Katharine McCall, Los Angeles Midwife, Gets Probation For Delivering Baby

LOS ANGELES -- Katharine McCall found herself in a tough spot over the Thanksgiving weekend four years ago as she tended to a woman in labor. The student midwife said she was unable to reach a licensed supervisor, so she did what anyone would do in that situation – she delivered the baby.

Her actions and her intentions were contested in a criminal case that concluded Friday in a Los Angeles courtroom, where a judge sentenced McCall to three years of probation. The case raised questions about the practice of midwifery and whether state officials were too aggressive in filing charges against her.

Midwifery has been controversial in the United States because some physicians believe it's unsafe. Ten states prohibit the profession, according to Midwives Alliance of North America. The advocacy group estimates more than 8,000 midwives practice in the U.S.

Brietta Clark, a professor at Loyola Law School, said there's a movement among mothers who want to give birth outside of hospitals. She said she understood why McCall was charged, because the medical board wants to ensure people are receiving safe services and advised properly.

"People don't have a good sense of what complications there may be," Clark said. "The licensing of midwives makes sure people are trained to respect the holistic aspect while having a trained eye."

In McCall's case, a complaint was made to the California Medical Board about a November 2007 delivery in which the baby's shoulder was stuck and the mother suffered a vaginal tear. Although the mother and baby recovered fully, McCall was charged and found guilty last month of one count of practicing medicine without a license.

Superior Court Judge Stephen Marcus said while McCall used very poor judgment and she appeared to be motivated by money, she has had no problems with any other births since she received her license last year.

"Delivering babies is a serious business," Marcus said. "I don't accept that Ms. McCall had a right or an obligation to deliver a baby without a licensed midwife there."

McCall had faced up to three years in state prison, and prosecutors indicated to Marcus they initially were seeking a 16-month term. After consulting with a supervisor, Deputy District Attorney Hubert Yun sought a reduced sentence in which she would serve time in jail and perform community service.

Yun contended McCall never intended to have a licensed midwife deliver the baby and even bragged upon arriving at the pregnant woman's house that she had helped deliver another child without anyone's help.

"She never took responsibility in this case," Yun said. "She has no remorse, your honor. She put two lives at risk during this delivery."

McCall's attorney, Stephen Demik, argued his client tried to get the pregnant woman to go to the hospital when hemorrhaging occurred during the delivery, but that she refused.

Demik, who took the case pro bono, said McCall should have never been charged with a crime.

"This should have been handled administratively" by the state medical board, Demik said.

McCall had a legion of supporters at the sentencing, where the judge noted he received about 25 letters in favor of a noncustodial sentence. A website also was created to support McCall.

After the sentencing, McCall received hugs and well-wishes.

"I am very much relieved," she said.

Her mother, Ellen Gross, said she learned a lot about the legal system during her daughter's case.

"It's made up of laws that are unclear, unfair and misunderstood," Gross said. "I think it's the best possible outcome we could have hoped for."

In addition to probation, McCall must perform 280 hours of community service, pay $10,000 restitution to the medical board and can no longer practice midwifery per the judge's order.

The judge does not have the authority to revoke McCall's medical license. But with McCall's felony conviction, revocation was likely after a future review before the state medical board.

Marcus said he will consider reducing the felony conviction to a misdemeanor if McCall meets the conditions of her probation. That would allow McCall to resume midwifery.

"I hope this ends up working out for you," the judge told McCall. "I hope you get your license back."

Comments

[Tumerica]

07:20 PM on 10/13/2011

I keep thinking about this--if someone is trained in CPR and a person is dying of a heart attack right in front of them, should the CPR-trainee--who is not medically LICENSED--let the heart attack victim die? Same for someone drowning--do you refuse to save them because you don't have a life-guard's license? Or a child is choking in front of you--you know how to do the Heimlich maneuver but you don't have a license to practice it? Do you let the kid die? I tell you, mothers save their kids' lives all the time during life-threatening situations (my mother saved me from choking to death on a grape--true story!). Do all mothers need licenses? There is something INSIDIOUS about that ruling. Just completely wrong!

[Marge McNaught]

08:02 PM on 10/09/2011

If anyone is interested in helping to fix the systems that allowed this travesty to happen to Katie, please go to www.supportmidwifekatiemccall.com and see ways you can help.

[pklspy]

06:46 AM on 09/24/2011

I may be considered cold and cruel for this, but if it's done at home without a team of professionals, and someone dies, isn't that natural? Maybe it wasn't supposed to happen?
Why do humans have such difficulty giving birth compared to other mammals? Maybe because humans have intervened thus destroying the natural process that would have eliminated women who cannot reproduce normally. And using science to impregnate women who cannot do so naturally. Nature is saying these women should not have offspring, but they do it anyway. Nature and the process of sexual reproduction has created incredible life forms, virtually all life you see, but this would not have been possible if those meant to be removed from the gene pool are instead passing those genes along. If someone had been there throughout history to "help" our primitive mammalian ancestors give birth and saved those meant to die, we would not exist. We all know how dangerous it is to tinker with something we know little about, yet here we are playing God with the most complex system known.
Also our numbers are well past the limits of what our environment can support, yet here we are trying our best to make more people, like it's a game.
The bottom line of these problems is greed and selfishness. People care about nothing but themselves and what they want. They may deny it, but in the end it's all about themselves.

[vlynnieg]

06:48 AM on 09/20/2011

I just want to comment on the sheer volume of comments and overall tone. I notice people on one side demonizing doctors and hospitals like they're the boogeymen out to get poor unsuspecting women and their babies. I see people on the other side of the fence painting a disaster-waiting -to -happen picture on home birth. Both can be a safe and rewarding experience for a mother/family. Both have the potential for things to go horribly wrong. It's two different care models, but both have people dedicated to the mother and child and a good outcome. I don't know a single midwife, OB, or labor nurse that isn't in if for the right reasons. I love my patients, and they trust me and I am careful to live up to that trust every day. It pains me to see some of the hateful and hurtful comments some people have made on here! About midwives and about OBs. (and, yes, even about us nurses, too) Breaks my heart. You talk to ANY of my patients before you say anything about me or thye care I give, and you'll see.

[pklspy]

06:41 AM on 09/24/2011

You are probably right about most of that, but the bottom line in medicine is nothing other than money. If this woman is part of a trend that will take money away from the system, then you bet they'll be against it and use the word "safety" to get their way.

[HudsonSpeaks]

05:08 PM on 09/29/2011

I will only partially agree. Certainly a lot of doctors went into that profession for the financial benefits, and NO midwives that I know of do that...there is no money in it. BUT that doesn't mean that all doctors are money grubbers, who care nothing for their patients. There are good and bad doctors, nurses, midwives, teachers, bus drivers, etc. etc.

Of course "systems" with financial interests often will react this way to the possibility of losing income, hence the assault on many forms of alternative living, be it home birth, raw milk, homeschooling, farmer's markets, etc. But history shows that MORE options and education and understanding will do nothing but help all types of care or life choices to have better outcomes, both medically and socially. VLYNNIEG has the right attitude...live and let live, with full knowledge and informed consent. We are all on this planet together, let's talk about our differing opinions, rather than spewing hatred at each other. :)

[Marge McNaught]

08:00 PM on 10/09/2011

I agree with you. Katie's grandfather was a general surgeon and an amazingly humble and generous man. I know this because he was my father. I remember the IRS auditing him 3 years in a row because they didn't believe how much he and my mother donated to charitable purposes. I know Katie gets her compassion for helping others medically from his genes. I can't speak to other people's experiences, but it seemed to me that Katie's situation arose from a ridiculous District Attorney decision to prosecute her. Compare that to the situation with New York DA Cyrus Vance who recently made a decision to not prosecute a case he felt was unjust, despite pollitical heat he would face.

[Birdie]

02:11 PM on 09/19/2011

I can hardly believe this outcome! Was there an alternative course of action other than for the midwife to walk out the door when it became evident there was a problem with the baby's shoulder getting stuck. Is this what the judge would have wanted her to do? I seriously doubt it. What a travesty of justice.

[roald]

01:15 PM on 09/21/2011

The alternative course of action was to ensure that she had a licensed midwife in the room with her.

[Marge McNaught]

07:52 PM on 10/09/2011

I am Katie's aunt, so am somewhat familiar with the case. A licensed midwife was lined up to be there, but had another client go into labor so couldn't come. Katie tried to contact other midwives, but it was Thanksgiving weekend and she couldn't reach anyone.

[Bonnie B Matheson]

02:02 PM on 09/19/2011

No one has a right to tell a mother where to give birth. NO ONE SHOULD HAVE THE RIGHT TO TELL HER WHO SHE CAN HAVE WITH HER TO HELP HER.

Childbirth is NOT an illness. It is NOT medicine. Even if there is a problem that does not require a C-section, it is not really medicine. Repairs to tears, are more like mending one's torn clothes. (and you don't need a plastic surgeon to sew up a tear, even an artery.)

Getting that babies shoulder "unstuck" was a procedure that saved it's life. But it is also a procedure that can be learned just as people who are NOT DOCTORS are taught lifesaving CPR. Would you sue me if I tried to resuscitate a dying heart attack victim and SUCCEEDED?

I hope that women will start suing hospitals for traumatizing them at their births. (Not really, ‘cause I HATE litigious people) It would serve them right. So many women have horror stories about the way they were treated, and often it is YEARS before they can even talk about it.

Katie should be getting a hero’s congratulations not a lot of ignorant, snide comments about doing it for money. Believe me NO ONE goes into midwifery for the money. She stayed when she KNEW it was getting dicy because she is a helper by "Vocation" not because she was being well paid. She is a midwife to her core.

This witch hunt is outrageous.

[vlynnieg]

08:17 AM on 09/21/2011

I really have to address a small part of your comment that reallybothers me, "Repairs to tears, are more like mending one's torn clothes. (and you don't need a plastic surgeon to sew up a tear, even an artery.)". Many women are very self-conscious about how they look down there. In addition to that, if there is a nerve-ending left exposed, it can be quite painful. I know this first-hand. I'm talking pain all day/every day for 5 1/2 years from after delivering my first son until I delivered my second son and my doctor corrected it for me. Pain-free ever since and SO thankful!

[Bonnie B Matheson]

01:51 PM on 09/19/2011

Katie saved the woman and the baby. PERIOD. The mother did NOT want to go to the hospital. She had a right to refuse "transport". Do you have any idea of the distaste many women feel for the medical model of care when it comes to birthing babies? They are terrified of the hospital's rules and time tables and fear of Insurance company led "protocols". Doctors are so scared of lawsuits that some have 60 or 70% C-section rate. No wonder women fear getting into their clutches.

There is a lot of ignorance about birth in evidence in the comments here. Obviously some of these people got their information from TV shows about birth rather than hands on experience. Midwives become experienced by "doing". Katie did have a preceptor who could not come. Some of you have acted as if she never meant to have help, yet I believe that it was just a coincidence that the other midwife was busy. Recently I was asked to come help a midwife when my daughter in law gave birth at home to her 4th child. The second Midwife had to leave suddenly because another client was having a baby right at the same time.

This sort of thing happens. Home births are not induced at a convenient time for the care providers. (like hospital births are) In fact home births are not induced at all. So sometimes they double up with more than one birth happening simultaneously. It happens.

[roald]

01:17 PM on 09/21/2011

She should have had a fully trained midwife there with her. That might have led to a different outcome, though we will never know.

[jrd8]

10:45 AM on 09/30/2011

While this comment may be relevant when a student midwife has poor outcomes, it is completely irrelevant to this case. This student midwife handled TWO obstetric emergencies, with a healthy mom and baby as the outcome. I'll spell it out for you: The outcomes in this case ARE GOOD OUTCOMES. Perineal tears are incredibly common and happen in many circumstances, and in many instances do not need sutures.

Shoulder dystocia and maternal hemorrhage are not complications that are prevented by how skilled providers are, they are complications that are managed either effectively or ineffectively, and in this case, they were managed effectively. To punish someone for handling these emergencies well makes no sense, especially since the mother refused to transfer to the hospital.

What would you do in her situation? Would you leave a laboring mom at home and say "Too bad" later when you heard her baby died or had a major nerve injury or brain damage because of a shoulder dystocia that didn't get managed properly? Or when you heard the mom hemorrhaged enough to go into shock and need blood transfusions or possibly not make it to the hospital in time to save her life? These are the things that DIDN'T HAPPEN because Katie McCall stayed with this family when they refused to go to the hospital.

[pattio66]

12:43 PM on 09/19/2011

Sheesh, how did the human race survive all these millennia without licensed medical professionals in sterile environments delivering all the babies? I'm not a licensed medical anything, but if I saw a woman on the street with a baby crowning, I'd stop to help out. Sure, I could be sued, fined, incarcerated, whatever, but at least I'd be human. What I'm reading between the lines here is that neither a hospital nor a doctor was able to cash in on this most natural of processes and medibusiness wants their money!

[Conuly]

01:50 PM on 09/19/2011

In fairness, all those millennia, lots of women and babies died. Of those that didn't, many of them sustained serious injuries in birth, ranging from dislocated limbs and lack of oxygen for babies to tearing leading to chronic and permanent incontinence for the mothers.

[choriza]

04:30 PM on 09/19/2011

In fairness, are you saying lots women and babies don't die now? That no women today sustain serious injuries at birth? I'd love to see those stats!

Maybe the injuries aren't the same as they were "before" but that doesn't mean birth injuries no longer exist.

The tearing is inconsequential as a tear can be sutured up, and we know how to exercise the pelvic floor muscles to help relieve incontinence. Midwife attendance of a birth at home or in a hospital has no bearing on the tearing. And what about episiotomies, anyway?

[kelly darrah]

10:03 AM on 09/19/2011

Taxi cab drivers deliver babies and are considered heroes. Katie attended the birth of my son and is a more than competent person to "catch" a baby. During my son's birth, the midwive' who I originally hired' turned her phone off and could not be reached. Katie had to call in a different midwife to catch my baby. Fortunately' there was one nearby who was able to get there in time. These things happen. If a midwife was not able to be found I would have refused to go to the hospital too. People who believe in home births and midwifery don't want to go to the hospital, that's the whole point. This was not the case of a money hungry criminal, as that lawyer put it. Katie is a caring passionate woman who is damn good at what she does. How is it right to take away someone's livelihood, and slap her with felony? What good is going to come from that? If they are calling it poor judment, then what is the punishment for that? How can they charge her with practicing medicine without a license? That's what they say about those nuts who do plastic surgery on people without a degree. Katie is not one of those people. She has atteneded more births than an OB med student. This is heartbreaking. It really is. It's a sad display of our government at work. Go after real criminals. Katie is a hero in my eyes.

[Elizabeth Allemann]

08:56 AM on 09/19/2011

The most basic human right a woman has is to choose the place she give birth and to choose her attendant. All women in this country know that they can go to the hospital to have a baby. This woman made another choice. She asked Ms. McCall to help her. Ms. McCall did. Helping a woman in childbirth is the most intrinsically noble act known to humans. The state has no business in the bedroom. Charging, trying, and sentencing Ms. McCall is an outrage and reflects to power that organized medicine has in our country and our world. Under current law, Ms. McCall will never regain her license to practice midwifery in California and has lost her ability to support herself and her two children--all because she helped a woman at a most vulnerable time, and possibly provided life-saving skills. The only ones to profit from this sentence are physicians and hospitals who are feeling threatened by the competition that home birth presents to them. Since the time of Moses, midwives have stood up for women and babies and been punished by governments for this outrage.

[irishdoc]

02:55 AM on 09/19/2011

There is a concerted effort to convince women that home birth is safe and without tragic consequences. It has only through the concerted efforts of web sites like "hurtby homebirth" that women are able to see what can really go wrong during one of these home births.
Make no bones about it, I am an MD. I don't deliver babies. However, I will never forget the day that a birthing center disaster arrived in my ER and I had to get involved trying to keep a woman from bleeding to death. The midwife not only didn't accompany the woman, but HUNG UP on me when I called to find out how much blood was lost in the field and what had been done prior to arrival. I stood by that woman's bedside watching her vitals, waiting, and waiting, and waiting for OB to get out of the C-section they were scrubbed into so that they could take my patient. And I have to wait for the eventual lawsuit, since her midwife didn't carry malpractice insurance, that will threaten my license and livelihood and put my children's futures at risk.
So when I hear about some arrogant STUDENT who thinks they know it all and has no idea of how bad things can get in a delivery, I say throw the book at her. Because she isn't just risking the mother and the baby, she is forcing the EMT's, nurses and doctors to clean up her mess.

[ArtiesMama]

08:02 AM on 09/19/2011

Hi Amy.

[Elizabeth Allemann]

09:00 AM on 09/19/2011

I am a physician. I have attended births at home, in birth centers, and in hospitals. The evidence is clear: all are equivalent as far as survival of the mother and the baby go. But if you want to look at cesarean section rates, breastfeeding rates, and the mother's satisfaction with the birth, out of hospital wins hands down. In one Canadian study, post partum hemorrhage was rarer at home than in the hospital. With great compassion for you, handling a life-threatening emergency beyond your skills, I would invite you to open your heart and look at the research. Elizabeth Allemann, MD

[Eleanor of Aquitaine]

03:34 PM on 09/19/2011

This is purely a legal issue, not a medical one. There are laws. As a doctor I assume you are smart enough to know the difference between a cab driver or police office happening upon a birth and having to deliver in an emergent situation and an unlicensed student midwife, arranged ahead of time, charging a fee to deliver a baby even though the necessary licensed midwife was not coming. There was time to call for help and while she asked the parents to let her call for help - and they refused. She had a legal responsibility to call for an ambulance anyway when it was clear she could not legally deliver the baby without oversight.

Yes, she helped the parents. I'm glad she stayed. Yes an ambulance was eventually called AFTER it was all over, and that was obviously taken into consideration by the judge who did not put her in jail. Legally, that should have been her first call after the licensed midwife couldn't make it, then none of this would have happened to her.

[JanieneMB]

12:33 AM on 09/19/2011

My husband and I decided that on our third child we wanted to labor and deliver at home. We birthed a healthy perfect baby girl with Katie as our midwife. Katie offered such amazing support and afterbirth care. She made sure I had an OB and that I went to my OB visits for the length of my pregnancy. I was registered at a hospital to deliver should any signs of labor show that I needed to be transported. We felt so safe, confident and comfortable in her care. She is a phenomenal midwife. Before you judge a person through an opinion you have after reading one article, make sure you have all the facts and a good understanding of someones character. She should absolutely get her license back. The judge, after all was said and reviewed, gave her his best wishes that she would one day be able to return to her profession of midwifery. The sad outcome of this sentence and conviction is that she will never be able to practice midwifery again. She worked over a decade to get her license and the same board that knew about this birth and then gave her a license is going to take it away! Speak up people! She is an incredible midwife and I would ask her to be my midwife again and again.......LET HER KEEP HER LICENSE!!!!!

[Justine Arian]

12:05 AM on 09/19/2011

I know Katie personally and it saddens me to know that a person of her integrity, compassion and ability would lose the opportunity to do her life's work because of a ridiculous complaint, which did not come from the parents. The outcome of this birth was positive primarily due to Katie's knowledge and skills. I agree that she put herself in a tough situation but I know that it was due to her commitment to serving moms and babies. Katie did what she thought was the right thing to do and because of that the outcome was good. She is very skilled, committed and has earned her license since this event occurred so she should be able to keep her license. Horrific outcomes happen in hospitals all the time under MD care with no criminal charges or media attention brought to them. This case was unnecessary in my opinion. I honestly don't think it's going to change the way midwives practice, it only serves to put negative light on home birth and midwifery care. At least it's opening a dialogue.

[vlynnieg]

12:36 PM on 09/18/2011

What worries me about home birthing is that sure 9/10 babies just meed suction and tactile stimulation (rub them dry and use the bulb syringe), 1/10 need more. Now, 9/10 of those that need more, usually just need a little blowby (put an oxygen flow in front of their nose/mouth area) and they're fine. It's that 1/10 of that 1/10 (in other words, 1/100) that need more, a LOT more. If they need deep suction for example if they aspirated meconium, or if they need actual NRP (neonatal resuscitation) including bag and mask ventilation, how is this prepared for at home? Before I do even the first push, I've got my O2 and suction ON: better to have it and not need it than need it and not have it. Every second counts when it comes to newborns.

[Ellen Gross]

11:20 PM on 09/18/2011

NRP IS done at home. Perhaps if you educate yourself a bit more on what midwives do in homebirth, or even attended a few homebirths, you would see what the safety preparations are. Or better yet, take a look at the largest study to date: http://www.bmj.com/content/330/7505/1416.full

[vlynnieg]

06:25 AM on 09/19/2011

That's what I wanted to know. Like I said: it's better to have it and not need it than need it and not have it.

[ArtiesMama]

08:03 AM on 09/19/2011

Btw, there's no need to use a bulb syringe at all, in 9/10 births. Most homebirth MWs know better than that, thankfully!!!!! For my homebirth, I birthed my baby into my own hands, brought him to my chest and no one else even touched him. There were no syringes shoved into his nose or mouth and no one rubbed him. The normal physiological process is best.

[vlynnieg]

10:53 PM on 09/19/2011

That's great. Evidence based practice shows that babies lose their body heat faster when they are wet. Rubbing them dry is great to stimulate them, and to help them maintain normal body temperature. Cold shock is very bad for newborns, ask your midwife, she'll agree.

[hatenomor]

11:44 AM on 09/18/2011

Another example of liberal big brotherism. If big brother doesn't approve, you go to jail.