Friday, September 19, 2008

CPM presides over 2 separate deaths in 6 weeks

A Virginia CPM was suspended from practice last week concluding that she posed a "substantial danger to public health or safety. She presided over, and appears to be responsible for, not one, but two separate neonatal deaths in a 6 week period.

The midwife made so many egregious errors during the care of both mothers, that they can't possibly fit into one post. The evidence presented at her suspension hearing is chilling. Regarding Patient A:
... Ms. Zittle did not perform a vaginal examination of Patient A until ... approximately six hours after contractions began and approximately 27 hours after the spontaneous rupture of membranes, at which time Ms. Zittle incorrectly identified the presence of a nuchal hand.

Although a vaginal examination at 5:02 a.m. ... revealed Patient A to be 8 centimeters dilated with the foot, thigh, and shin of the left foot presenting, Ms. Zittle ... did not transfer Patient A to the hospital. Even though Ms. Zittle had never before performed a breech delivery, she opted to continue with a home delivery ..

Delivery of Patient A's infant began at approximately 6:06 a.m., when the left foot delivered... Ms. Zittle ... did not physically intervene to assist the delivery of the infant until approximately 6:35 a.m., when the pulsating umbilicus emerged and Ms. Zittle used her right hand to prevent cord compression. The infant's buttocks emerged at 6:22 a.m. and by 6:38 a.m. the chest, only to the nipple line, had cleared the cervix. Although Ms. Zittle subsequently noted that the umbilical pulse was getting weaker and, at 6:40 a.m., documented the absence of a fetal heart rate, she did not initiate a 911 call until after the infant was born at 6:42 a.m. in a lifeless condition... Ms. Zittle immediately began performing Delee suction of the mouth, then nose, and began performing CPR, which she had never performed before on an infant.

An autopsy on Patient A's infant revealed that the liver had ruptured, spilling 55 cc's of blood into the abdomen, and also that the infant was positive for Group B strep infection. The Medical Examiner who performed the autopsy stated that the condition of the liver indicated that the infant had been breech for some time; that the rupture had developed over time, most likely from being pressed against Patient A's hard pelvic floor; and that "a c-section would have been life saving in this case."
Patient B, expecting her 3rd child:
Ms. Zittle failed to respond in a timely fashion to ... the intensification [of patient's contractions] around 10:O0 p.m. on June 9, 2008, in that she did not leave to go to Patient B's home to attend her labor and delivery until approximately 12:34 a.m. ... notwithstanding the 45-50 minute drive anticipated to Patient B's home and the fact that Patient B was located approximately 17 miles from the nearest hospital and lacked transportation at that time...

En route to Patient B's home, after Ms. Zittle was aware that Patient B was in the midst of a footling breech delivery, EMT personnel informed Ms. Zittle by telephone that Patient B's infant had been delivered up to the chest but they were unable to further deliver the infant. Notwithstanding this information, Ms. Zittle instructed EMT personnel not to take Patient B to the hospital, but instead to assist Patient B in delivering her infant at home in the birthing tub. Ms. Zittle also instructed EMT personnel to wait for her arrival, estimated to be approximately 30 minutes later, before transporting Patient B to the hospital.

After transport to the emergency room by EMS, at approximately 1:37 a.m. ..., Patient B delivered an infant with a distended abdomen and without respiration, color, movement, or a heartbeat, who was pronounced dead... The cause of death listed on the death certificate was umbilical cord entanglement and compression subsequent to breech delivery.
This midwife is still advertising her services on her own website, although she claims she is available only as a monitrice despite her status as a certified midwife.


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