Who is REALLY at Fault?

This photo is what dangerous arrogance looks like.  Angela Hock, an unlicensed midwife was charged with “negligent child abuse resulting in death after a baby died following an unsuccessful home delivery in Omaha.”

Last month paramedics were called to the home, where they “found Hock, who operates Nebraska Birth Keeper, attempting to help 25-year-old Emily Noe deliver a breech baby in the home. Noe was on her hands and knees as another woman held the partially delivered baby, the affidavit said.”

The female infant was delivered en route to the hospital, limp and apneic, where the on-call OB determined she was likely suffering anoxic cerebral edema.  She was taken to the NICU, where she died 3 days later. 

“According to the website, Hock began her ‘journey as a birth professional’ in 2004 and started attending births as a doula in 2013 ‘before discovering my calling to help women find their power and ancient wisdom through traditional midwifery.’” 

“I believe … that women possess the God-given wisdom and intuition to birth their babies free from regulation,” said the former doula, as worthless a distinction as I could imagine.

“Mr. Dornan said Ms. Hock had performed about 50 deliveries in the past without any episodes, as well as aiding in an additional 25 to 50 deliveries before that as a doula, a person who has no medical training but provides guidance during pregnancy and birth…’She is not a medical provider,’ Mr. Dornan said of Ms. Hock. ‘She makes that clear with respect to her clientele. My client is an old school midwife, in that she’s not certified. Midwife is in the Old Testament, if you will.'”

“When the emergency responders arrived at the home, Mr. Dornan said, they gave Ms. Hock a pair of scissors to try to help make a wider opening for the baby, which is considered to be a surgical procedure and is mentioned in the criminal complaint against his client.”  Yes, I have sewn those up in the L&D suite once the OB was through, and I would consider that to be a surgical procedure.  And I’m glad I never had to perform one.

“’You’re looking at a choice of evils, if you will,’ he said.”  And sad I am to say that I think the lawyer has a point.  But we are looking not at a choice of evils, but collaborative ones.

Dear merciful heavens, this is not the Nebraska of sod houses and laudanum.  This mother had a C-section with her first child at their local hospital, so SHE chose to have a VBAC with an untrained doula-quack (sorry, redundant) under completely unnecessary circumstances, incurring almost completely avoidable risks.  

I’m fine if they throw the maximum 20-year prison penalty book at this charlatan for her arrogant disregard of the child’s life.  We here try to describe the proper line between not blaming the patient, and holding them accountable for their choices.  Some of you won’t like this.  But the couple that paid $4,000 cash for an in-home birth experience had every opportunity to seek professional, trained care, and did not.  As far as I’m concerned, in this day, in this nation, the parents deserve equal blame for the death of this child.  I’m a “buyer beware” kinda guy, but at some point, especially with 9 months of lead-time, it falls to the patient – or parents – to demand proper care.  

Education and training matter.

Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  8 comments for “Who is REALLY at Fault?

  1. Scott
    July 11, 2019 at 10:12 pm

    The root cause of people seeking non-medical care is the difficulty accessing medical care. The only solution is to train more doctors. Unfortunately, there is a residency shortage. Therefore, both nursing and alternative care of all types fill the void left by lack of doctors. The States become desperate for more healthcare providers, and give responsibilities that are too great to non-physicians. Then, more patients fall victim to seeking care from whoever they can find, and it may not be a doctor. This is the reason behind the growth of alternative care, nursing, the anti-vaccination movement, etc, etc. The lack of doctors has resulted in other voices and professions becoming more dominant.

    Only having more residency programs can reverse the tide and make Medicine dominant again. The way I see it, we doctors have abdicated our responsibility by having too few of us to fill the public’s needs, and it is therefore understandable that the public turns to whoever they can find, when we are not able to see them. Ultimately, their care suffers by having people with less training care for them.

    The root cause is insufficient residency programs and medical schooling. In order for this to occur, while maintaining a good salary, doctors must learn how to cast off the shackles of insurance, corporations, and medical maintenance of certification, and become our own bosses again. Right now most of our earnings go to pay insurance companies, medical “leadership” organizations and lobbyists, and corporation leaders who never do any clinical care. We have to fix this. Bring back private medicine in force, and the people will come, and improved health will result.

  2. Steve O'
    July 11, 2019 at 7:40 am

    40% of the world’s births occur in hospitals, by my recollection. Most of the rest are so, from lack of access.
    Ask the women of Tibet or the Congo or a remote Pacific island for their comments. They may not be charitable.

  3. Sir Lance-a-lot
    July 10, 2019 at 10:25 pm

    Eh. I don’t know, Pat.

    I don’t have a problem with “real” midwives, who’ve gone through academic and clinical programs and obtained certifications, partly because they “know what they don’t know,” and would have had this woman at L&D before this could ever have gotten this far.

    As far as this lady being a “non-certified midwife” or whatever she was, well, in my opinion giving birth is a normal biological function, not a medical condition or procedure. Certainly when it goes wrong, it can become a surgical emergency right quick, but a regular delivery is as normal as taking a crap, and we don’t have medical assistance for that (yet).
    I mean, if you want to crawl under the stairs, pop the kid out, and bite through the cord like a cat, it’s a free country, but don’t complain if you get puerperal fever.

    So, as far as I’m concerned, if this lady was honest with the parents about her lack of any status whatsoever, and if they were stupid enough to believe that was okay, well it looks like the lifeguard just blew the whistle and threw them out of the gene pool.

    They paid a high price to learn a simple lesson, but I don’t think anything criminal occurred here.

  4. Jesse Lee Belville,PA-C
    July 10, 2019 at 8:41 pm

    Tragic and the parents will live with the consequences of their decision for the rest of their lives. The non medical person pretending to be a midwife is a stupid arrogant person who should be jailed to the full length of the state law . Otherwise she will do this again,and again. More tragedy.

  5. Jaclyn Nadler
    July 10, 2019 at 8:21 pm

    I don’t know; I have mixed feelings about this. Yes parents/patients bear some responsibility for poor choices, but unfortunately many of our public are misguided either through fault of their own or deliberate deception by individuals, corporations or our own government that portray non-physician care as acceptable. In this case, I feel the doula bears most of the responsibility. She was providing a service that she had inadequate training to perform, ultimately leading her to be unprepared to handle the situation of a breech delivery and she should’ve simply said no in this already high-risk patient.

  6. JRDO
    July 10, 2019 at 1:50 pm

    Tragic. Yes, of course the parents bear responsibility for their poor choice.
    The question is whether the parents poor choice which resulted in the death of their child is a criminal misdeed.
    In other words, should the baby have the “right to life” which was taken away by the parent’s poor choice.
    What say you?

    • Pat
      July 10, 2019 at 9:40 pm

      That is a great, extremely complex question. I’ve been conflicted over whether mothers on drugs should be held liable for in-utero defects. Should a woman be held liable if she refuses folic acid and her baby has spina bifida? Maternal age vs Down’s, should an obviously pregnant woman chugging a beer be charged with abuse, does a fetal death in a DUI case warrant homicide charges, and on and on…? Part of me wants this foolish woman to be given a BTL, but I don’t want the government forcing surgical procedures. This seems to be a conflict between the rights of parents and their offspring, where either choice will harm innocents. I just don’t know…
      If the quack midwife can be held liable, can not those who retained her be considered accessories?

      I am on your turf, and would love to hear you expound, what am I missing?

      • JRDO
        July 11, 2019 at 10:27 am

        IMO it is a difficult but not complex question as the choice is binary.

        One either believes that conception is the point along the journey of life at which time legal protection should be afforded or that birth is that point. (Personally, I think trying to pick a particular gestational age is impracticable but I understand the desire to afford legal rights to “late term” fetuses.)

        If conception, one would be pro-life/anti-abortion and the baby in this case should have legal rights and therefore the parents and the doula would be guilty of negligent homicide.

        If birth, one would be pro-choice and the baby in the case wouldn’t have rights in-utero and therefore the parents and/or doula would not be legally responsible.

        Fwiw, my personal views are aligned with the latter.

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