More Midwife Strife

The state Health Department is investigating a controversial home-birth advocate—again.

The state Department of Health has opened a new investigation into a case involving radical birthing guru Debra O'Conner and the death of a baby. This is at least the third investigation of O'Conner, a charismatic proponent of "true" midwifery who takes natural childbirth to an extreme. The department sanctioned her twice previously in connection with six cases in all, including three in which babies died. Though the department did not hold her responsible for the deaths, it did severely restrict her ability to practice in 2001, and O'Conner subsequently let expire her license related to the practice of midwifery.

The new investigation raises the possibility that O'Conner has found a way around the rules. And the possible ineffectiveness of the department in preventing another seemingly tragic case has confounded many of O'Conner's peers, who are increasingly willing to criticize her publicly. "I feel like, well, it didn't stop with the state's intervention," says Ann Darlington, a midwife who is employed by Puget Sound Neighborhood Health Centers and practices with Group Health Cooperative. "Now what do we do? There is a potential danger to the public here, and we've tried to follow the legal system. It's not that the system failed. It's that this person may be functioning outside the system."

Darlington previously lodged a complaint against O'Conner after treating a patient who had tried to give birth at home and was taken to Group Health. According to the state's findings of fact, the patient continued pushing at home for longer than she should have, given signs of a possible infection and the presence of meconium in the amniotic fluid. Meconium, which is the baby's discharge, presents a danger of asphyxiation; in this case, the baby was born in the hospital with respiratory distress but was ultimately fine. O'Conner maintained that it was the patient's choice to stay at home as long as she did, and she questioned the utility of the suctioning technique hospitals use for meconium. She ardently argues that many medical interventions cause more harm than good. "So I have to find a way to buy out of that," she explained to Seattle Weekly in an extensive series of interviews last year. (See "Birth Rights and Wrongs," March 24, 2004.)

Other believers in natural birth, however, say O'Conner has gone too far. "Debra is a renegade," says Ali Toperoski, president of the Midwives' Association of Washington State and an owner of the Puget Sound Birth Center, where O'Conner once practiced. "I'm hearing from a lot of midwives that she's careless and she needs to be stopped. I've even heard midwives say, 'Can't we just call the cops?'"

It's not clear what, if anything, O'Conner might have done to prompt this latest probe. The state doesn't release details of ongoing investigations, and in this case will only say that it received three complaints Feb. 10, opened an investigation the next day, and has given it a "high priority" given reports of an infant death. O'Conner declines to be interviewed. "I don't think she knows very much about it," says her attorney, William Bishin. He says the state delivered a brief notice that alerted her of its investigation but did not specify the case at hand.

It's not known in what capacity O'Conner was acting. When interviewed last year while under state sanction, she was accepting clients as a doula—someone who acts as a labor coach but is not empowered to serve as a primary health care practitioner. The notice of investigation O'Conner received this time referred to a claim of "exceeding the scope of practice," according to her attorney, who discounts that possibility. "Debra is very, very careful," says Bishin. "She's meticulous. She knows what the rules are, and she sticks to them."

Oddly enough, due to the vagaries of state law, O'Conner could be practicing legally as a midwife—as a "lay midwife" who doesn't advertise or accept a fee for her services. In fact, last year she was training a group of students to be lay midwives— students who wanted to be, as one explained, free of the government regulation that comes with licensing.

If the state doesn't regulate lay midwives, could it do anything about O'Conner if she was practicing this way? Paula Meyer, head of the branch within the Department of Health that regulates midwives, in the Health Professionals Quality Assurance office, says that it could. Because lay midwives have traditionally confined themselves to "normal" pregnancies, without complications like high blood pressure or a prolonged labor, a lay midwife practicing outside that scope could be charged with practicing without a license. So could a doula who encroached on midwife terrain. If there was such a finding, the department could issue a cease-and-desist order, violation of which carries potential criminal penalties.

But typically the practice of lay midwives is off the radar of the state, which has no record of how many there might be. That might be problematic when it comes to the circle around O'Conner, believes Victoria Malloy, a onetime apprentice of O'Conner who now runs a medical billing service. "She's got these groups of young girls who believe they don't need licensure," says Malloy. "Who's going to regulate them?"

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