s and children’s services at McKenzie-Willamette Medical Center near Eugene. “Midwives cover for other midwives like you wouldn’t believe.”
Two decades ago, the board’s then-chairwoman resigned over similar concerns.
Kate Davidson cited her fellow members’ failure to revoke the license of a midwife who left a mother without delivering her placenta after childbirth. A retained placenta can lead to infection and blood loss and can be fatal in some cases.
The board placed the midwife on probation. Davidson said it wasn’t sufficient punishment.
“I do not feel I can honestly continue to serve and maintain my own personal integrity,” Davidson wrote in her May 1999 resignation letter. “I feel this was an aggregious (sic) act and failure to revoke the license conflicts with the Board’s duty to protect the public.”
The midwife voluntarily surrendered her license one year later — after the board received a second complaint, this time about a baby who died under her care, state documents show.
Davidson, a certified nurse midwife in Salem, hasn’t been involved with the board since then and couldn’t comment on its current performance. But she said midwifery in Oregon is safe and that not all fatal outcomes are the fault of the midwife or should result in license revocation.
When a midwife’s negligence is to blame for a death, however, Davidson said the board needs to hold that person accountable. Failure to do so does the public a disservice, she said.
It also further aggrieves families who, after experiencing a birth trauma, endure an emotional complaint process that ends with few results.