Midwives investigated in three Idaho deaths

Rachel Rabey had her first baby at home in Gig Harbor, Wash., with a midwife guiding her through labor and delivery. She remembers the birth four years ago as “beautiful” and “perfect.”

After moving to Boise with her husband, she wanted the midwife experience again with her second baby. She looked up “Boise birth center” on Google and contacted the businesses that popped up.

The Baby Place in Meridian was the first to get back to her. Owner and former midwife Coleen M. Goodwin had attended hundreds of births, so Rabey figured Goodwin had seen it all.

“Prenatal visits (were) very casual, which at the time I was fine with,” she said. “I thought, ‘Well, these midwives are a little loose, but it’s fine.’ ”

But Rabey had complications during her June 2010 labor: flulike symptoms, vomiting and diarrhea. After what Rabey remembers as a confusing, terrifying and painful birth, her newborn son died.

Rabey’s case is one of three involving newborn deaths in the past two years that prompted the state’s Board of Midwifery to take emergency action in late March against Goodwin and her daughter, Jerusha Goodwin, midwives at The Baby Place, 270 N. Linder Road. Both women were ordered to stop practicing midwifery and not to seek license renewal until the board reaches a conclusion in the cases.

The board said the allegations against the Goodwins — investigated by the Idaho Bureau of Occupational Licenses — suggest “an immediate and ongoing danger to the public health, safety and welfare.”

Neither midwife responded to a message left by the Statesman last week. A receptionist who declined to identify herself said Wednesday that the center is “not making any statements at this time.”

The Meridian Police Department is looking into one of the cases, involving the death of a baby delivered last August. Deputy Chief Tracy Basterrechea said police got involved after responding to a call for a paramedic. The case has been active since, he said.

“Our investigation is to determine whether or not there (were) any criminal violations,” he said.

Midwives generally train in apprenticeships and must have certification and coursework to obtain licenses. They differ from nurse-midwives, who don’t require midwifery licensure, go through nursing school and can double as primary-care providers.

Dr. Martha Lund, an obstetrician in Boise, says the Treasure Valley has some good licensed midwives, but she worries about licensed midwifery after seeing midwife-attended patients come into Saint Alphonsus Regional Medical Center with emergencies.

She estimates that about one such woman comes into the hospital each week.

“You’re laboring outside of the hospital, (so) you’re always taking some risk,” she said.

WANTING ANSWERS

Rachel Rabey doesn’t know why her son, Grant, died. She knows the midwives told her to start pushing before she was fully dilated. She knows they called for paramedics, but according to records, they wouldn’t let the medics into the room for at least four minutes.

She knows she argued with Coleen Goodwin about which hospital was best. Rabey wanted the nearby St. Luke’s hospital in Meridian, but the midwife, who was riding in the back of the ambulance — Rabey’s husband was in the front — told the driver to go to the St. Luke’s in Downtown Boise.

Rabey said Goodwin whispered in her ear that the Meridian hospital wouldn’t let Goodwin stay in the room with her.

The baby died at the hospital about an hour after paramedics were called.

Rabey cries when she remembers that, and when she remembers being asked whether she wanted an autopsy. She said no.

“When you’re in the hospital, holding your child ... it’s impossible to let them do that,” Rabey said. “When you’re holding him, and he’s perfect, it just doesn’t seem like something you could let them do.”

Now she wishes she had said yes, because it might have given her more answers.

Rabey hasn’t talked to Meridian police, but she allowed state investigators to give her medical records to a detective.

She said she considered suing the birth center, but like other Idaho midwifery practices, The Baby Place is not required to carry insurance. She was told that “any lawsuit that’s pursued with them is somewhat fruitless.”

THE CASES

In each of the three cases investigated by the state, the baby’s heart rate dropped well below normal, and records lacked crucial details or had been altered, according to the midwifery board. The midwives didn’t cooperate with paramedics and hospital providers and did not give them medical records.

Here’s what the board says happened in the two cases besides Rabey’s:

In October 2010, a baby girl died two weeks after delivery. She was born with respiratory failure and brain damage. While at the birth center, the baby’s heart rate had dropped to less than half the normal range. When she was born, a student midwife cut the baby’s umbilical cord without clamping it, causing the baby to lose “a significant amount of blood.”

In August 2011, midwives delivered a baby boy for a woman whose pregnancy had outlasted Idaho’s 42-week legal limit for a midwife-assisted delivery. The mother had a “greenish” vaginal discharge, and when her water broke, it contained the newborn’s feces.

The baby boy wasn’t born for 19 hours; the mother was in labor for more than 48. When he was born, he was “limp, unresponsive and pale,” with newborn feces stains around his mouth and a low heart rate.

Jerusha Goodwin tried to resuscitate the baby but did not do it properly. She waited about 11 minutes after the birth to call 911. The baby died in the hospital.

The Idaho Legislature passed a law in 2009 to require all midwives to be licensed by summer 2010. It also set rules for them to follow. Midwives sought the law to set those rules, to secure legal authority to deliver babies and to be able to accept Medicaid.

Among other things, the law gave midwives the authority to administer certain medications that can be life-saving if used properly, including oxygen to help a mother or baby breathe, the oxytocin hormone to stop bleeding, and antibiotics to prevent severe bacterial infection.

But during the hearings on the bill that passed, legislators worried about the occasional labor emergency getting out of control.

Board documents say the Goodwins’ actions broke numerous board rules.

TOUGH RESEARCH

Rabey said she interviewed the midwives, toured the birth center and checked the Goodwins’ licenses for black marks. Doing her homework gave her a false sense of security, she said.

“I don’t really know of any way you would ever find out if a place is safe or not,” she said. “Even now, researching, you really have to go out of your way to find information about (the midwives at) The Baby Place” from the Board of Midwifery’s website.

The site contains a link to a database of disciplinary actions taken by the board, though it does not include pending complaints or those resolved without discipline.

Barbara Rawlings, a Bonners Ferry midwife who chairs the Board of Midwifery, said the board doesn’t act until the Bureau of Occupational Licenses investigates and tells the board what it found.

“It always feels excruciatingly long” before a complaint can get resolved, she said. “Some of the professions are much larger than ours, so sometimes we take a back seat.”

MOVING ON

Just three weeks ago, Rabey gave birth to a baby girl. She had her daughter at the St. Luke’s hospital in Downtown Boise. “I had met some really wonderful nurses and doctors” at St. Luke’s the night of her son’s death, Rabey said.

But she wishes there were a better way to know whether a midwife could save a woman’s life, and that of her baby, before making the decision to give birth outside a hospital.

She filed the complaint about her baby’s death last fall, several months before it was made public.

“I know this is a process,” she said. “But I wish there was some way for people to know (about) filed complaints.”

Audrey Dutton: 377-6448

This story was originally published April 19, 2012 at 12:00 AM with the headline "Midwives investigated in three Idaho deaths."