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Terms lifted on midwife's license to practice

By Sally Voth -- svoth@nvdaily.com

The Virginia Board of Medicine has lifted the conditions placed on the license of a licensed midwife it had reprimanded in January.

Lori L. Orme, of Warrenton, was reprimanded Jan. 23, and ordered to complete eight hours of continuing education regarding diagnosing and managing gestational diabetes, according to an order from the Board of Medicine.

That order came after the board looked into the cases of two of Orme's patients, one of whose baby died, according to online board documents.

Documents state Orme took on a 25-year-old obese patient 12 weeks into pregnancy, and didn't recognize the risks that could come accompany a home birth in her case. They state the woman refused to be weighed throughout the pregnancy or to be tested for glucose tolerance.

Orme told the board that she had asked the woman to weigh herself, and the patient wouldn't because she said that would be too stressful, according to the board order. She also counseled her on diet and the risks of developing gestational diabetes.

When the woman's water broke, she called Orme and said the fluid was miscolored, according to the order, and the midwife "failed to appropriately consider that such fluid was highly suggestive of old meconium, indicating that the fetus might be compromised or require intervention that could not be provided in a homebirth setting."

About two hours after the patient started pushing, fetal distress was noted, according to the order.

It states the woman had a "difficult emergency Cesarean section." The baby did not survive.

"Ms. Orme said she has learned a great deal from this experience and has read many studies about meconium," the order states.

In the other case, Orme took over the care of a 39-weeks' pregnant woman from another midwife. That woman had previously had two C-sections, and a surgical report from the second said she wasn't to labor in subsequent pregnancies due to a thin "uterine segment that separated into a self-incision at the physician's touch," the order states.

It states Orme was aware of a document from another obstetrician that stated the patient would require "repeat [C-section] at 36-37 weeks, cannot labor!"

Orme told the board that she "felt comfortable supporting the decision of [the other midwife] to proceed with an at home birth, as this was Patient B's choice," the order states. "Ms. Orme felt that she was complying with the midwifery model of care in honoring Patient B's decision..."

That patient, who ended up having an emergency C-section, also suffered a uterine rupture, and her baby's lower body protruded from her uterus into her abdomen, according to the order.

The board received verification that Orme had complied with its order, and on Wednesday had its record reflect that she has a full and unrestricted license, according to online documents.

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