In August of 2009 Jesica Dolin, of Andaluz Waterbirth Center, was referred to a mother from Washington State by Debra Conner, a RN who performed midwifery services and who was investigated in the death of one infant and severe injury to another. This mother was carrying a confirmed breech infant. Midwives in Washington had informed the mother that she would have to be referred to a physician for delivery. This mother was adamant that she was willing to take the risk of delivering without medical help and Ms. Dolin assured the mother that breech birth was safe and that she would meet her at a hotel in Oregon to deliver her baby. Plans were made to do so but the mother waited too long to make the trip to Portland. After calling Ms. Dolin to tell her that the labor had progressed too far for her to come to Portland for the delivery at the hotel, “Jesica agreed that we probably wouldn’t make it,[to Portland] but we could call her any time we had a question and she would accompany the birth by phone.”
Ms. Dolin then proceeded over the phone, to talk this mother through the delivery of her footling breech infant! At no time did she advise the mother to call 911 or seek medical help for this most dangerous of breech deliveries.
Questions to consider:
- Did Dolin charge for this “service”? Did she charge the full fee of around $3000?
- Did Dolin fully inform this woman that as many as 25% of footling breech births involve a cord prolapse? Did she fully inform her as to how urgent such an emergency is, and the high likelihood of it being fatal for the baby if it occurs remote from an operating room? http://www.medscape.com/medline/abstract/8377990
- Did Dolin order ultrasounds to check for additional risk factors such as neck hyper-extension or fetal malformations? Did she conduct pelvimetry to assess this woman’s likelihood of being able to accommodate a breech birth? http://emedicine.medscape.com/article/262159-overview#aw2aab6b3
- Did she fully inform the woman about the risks of head entrapment? About the high rates of mortality and morbidity for breech births in general, but especially in a homebirth setting?
- Why did Dolin not summon help to the scene when it was apparent she could not get there in time?