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Posted May 14, 2012 | comments 2 Comments

Midwife's behavior concerns medical board

By Sally Voth -- svoth@nvdaily.com

A Virginia Board of Medicine special conference committee expressed concern that a midwife has come before it twice in less than a year for the "inappropriate treatment" of two women seeking vaginal births after a cesarean section. Each incident resulted in a formal reprimand.

The committee reprimanded Peggy Lee Franklin, of Gainesville, on May 9, according to an order from Dr. William L. Harp, executive director of the state Board of Medicine.

Franklin is a registered nurse, as well as a licensed midwife, according to the Virginia Department of Health Professions website.

The committee, which included a member of the Midwifery Advisory Board, met with Franklin on May 2, according to the order.

It states she violated regulations relating to the practice of licensed midwives when it came to her care of a 34-year-old woman who had had a C-section in July 2005.

Franklin continued to treat the patient without turning her over to or consulting with a physician when she went two weeks past her due date and her baby was known to be large, the notice states.

The patient called Franklin on Sept. 24 after her water broke and included brown fluid, but the midwife didn't document the timing of the rupture, the order states, and let the patient continue in labor for about 15 hours after an exam showed meconium.

According to the National Institutes of Health and U.S. National Library of Medicine's MedlinePlus website, meconium is a baby's first stool, normally excreted after birth. If passed while still in the womb, it can be breathed in to the baby's lungs, causing breathing problems.

The mother had an emergency C-section on Sept. 25, and "thick meconium was noted," the order says. The baby, which was more than 10 pounds, was diagnosed with neonatal sepsis, and needed to spend a week in the neonatal intensive care unit, according to the order.

It states the woman labored for more than 16 hours while making "very little progress ... even though such action was contraindicated in the face of a patient at 42+ weeks gestation with ruptured membranes, meconium stained amniotic fluid, and a macrosomic infant measuring in the 93rd weight percentile."

Franklin told the committee the woman didn't want to be treated by her obstetrician for fear the doctor would insist on a cesarean, and said the woman "was very insistent that she be allowed to continue to try for a vaginal birth, which Ms. Franklin thought was reasonable at the time," according to the order.

"The committee is concerned that this is the second time in less than a year that Ms. Franklin has appeared before it regarding inappropriate treatment of a VBAC patient with rupture of membranes..." it states. "In both cases, Ms. Franklin failed to recognize and timely transfer these patients to a physician or hospital when circumstances indicated a midwife-assisted labor and delivery was no longer indicated and a higher level of care was necessitated for the safety of the patient and unborn infant."

In addition to the reprimand, the committee ordered that Franklin complete at least 12 hours of continuing education related to identifying and assessing high-risk pregnancies.

Franklin's treatment of this patient came over a month after she'd been reprimanded by the board of medicine for an incident involving another patient whose water had broken and who didn't seek hospital treatment for more than two days.

That patient was also attempting a vaginal birth after C-section, and she and Franklin misled hospital staff on how long it had been since the rupture of her membranes, according to Board of Medicine documents. The documents also state Franklin violated other regulations, including those related to disclosure to the patient.

The baby was born floppy via emergency cesarean, and needed resuscitation for respiratory distress, according to board records.

In that case, Franklin was ordered to obtain continuing education related to ethics, and her license was fully reinstated at the end of January, according to board documents.

According to Birth by Design Midwifery Services' website, Franklin is also a naturopathic doctor and a certified professional midwife.

"I have seen childbirth practices change and evolve over 35 years, always loving natural birth and concerned about the medical practices that interrupted this fragile physical miracle," Franklin states on the website.

"I believe our bodies were made to birth babies and that most healthy women can successfully birth with a midwife at home given the proper support, education, and experienced guidance. The parents are in charge of their birth. I am a silent observer and encourager, moving into their space only as they request or require. I love teaching couples about the usual childbirth practices, their risks and benefits, and encourage them to make their own decisions about the care they desire."

According to the site, Franklin also provides care at the NOVA Natural Birth Center in Chantilly.

Franklin did not return requests for comment.

2 Comments | Leave a comment

    I am mom of a 17 year old and am due for my second baby Oct 5th 2012. I believe mommies to be need to educate themselves..learn what signs of labor and signs of distress are. Take childbirthing classes. While the midwife is to blame..these women are too..at some point they to think to themselves..ok..this isnt working out an dhow is this affecting my unborn child..maybe its time to call 911 or get to a hospital asap. I did not choose a midwife for my 1st child and did not this time around..Im not educated on their uses..can someone help out with this one? Are midwives supposed to educate moms to be on when their time is up so to speak should there be complications? Im interested to hear from other mothers who chose a midwife or are currently using one.

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    To be honest this was not the midwife's choice. It was the mother's choice. You cannot force a medical treatment or surgery on a patient. Had I been the mom and been forced to have a c-section before, I would have gone for an unassisted birth and not worried one iota about a dr or midwife. Because dates are often wrong and gestation often needs to go beyond 40 or even 42 weeks, it is wrong and harmful to insist on an induction or c-section just because of dates. Babies born with meconium around them need medicine but that is all in most cases unless the child has a congenital issue. The midwife acted ethically and honestly she probably was the one who convinced the mom to go to the hospital otherwise that mother probably would have refused and stayed home.


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