Baby Daxton was born at the Carolina Community Maternity Center in January 2015 and died the same day. I have worded this account based on notes I took during midwife Christine Strothers’ testimony at the coroner’s inquest. It tells the story of Daxton’s birth and death from her perspective based exclusively on her sworn testimony, the exact wording of which is a matter of public record. Once the transcripts are available to the public, anyone who wishes to will be welcome to check the veracity of my version. I am carefully avoiding exact quotes and any manipulation of content because I know that my best defense against libel is that everything here is a true and accurate representation. Anything in brackets is my clarification or commentary.
Christine Strothers’ sworn testimony, summarized in detail:
M.G. [Daxton’s mother] had a very straightforward pregnancy with no problems. Christine opted to use the due date from the 5-week ultrasound, saying that a very early ultrasound is more accurate for dating purposes than the LMP (last menstrual period) due date.
M.G. had a prenatal appointment with Christine on the 19th, during which all the typical assessments were done plus a cervical exam, and everything seemed normal. Christine advised M.G. to go to a physician for a biophysical profile [a special ultrasound to assess fetal wellbeing] at 41 weeks, and the appointment was made for the next day, the 20th, to see Dr. Leslie Brown in Monroe, NC.
[Note: this appointment was made for 41 weeks using the ultrasound due date; it would have been 42 weeks by the LMP due date.]
The coroner asked if Christine and M.G. had discussed the possibility of an alternative birth location if she didn’t go into labor by 42 weeks, and Christine replied that yes, they had. Christine explained that birth center guidelines don’t allow for birth center birth after a 42-week consult with a doctor, even if the doctor said everything was fine. However, the midwifery regulations do not preclude a home birth after a favorable 42-week doctor consult.
The coroner asked Christine why the birth center regulations required that women be between 37 and 42 weeks gestation in order to have their babies in the center and if there were any risks to the infant being outside of that range. Christine replied that when babies are born before 37 weeks they could have respiratory problems.
[Note: There are also risks to approaching or going past 42 weeks gestation. Christine did not address them despite the fact that Daxton’s complications are classic examples of those risks.]
M.G. arrived at the birth center at about 2am [January 20th]. She needed to relax because the car ride had been difficult for her, so Christine put her in the tub. Christine conducted a vaginal exam after M.G. got in the birth tub, and she was about 5-6 centimeters dilated. When the coroner asked why Christine put Megan in the tub, Christine explained that a lot of moms want to labor in the water to help them to relax, and some people think that the water makes for a calmer environment for the baby.
The coroner asked if Christine was ever concerned about the baby’s heartbeat. Christine explained that shortly after M.G. got in the tub, Christine attempted to listen to heart tones using a waterproof Doppler. She was trying to listen “through” a contraction [unclear if this means “during” or “for the duration of” in this context] and M.G. was moving around, and the water against the transducer was making a lot of noise. Christine asked M.G. to try to be still so she could hear, and once she held still, Christine could hear the heart tones well.
The coroner asked how often Christine generally listens to heart tones, and she replied that she generally listens every 30 minutes during the first stage of labor and every 15 minutes, or more often, during pushing. When asked how long she listens for, Christine said that it depends on how long she has before another contraction starts, but that she listens long enough to feel like she’s got a good read on it.
Christine testified that she thought M.G.’s water had broken in the tub because she noticed a flow of fluid, blood, and vernix in the water, which she fished out of the water with a fish net. When the coroner asked if she noticed any discoloration to the water, Christine clarified that the tubs are white, so it would be easy to see if the water was discolored, and she inspected the water with a flashlight and it was not discolored. Christine also explained that when M.G. first came in, Christine could feel a bulging bag of waters in front of the baby’s head when she conducted a vaginal exam, but after her water broke in the tub, Christine could no longer feel that.
Christine recalled that it was primarily her decision to get M.G. out of the tub. When asked why, Christine explained that M.G. had been in the tub for a while and Christine wanted her to empty her bladder on the toilet and thought she might have a better urge to push outside of the tub.
The coroner noted that in the chart, from time to time, there is a note that says something like “20 seconds after contraction accels noted,” [“accels” are short for accelerations of the fetal heart rate] but the chart never notes any decels [decelerations], and asked if this was normal. Christine replied that you would not usually hear decels during the first stage of labor, but in the pushing phase you could expect to hear some decels due to head compression. She explained that the midwives did hear one or more decels right when Daxton was about to be born, but they were not of any concern.
M.G. started pushing a little bit when she got on the bed, but it took her a while to get the hang of pushing, and she wasn’t really pushing in earnest for that entire time.
[Note: midwives often purposely underestimate a mother’s pushing efforts early in the second stage to avoid having to chart a prolonged pushing phase, because prolonged pushing is an indication for transport to a hospital. Generally speaking, over two hours of pushing is considered prolonged.]
The coroner asked why M.G. was put on oxygen. Christine replied that M.G. had been pushing and was making good progress, but she said she was feeling lightheaded, was not really hyperventilating but doing that type of breathing, and seemed agitated. Christine reported that another midwife in the room [either Lori Gibson or apprentice Stacy Gunter] suggested oxygen might help her feel better, so Christine said, “Sure.” They also got M.G. some food and gave her some fluids [by mouth]. When the coroner asked if it is routine to give oxygen as a comfort measure, Christine replied that it isn’t routine but also isn’t out of the ordinary, and that she also sometimes uses it when moms feel lightheaded after birth.
[Note: I don’t remember ever applying oxygen postpartum or seeing it done by any other midwife.]
The coroner said that at some point in her investigation someone said that M.G. was told, “The baby needs the oxygen,” and asked if Christine recalled that. She replied that no, she didn’t, and that nothing in the heart rate suggested that said baby needed more oxygen; if any midwife had said that, it was probably just to encourage the mom. Christine reiterated that there were no warning signs that the baby needed more oxygen and his heart rate was always very much in the normal range. The only time that the baby’s heartbeat went below 120 was when the baby was on the perineum [head showing], and it only went as low as 110, which is a very normal drop for when the baby’s head is being compressed.
The coroner asked why Christine had requested during the birth that the neonatal resuscitation bag and mask be placed close by, and Christine replied that it was just because it is good to be safe. The coroner asked if Christine remembered the statement, “We’ve got to get this baby out” being said during the birth, and Christine did not.
[Note: I have only heard this said in incredibly tense birth situations wherein the baby’s heart rate is of considerable concern.]
M.G. was on the bed pushing and the midwives were listening to the baby’s heartbeat between all contractions. Christine was helping the baby come through when the head came out and she noticed that the baby’s umbilical cord was around his neck. As Christine moved to unloop it, the rest of Daxton’s body started coming out with a lot of meconium. Christine put him on M.G. for a couple seconds to allow some fluid to drain out of his mouth.
There was a lot of old meconium all around Daxton. He was floppy and showed no effort to start breathing. Christine wiped him off and gave him some oxygen with the bag and mask. The midwives suctioned him with a bulb syringe, and a little while later also used a DeLee. They checked for his heart rate and a heartbeat was detected but was under 100 and not rising because he wasn’t breathing, so Christine began chest compressions and asked for 911 to be called. Lisa Johnson came in to help.
[Note: this portion of Christine’s testimony was a bit disorganized. I am not clear whether Daxton was suctioned with the bulb syringe before they started ventilating him with the bag and mask. I am under the impression that the DeLee suction was used later, after he had already been given breaths.]
Christine sent the birth center’s consulting physician a text after the birth and talked by phone some time later. M.G. later transported to the hospital because her placenta would not deliver.
The coroner asked Christine if there was anything else she wanted the jury to know, and she had nothing to add.
Please read Daxton’s Father Testifies for the dad’s perspective.
Read It Could Have Been Me for my first reaction to the jury’s decision of homicide.
UPDATE: This was not the first time Midwife Christine Strothers attended a postdates birth and failed to summon medical help in a timely fashion.
ACOG and the Society for MFM recommend early ultrasound for most accurate method of dating of a pregnancy. Was it only incorrect because a midwife did it?
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Method-for-Estimating-Due-Date
I agree that there are many things that were done incorrectly by the midwife and the birth center, but basing a due date on early ultrasound was not one of them. Including this detail becomes a distraction, and makes me wonder why the OB and MFM did not reference their own guidelines when testifying against this midwife.
I actually completely agree with you, Liz. This detail was focused on by the coroner and expert witnesses present, which is why I did include it. My personal opinion is that if there was a 5-week ultrasound date, there was nothing wrong with using that date. However, she was still 41 weeks by that ultrasound date anyway, and should have been treated with the extra caution due a 41-week pregnancy. That I think we can agree was not done. In addition, there is the question of why they seemingly waited until the end of her pregnancy to switch the date. If they felt it was so accurate, they should have used the ultrasound due date from the get-go, not waited until she went post-dates and then done so. If she had gone into labor at 37 weeks, which due date do you think they would have used?
To me, the problem is not that she used the ultrasound date, but that she changed the date at term. You date the pregnancy as early as you can with the most reliable information you have, and you stuck with it. Changing the date in the third trimester is not ok.
Yes, you’re exactly right, Kimberly.
I agree, she was subverting the standard of care throughout the entire pregnancy by not using the first trimester US date at the time of the ultrasound.
Of course, using the LMP would have placed the women at 37 weeks one week earlier. So had she gone into labor at 37 weeks by LMP – all would have been good to go for a midwife-attended birth.
Nope, too much slush, there. Highly unethical. She’s writing her own rules. Now that I understand that she changed this date during the last weeks of pregnancy – I can only shake my head. Horrible.
The MFM testified that his standard was to stick with the LMP unless the u/s date is more than ten days off. Since the u/s date was Jan 12, seven days different, he personally would not have changed the due date of Jan 5.
According to my notes he did mention that when the ultrasound is performed before 10 weeks, he sticks w/ LMP unless the date is more than 5 days off. Since it was 7 days off at 5 week ultrasound, this would have fallen within his guidelines.
OK, so wait a minute – the MFM makes his own guidelines?
Isn’t this what we are criticizing midwives of doing?
The position statement I linked to pretty clearly states that a first trimester ultrasound is the most accurate way to date a pregnancy.
” If ultrasound dating before 14 0/7 weeks of gestation differs by more than 7 days from LMP dating, the EDD should be changed to correspond with the ultrasound dating. Dating changes for smaller discrepancies are appropriate based on how early in the first trimester the ultrasound examination was performed and clinical assessment of the reliability of the LMP date (Table 1). For instance, before 9 0/7 weeks of gestation, a discrepancy of more than 5 days is an appropriate reason for changing the EDD.”
Let’s not get sucked into the idea that it’s ok for certain practitioners (MFMs, OBs) to invent their own guidelines. It’s not ok for midwives and it’s not ok for physicians.
I apologize, Leigh, your comment is correct. I was responding to the post saying that this MFM was saying the LMP was the most appropriate way to date this pregnancy. Which is confusing, and what has been reported in the media – but it is not correct.
Your notes are consistent with the ACOG/SMFM guidelines.
A five week ultrasound is not optimal for dating a pregnancy. There my not have been a fetal pole observable yet, and so dating might have been determined based on the gestational sac and a yolk sac, but no crown-length measurement and no fetal heart tones seen yet. An additional ultrasound at 7 weeks would have had all this information and would have dated the pregnancy much more accurately. I wonder why an ultrasound was done in the first place, if mom had a certain LMP, why do it?
It is painfully obvious that she is full of shit and is trying to cover her negligent ass. Even I, a layperson, can tell that what she says doesn’t add up. What a despicable person. I wish she could be sent to jail for her negligence, but I know that is wishful thinking.
Thank you for reading. It is painful, isn’t it?
Her use of oxygen was…. confusing, confounding, negligent, ignorant and completely inappropriate.
Do these midwives (one was an L&D RN?!!) not understand the physiology of oxygen administration, the indications for maternal oxygen administration during labor, and the possible effects (both good and bad!) of using oxygen?
What guidelines are they using? Oh, wait. There are no guidelines.
How can these people claim to be knowledgeable about anything?
And it is sad and tragic that people are duped into hiring these midwives as professional maternity care providers. Very, very sad.
Not to mention using positive pressure ventilation to force massive amounts of meconium into the baby’s lungs because you didn’t suction that out first. My heart weeps for this family, and other families with similar outcomes.
Traditionally, mec babies who are not vigorous are typically intubated and suctioned with an ET tube if mec is seen at or below the chords. The new 2015 NRP guidelines have changed this somewhat. But it seems that better use of NRP techniques could have been employed.