Mennonite Midwife Freida Miller Arrested in Ohio
for properly using Pitocin to prevent a dangerous PP Hemorrhage

Editor's Note: This is a copy of two letters to the editors written by the ACDM on behalf
of Freida Miller and her situation as it relates to the safety of childbearing women


American College of Domiciliary Midwives
3889 Middlefield Road
Palo Alto, CA 94303
650 / 328-8491

March 7, 2002

The Canton Repository
500 market Avenue
Canton, OH 44701
330 / 580-8300; 454-5745 ~ fax
Letter to the Editor  letters@cantonrep.com

Akron Beacon Journal
Voice of the People
PO 640
Akron, OH 44309-0640
330 / 996-3000; fax

Letters to the editor vop@thebeasonjournal.com

I am writing about the inappropriate criminal prosecution of Mennonite Midwife Freida Miller 
- a clear case of “No good deed goes unpunished!

I am a former Labor and Delivery Room nurse and currently the director of the American College of Domiciliary Midwives, a professional organization representing community-based midwifery. Personally I am a Mennonite midwife living in California who has provided maternity care for the last 20 years under the religious exemptions clause of our state’s medical practice act. I am also licensed under our state’s direct-entry midwifery law and practice lawfully under the authority of both provisions.

Scientifically speaking, skilled midwives are the safest and most appropriate provider of maternity services for healthy women with normal pregnancies. The safety of home-based care with an experienced midwife is equal to hospital birth for low and moderate-risk mothers. The safest form of midwifery is that which is well articulate with obstetrical services and the safest form of obstetrics is that which is well integrated with midwifery principles and practice. State laws should support a complementary and cooperative relationship between doctors and midwives. The criminalizaton of community-based midwifery is always based on political strategies of organized medicine and not any credible scientific evidence. Frivolous prosecutions of midwives are detrimental to the practical well being of mothers and babies. 

I am frequently called upon to review midwifery cases for attorneys to determine if the midwife’s care was safe and effective. It is my expert opinion that Frieda Miller is to be commended for: (a) carrying oxytocin  -- i.e., Pitocin – a safe emergency drug to control uterine bleeding; (b) astutely recognizing the necessity for its use in serious postpartum bleeding; (c) being brave and honest enough to inform the ER physician that the mother had already received a dose of this emergency drug, thus alerting him to the seriousness of the situation. In regard to a “community” standard of care by direct-entry midwives in the US, this was perfect midwifery management – A+ care. 

This inexpensive emergency drug (about 50 cents) could have prevented the death of the wife of the 17th century Indian Maharajah, Shah Jahan. She died of the complications of postpartum hemorrhage after giving birth to her ninth child. The world-famous mausoleum at Agra, India – the Taj Mahal -- was built in her memory by her grieving husband between 1632-1645. It was his wife’s bad luck (and that of her 9 orphaned children) to give birth before the discovery of this safe, inexpensive, life-saving drug in 1952 and the expertise and bravery of midwives such as Freida Miller to carry and properly administer it when necessary. Let us not permit the Taj Mahal to symbolize the needless sacrifice of childbearing women to either ignorance or base political motives.

The “Freida Miller” Law

Oxytocin / Pitocin should be available to every childbearing woman, regardless of where she gives birth (home, hospital or ambulance) or the status of the caregiver who attends her birth (religious practitioner, midwife, doctor or EMT). Perhaps the Ohio legislature could be moved to introduce a bill authorizing the emergency use of oxytocin by all first responders, to be known as the “Freida Miller Law” – in honor of Freida’s commendable actions and the considerable contribution of her case to the public’s understanding of how important it is to make this life-saving emergency drug widely available. Parke-Davis, the pharmaceutical company who manufactures it, might be happy to get on that bandwagon.  

Safety of the Drug and the Treatment

It is important to understand that Pitocin, when administered in a postpartum situation (i.e., after the baby is born) is one of the safest drugs in the world, in fact safer than aspirin as, unlike aspirin, it is impossible to be allergic to oxytocin. Pitocin is only medicinally effective on the pregnant uterus and in a normal dose (1-3 ampules) has virtually no side effects, contra-inductions or allergic reactions and is never an “over-dose”.  The only medicinal effect it has in this minimal dose, in addition to stimulating the uterus to contract, is to be mildly “anti-diuretic”, that is to conserve or retain body fluids and blood volume. This is in the interest of a mother who has bled excessively. 

Emergency Exemptions Clause  

The emergency use of this safe and non-addictive drug by Frieda Miller not only protected the life of the mother but also the well being of her newborn baby and all other children in her family from the extreme and long-lasting distress of being orphaned. Also sever postpartum hemorrhage can cause permanent damage to the pituitary gland, causing Sheehan’s syndrome which, among other disease processes, makes it impossible to produce breast milk.  

The basic purpose of medical practice legislation is consumer safety. Any application of these laws should be consistent with (and not contradictory to) the well being of the public. For that reason, medical practice acts normally include an “emergency exemptions clause” that exempts laypersons from the technical requirements of regulated medical practice in a bona fide emergency. This is usually defined as a medical emergency occurring when no physician is present.

Functionally such “first responders” are restricted to actions made in an attempt to save a life, prevent permanent damage or extreme suffering and are within the technical ability and resources of the emergency responder. In war, natural disaster or accidents, lay rescuers perform all sorts of “medical” and even surgical interventions, such as an emergency tracheotomy on someone with an obstructed airway. As a counselor at a wilderness camp for kids, I was issued a pre-filled hypodermic syringe with epinephrine to use in case an allergic child was stung by a bee. There is ample precedent for the emergency use of anti-hemorrhagic emergency drugs.

In Freida Miller’s case, she appropriately administered a safe, single-purpose emergency drug that did not require her to either “diagnosis” between a variety of non-obvious medical conditions (tell the difference between a heart disease versus acute indigestion) or make choices between an array of different drugs (to give an antibiotics versus an antacid) or choose between various doses of the right drug. Pitocin comes in a 1 cc amp and you give one amp and repeat if necessary. Postpartum hemorrhage is a “clear and present danger”, a well-known complication of childbirth, of the same category of evident emergency as someone not breathing, suffering from anaphylactic shock, a sever asthma attack or arterial bleeding from an accident. It makes no sense to treat maternity emergencies differently than other medical emergencies that are protected by these well-founded legal principles.

 An Experienced Midwife is an Educated Observer
with Emergency Response Capacity

A midwife is by the nature of her role a ‘first responder”. As a religious practitioner, I always carried this drug. Not to do so would have been, for me at least, a violation of conscience and of my religious values. The Golden Rule counsels us “do unto others as you would have others do unto you”.  Were it my daughter and my unborn or newborn grandchild, I’d want her midwife to carry and use emergency supplies and equipment.

To criminalize the use of emergency drugs is to purposefully make childbirth unnecessarily dangerous. If the problem is the law, then the law needs to be changed, as it must be kept in mind that the basic purpose of medical practice legislation is consumer safety, not as a political tool for promoting a medical monopoly. Enforcing medical practice laws in a manner contradictory to common sense and the well being of the public is indeed to permit the Taj Mahal to symbolize the needless sacrifice of childbearing women to either ignorance and/or base political motives. This is not in the interest of childbearing families or a civil society.  I hope to see this unfortunate case have a fortunate outcome – perhaps some version of “Frieda’s Law” -- a triumph of reason, compassion and just plain common sense in the interest of healthy mothers, happy babies and a stable society. 

My Professional Background:

Prior to becoming a religious practitioner of midwifery in 1981, I was an L&D nurse over the course of approximately 17 years. In the 40 years that I have been attending births in both homes and hospital in the role of nurse or midwife, I have been present at approximately 3500 births. Over the last 2 decades I have amassed a unique library of historical, legal and legislative resources and frequently provide information on the historical and contemporary practice of midwifery to lawyers, the state medical board and our legislators. Many of these documents can be read or downloaded from our web site (www.collegeofmidwives.org).

I was a consultant to the legislator who authored a recent amendment to the Licensed Midwifery Practice Act. I am the liaison between the ACDM and the Medical Board of California and have also been an expert witness for the defense in a criminal and administrative case. I was named by my peers to be an “exemplary” practitioner of midwifery and was a contributor to a study on the exemplary practice of midwifery published in the Journal of Nurse Midwifery. Guidelines for the safe and effective practice of midwifery are posted on the ACDM web site, entitled “Characteristics of Clinical Competency”  ~ URL https://collegeofmidwives.org/college_of_midiwves01/CharClinicalComp%2001.htm

Warm Regards,

Faith Gibson, LM, CPM
Executive Director, ACDM; California College of Midwives
650 / 328-8491 info@collegeofmidwives.org    URL ~  www.collegeofmidwives.org

A copy of this letter is post on the College of Midwives web site under the “Breaking News” subdirectory  

 

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