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The Final Day of Testimony in Shaheeda Pierce's Breech Homebirth Trial

The Washington Court is Adjourned for a Breastfeeding Mama!!
The final day of testimony in Shaheeda Pierce's trial took place on Thursday 3rd November. The day seemed to go very well for Shaheeda's case. There were several inspiring moments during the day's proceedings, including one particularly poignant instance during the testimony of "Upel" Hsieh Yu Chin, the client whose breech birth Shaheeda attended. As Upel was speaking, her daughter, the breech baby who is now a healthy, vibrant 2 year old, ran up to her and wanted to nurse. Upel said, "My daughter needs to feed now." The judge responded, "Oh! I am up with that breastfeeding stuff!" and proceeded to share with the court that his daughter was now happily nursing his grandchild. Then he ADJOURNED THE COURT! He offered Upel a separate room where she could nurse her daughter peacefully, asking if she thought 10 minutes would be enough, or if she felt she would need more time!
There were several eloquent and passionate witnesses for Shaheeda's defense throughout the day. Jordan van Voast, the father of the child whose birth sparked this trial, continued his testimony from the previous day:

Jordan has a Master's degree in Psychology and Oriental Medicine, and he is a practicing acupuncturist. During his testimony, he described the research he and his wife did to prepare for the birth of their baby. "I became a student of midwifery, studying everything I could find... I started studying as soon as I found out my wife was pregnant." When they learned their baby was breech, they took a tour of the hospital and spoke to many doctors, all of whom said that the only option for a breech baby was a cesarean birth. This was unacceptable to Jordan and his wife. "It's a major surgery with inherent risks for mothers, and potential health issues for the lungs of the baby... We preferred to have a birth as natural as possible. My wife was born at home. All of her ancestors were born at home, and she was the 7th child of 7 born at home."

He spoke of his and his wife's Buddhist beliefs. For ethical, religious, and moral reasons, an unnecessary surgical birth simply didn't fit with their world view. Jordan contacted Ina Mae Gaskin, who sent him a list of doctors in the area who were willing to attend vaginal breech deliveries. He contacted every one of them, but found that they either were no longer practicing, or they were not attending breeches. Running out of options, he turned to the midwives in Washington state. They found one midwife who said that a "vaginal breech birth is an option, but you'd have to find someone who has those skills. She contacted Ms. Pierce, for which I am very grateful. We called her immediately and made an appointment to meet her... immediately we felt a deep, spiritual connection and sense of trust. We felt very welcomed... "

Jordan continued to talk about Shaheeda's care for them, and the ways they tried to get the baby to turn. "I'm pretty sure she said vaginal breech birth is a variation of normal... but if there's an opportunity to turn the baby, then that would be good... She made some recommendations of some things that may encourage the baby to turn: continue acupuncture and moxa to the Bladder 67 point. Several studies in China show 88% success rate in using moxa to turn fetuses. Shaheeda suggested Webster's technique. We made appointments with a chiropractor in Greenlake for 4 sessions... lying on slant board, playing peaceful music down low by birth canal, communicating with baby about turning... We had been taught how to listen to the baby's heart rate and to notice how the baby was moving, and I am an acupuncturist so I am used to taking pulses as part of my work. We had also taken a full series of prenatal and birth classes...

"The Supreme Court has ruled that a woman can (choose to) have an abortion. Can't a woman also choose to give birth?"

In the days after I posted the first story on Shaheeda's case, there was an outpouring of support and well-wishes from mother's, midwives, and women's rights advocates throughout the area. Thank you so much for your hopes and prayers. It means so much to Shaheeda, and to midwives, apprentices, and students everywhere!

There were also a few words of caution from various corners. I'd like to take a minute to address these concerns. I want it to be 100% clear that Upel and her husband were completely aware of their situation, of ALL the inherent risks of vaginal breech birth AND cesarean section. There was absolutely no question that they gave their fully informed consent at every step of this process. Some of the responses to the original post suggested that Upel might not have truly understood the terminology used by Shaheeda. Please note that Upel is fully fluent in THREE languages. She and her husband spent many weeks reading everything they could find, in English and Chinese, on homebirth and the particulars of breech presentations. As Upel herself stated: "I studied English since age 10 in Taiwan... and studied Tibetan language in India... studied in Buddhist University for 10 years... was a Buddhist nun for 7 years in India. Special words may be difficult (in English), so then we use this language machine (At this point, she pulls out pocket translator and explains it translates from Mandarin Chinese to English and from English to Mandarin Chinese). Simple words are okay. Jordan helps explain the forms we sign." It was they who sought Shaheeda out, because she was the ONLY person who was willing to offer them any other possibility besides surgery.

As Upel said, "I don't want to go to hospital (for breech birth). We tried very hard to find a midwife to help us with the home birth. When I talked to Shaheeda the first time, I had just one question: Can she help me? After talking (with Shaheeda), I know that she can help me. Shaheeda never tricked me about anything. I decided EVERYTHING! When I decided we (would) go to hospital, Shaheeda helped us by calling the doctor there. We were feeling sad (to go to hospital). We cried. Really home is very warm and a comfort to me."

Among the other witnesses who testified on behalf of Ms. Pierce were Linda Marks and Leslie Gesner, two Washington state midwives; Betty-Ann Daviss, co-author of a major study on the benefits of homebirth published in the British Medical Journal; and Ida Darragh, director of testing for NARM.

Leslie Gesner testified on the content of the Practical Skills Guide for Midwives, by Weaver and Evans, in which "breech births are listed under general skills. Under general skills simulation, the book gives you step-by-step instructions, equipment, and procedures." She read the steps listed in the book, and said that this is one of the recommended books to study before taking the NARM exam, which is the day-long exam required for a Washington state midwifery license. Linda also pointed out that as midwives, "We encourage babies to rotate (to a head-down position), but we trust that the babies may know something that we don't... "

Betty-Ann Daviss spoke of the study she co-authored, entitled 'Out comes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America,' BMJ 2005;330:1416 (18 June). The study is the first large-scale study of homebirth, and has given statistical and evidence-based credence to what we have always known to be true: Homebirth is a viable and safe option for low-risk pregnancies. She also spoke of the inconsistencies and methodological problems in another study, the 'Term Breech Trial,' which many OBs have used to argue in favor of surgical birth. "I received a call from one of the obstetricians who said, "Think of what we have been telling women for these last two years... think of what we have done to our patients- exposing them to the dangers of cesarean section!""

Ida Darragh, is the director of testing for NARM. NARM is the North American Registry of Midwives. They are responsible for writing and administering the examination that Washington state uses to license midwives. "There's nothing in our testing that would indicate an expectation for them (the midwives) not to use the skills they were tested on. Every CPM should know how to assist at a breech birth... " She spoke about the job analysis that was sent to hundreds of midwives around the world, asking for input on what topics to include in the exam. "For knowledge of management of breech birth, (the importance) rating was 6.56 out of 7 on the 2001 job analysis survey. This is considered a core skill for all CPMs."

Kendra Pitzler, the manager of the Washington Midwifery Department was subpoenaed to testify, apparently against her will, as an adverse witness. She said, "I don't think there's ever been a discussion as to whether it's outside the scope of practice (for a midwife to attend an out-of-hospital breech birth). There are no Rules (in Washington for midwives) defining "significant deviation from normal" (as mentioned in Washington statute, for when a midwife would consult a physician).

In his final rebuttal, Dr. Petty, the prosecution's "expert" witness, said such things as:
● "The woman (Upel) should not have been allowed to get up and move around during labour."
● "Midwives would always be doing very frequent pelvic exams during labour, and she (Shaheeda) should definitely have been doing them in this case."
● When questioned about midwives' tendency to not do internal exams, especially after the waters have broken, due to increased risk of infection and adding stress and discomfort to the mother, Petty said, "Oh, no. Midwives and OBs do that exactly alike!!

A final point to note is that, as the prosecution's primary witness, Dr. Petty, was paid $175 per hour, for five 7-hour days. You do the math... No- let me help you. That's $6125. He was paid by the Assistant DA's office. Yup, that's right. $6125 of Washington taxpayer's hard-earned money, to persecute a woman who did not break any laws or do anything wrong! And that's just what they paid to ONE WITNESS. So far, Shaheeda's legal expenses are well over $31,000. The cost of this and other investigations has basically bankrupted the Midwifery Department in Washington, which is required by law to have ALL of its costs born by the midwives. So, not only does Shaheeda have to cover her own legal expenses, she is required to shoulder the responsibility for the prosecution's expenses as well!

In the end, the final days of testimony went really well. While it still too early to tell for sure what the outcome of this trial will be, things seem positive for Shaheeda's defense. There are a few more days left in which objections may be made against anything that was brought up in the trial. And then we wait... The judge will have 30-60 days to make his decision. But he may not take that long. I will post again with news of the verdict as soon as it is available.

Throughout the trial, the judge was very respectful to Shaheeda and her fellow midwives. He seemed open to, and interested in, the non-conventional model of care that midwives adhere to. He said that in the course of his research for this trial, he had read Ann Frye's entire section on Breech Birth in her comprehensive textbook Holistic Midwifery, as well as watching Ina Mae Gaskin's video series. He said that the trial "opened his eyes to childbirth in a way I never knew before."

Ida Darragh said it just right. The reason women seek out midwives; the difference between home and hospital; the fatal flaw of the medical model of actively managing birth; the one thing that OBs and emergency rooms will never quite be able to understand... When asked if she was familiar with the term 'Spiritual Midwifery,' she replied, "Of course, all births are spiritual."

Please keep up the correspondence, and show your support of Shaheeda to those officials who are involved in creating midwifery legislation. Follow his link for addresses to write to: www.shaheedapierce.com/pages/contact.html

If you want to help out with Shaheeda's mounting legal costs, please feel free to mail your non-tax-deductible donations to:

Shaheeda Pierce, LM, CPM
10307 SW Cemetery Rd
Vashon Island, WA 98070

Or send by PayPal to  helpshaheeda@gmail.com


homepage: homepage: http://www.shaheedapierce.com

Keep strong 02.Dec.2005 14:40

Gloria Lemay, Vancouver, BC birth@uniserve.com

Dear Supporters,
I have been through these awful midwifery proceedings myself and look forward to the day that N. Americans join the civilized world and respect the occupation of midwife. Thanks for being there for Shaheeda and for providing the opportunity for more discussion of the importance of birth to our whole community. In solidarity, Gloria

I Cried 04.Dec.2005 05:54

Dorell Meikle dorellm@shaw.ca

I cried when I read of this court case. I cried for these parents who responsibly tried to seek the safest and best birth scenario for their baby and themselves. I cried for all babies who may not have such advantages as these parents tried to offer during the arrival of their children. I cried for the medical profession who is missing so much or the important stuff in childbirth. I cried for this midwife who fulfilled her role so well in responding with not only responsibility in this situation but a full understanding and caring of the parents' position. I cried for the judge in this case who is obviously a caring parent himself, and through this experience seems to have been awakened to a better way in childbirth. And last of all I cried for our society who through fear strives to override all the sensitive and caring needs of the birthing couple at a time which for them can never be recreated again.

May the truth triumph in this important case.
Dorell Meikle

oh please will someone discuss ALL the risks 09.Dec.2005 03:21

washington midwife

Why is there a complete lack of discussion about the potential risks to this mom and baby?! A double footling breech has a higher risk of cord prolapse, head entrapment, neurological damage, and death. Yes, higher than risks to mom and baby than with c-section. It is so hard for me to understand why all the posts are in support of this midwife without any critcal analysis of why did fulfill her obligation by law to consult, why did she not obtain an ultrasound to determine the exact type of breech and flexion of the baby's head, and why did she remain at home for a pushing stage that is prolonged even by vertex standards? I understand that this is an issue of choice, and providing informed choice to birthing parents, and that parents should have the ultimate right to make all these decisions...but the conversation cannot take place without recognizing the WHOLE ethical discussion...the larger role of the midwife's responsibility to the parents, and midwifery community. I don't believe this case is about vaginal breech birth, but did the midwife potentially create an undue risk to mom and baby by not recommending hospital transfer sooner, not obtaining consult and ultrasound.

why all the posts are in support of this midwife 12.Dec.2005 21:20

Ann Vanderpool-Kimura - midwifery consumer

For many, childbirth goes to the core of who they are. It is said some old women who can't remember much else, can remember their childbirths clearly. If there is a spirit in this life, for some that spirit is at it's strongest during childbirth and can't be argued with. To rob that spirit is also an ethical issue.
The parents in this case are well educated, intelligent people who did their research, were active participants in this decision, and still trust their midwife and her professional ability. They are not complaining, in fact are supporting the gift she gave them, so who is complaining and why? Whoever is complaining, I do believe it is none of their business. And Shaheeda's actions cannot be a threat to the midwifery community when half of that community supports her.
Had this couple gone against their heart and made the decision to go with a midwife who was more fearful than them, had they been coerced to transfer earlier to a C-section, they would now have to live forever with the "what-if". And that too is a risk. They followed their heart using their brain, and they have an outcome they can live with. Obstetrician means "to stand by" and, when this couple made the decision that they needed an obstetrician, he or she was there as his/her profession chooses to do.
There is a wide spectrum of childbirth consumers, as there is a wide spectrum of doctors, nurse-midwives, and direct-entry midwives. Thank goodness, we can all hire the care provider and make the decisions we are most comfortable with, and own those decisions. And we thank others to stay out of those decisions unless invited. That is why we are supporting Shaheeda.

From one of the midwives who was there 23.Dec.2005 04:09

Shaheeda Pierce shaheedapierce@hotmail.com

May you walk a mile in someone's shoes before you pass judgment on her.As one of the midwives who was present, I know in truth that this family was well aware of the possibilities that breech birth and surgery could entail. Actually, the family watched a very well-done breech birth training video in preparation, as well as studying the subject of breech births, cesareans, and births in general in two languages via books and the internet. Many discussions took place.All midwives and doctors who gave statements said that they generally give only oral informed consent when attending breech birth.

Washington has no obligation in law to "consult" unless there is something significantly abnormal, which Washington has not defined. While breech may be unusual at 3-4%, many do not consider it abnormal per se.I was taught that it was normal, although unusual. The case was discussed with a physician on several occasions. Some of the breech births I have attended have been some of the most normal births I have seen.

Nuchal cord, or umbilical cord around the neck, is seen in 20-25% of labors. If midwives were to be held accountable to predict this and send all these clients in for hospital births, no midwives would be left.Babies have been born for thousands of years without ultrasounds, which are not proven to be 100% safe. And ultrasounds cannot tell everything, if a woman can have two and neither one shows a nuchal cord, as happened in this case. Usually the babies come out just fine with a nuchal cord. As I testified, I see them often. They may be 1,2, or 3 times around the neck. If the baby doesn't come out, the woman has a cesarean, regardless of whether the baby is head-up or head-down.

The baby was in complete breech position, as we documented with textbook diagrams. She was well-engaged even before labor, and remained in a complete presentation. One can feel the bottom with a complete or frank breech, and with a complete breech one may additionally feel the feet next to the bottom. The definition of a complete breech is one that is flexed at the hips and flexed at the knees. I know what I felt. I have attended a complete breech before, and I have attended one that had a double nuchal cord. Babies do usually come out. When they don't, the mother can have them surgically removed. Some women choose not to have them surgically removed unless that becomes necessary.

There are several philosophies regarding breech babies' emergence, and whether there should be pushing at once, or withholding of pushing until birthed to the umbilicus, or undisturbed fetus ejection reflex. There are several philosophies around positions for the mother as well. Does this mean that one system is correct and all others are absolutely wrong? Perhaps it is not that simple.

Some midwives prefer to attend footling breeches. I myself have not ever experienced one on internal exam, and have not attended one, either single or double. I do not judge midwives who have attended them. I am thankful that these skills are not a totally lost art. I am thankful that cesareans are possible when necessary to save the life of a mother or baby, although generally I have found that a cesarean can be obtained in far less time than three hours after it is requested, if one is so concerned for the mother or the baby. I have generally good relations with the medical community. I am married to a physician, and several of my assistants have been nurses.

breech birth court case 25.May.2006 20:01

micheal sunanda michealspun@yahoo.com

aloha midwifery supporters i love the newstory about court case prosecuting a midwife for beech birthing. We wonder what decision was issued in the case. Godus help Shaheenda the midwife. I love natural homebirthing, laymidwifery, waterbirthing, baby massage, self led weaning, mother-baby bonding, the family bed, NET - natural elimination timing, nature play & Chi-kung at all ages. I self pub Kids Lib News - Family Instincts" zine, do send & hand out free by request. naturallyours micheal sunanda Oness press Causeffects in Eugene, Orgone, Ecotopia Kids Lib Family info at www.efn.org/~ecozma/sunergy