*Content warning: infant loss, birth trauma, medical trauma and neglect, death, pregnancy loss, mature content. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Gestational diabeteshttps://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339 Insights into the U.S. Maternal Mortality Crisis: An International Comparisonhttps://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison March of Dimeshttps://www.marchofdimes.org/peristats/about-us Maternal Mortality, A National Institutes of Health Pathways to Prevention Panel Reporthttps://pmc.ncbi.nlm.nih.gov/articles/PMC10863655/ Maternal Mortality Rates in the United States, 2022https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.pdf Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery Neonatal mortality is more than tripled at planned out-of-hospital births attended by direct-entry midwives. Grunebaum, Amos et al. American Journal of Obstetrics & Gynecology, Volume 222, Issue 1, S45. https://www.ajog.org/article/S0002-9378(19)31440-1/fulltext North American Registry of Midwives (NARM)https://narm.org/ Placental abruptionhttps://www.mayoclinic.org/diseases-conditions/placental-abruption/symptoms-causes/syc-20376458 Preeclampsiahttps://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745 Severe Maternal Morbidity and Mortality Among Indigenous Women in the United Stateshttps://pmc.ncbi.nlm.nih.gov/articles/PMC7012336/ State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ *SWW S22 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag’s original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookieboo See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Chapter 1: What is the focus of this season of Something Was Wrong?
This season is dedicated with love to Malik. This season on Something Was Wrong, we're investigating the maternal health care crisis in the United States and its impact on pregnant persons, infants, and their families. Survivors will be sharing harrowing stories of pregnancy and birth trauma, loss, and grief.
Through their experiences, it becomes clear that the system-wide inequities and ethical injustices have contributed to their trauma. Their experiences also mirror the nationwide systemic gaps. Currently, America has one of the highest, most alarming rates of maternal deaths among high-income countries, especially those who have high rates of healthcare spending.
Chapter 2: How serious is the maternal mortality crisis in the U.S.?
In 2022, the average maternal mortality rate in the US was 22 deaths per 100,000 live births. Black and indigenous women in the U.S. have even higher maternal mortality rates than other racial groups. In fact, in that same year, 2022, the maternal mortality rate for Black women was 49.5 deaths per 100,000 live births, more than double.
The steady increase in exponentially higher rates of maternal mortality in varied marginalized communities is a devastating sign of an inequitable medical landscape. And for pregnant persons, nearly two of three maternal deaths in the U.S. occur during the postpartum period, from delivery through the first 42 days that follow.
Many survivors you'll hear from this season were clients at the now-closed Origins Birth and Wellness Center, previously based in Dallas and Fort Worth, Texas. Their stories are sadly mirrored throughout the country by other survivors we've spoken to from various states that you'll hear from later in this season as well.
You'll also hear from many medical experts and researchers who are working daily to improve what they describe as a maternal health care crisis in the United States. According to the data from the Centers for Disease Control and Prevention, of the more than 400,000 out-of-hospital births attended by midwives in the last decade, nearly 60% involved direct-entry midwives.
A direct entry midwife is a midwife who becomes credentialed without first becoming a nurse, whereas certified nurse midwives, or CNMs, are registered nurses who have completed additional education and certification in midwifery.
Direct entry midwives tend to enter the field via midwifery schools or apprenticeships, and rarely collaborate with physicians or hospitals whose regulations fall under state guidelines. Meaning, the allowing of direct entry midwives to practice depends on the state.
Midwifery regulations are often established and overseen by state health departments, boards of nursing, or specific boards or agencies that are dedicated to regulating midwifery. In Texas, midwives are overseen by TDLR, or the Texas Department of Licensing and Regulation.
Some other things TDLR regulates, barbering and cosmetology, air conditioning and refrigeration, electrician licensing, driver education, massage therapy, boiler safety, elevator safety, auctioneering, and towing operators.
Because midwifery training standards and required education vary greatly state to state, there are deep inconsistencies in the birthing industry that leaves clients unaware of the potential risks involved. We are not here to demonize midwifery, birthing centers, hospitals, doctors, or home births.
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Chapter 3: What are the experiences of survivors at Origins Birth Center?
Chapter 4: What are the differences between direct entry midwives and certified nurse midwives?
Midwifery regulations are often established and overseen by state health departments, boards of nursing, or specific boards or agencies that are dedicated to regulating midwifery. In Texas, midwives are overseen by TDLR, or the Texas Department of Licensing and Regulation.
Some other things TDLR regulates, barbering and cosmetology, air conditioning and refrigeration, electrician licensing, driver education, massage therapy, boiler safety, elevator safety, auctioneering, and towing operators.
Because midwifery training standards and required education vary greatly state to state, there are deep inconsistencies in the birthing industry that leaves clients unaware of the potential risks involved. We are not here to demonize midwifery, birthing centers, hospitals, doctors, or home births.
We are, however, here to examine the places in which there is great concern for the safety of those states' citizens. We also aim to honor the experiences of the survivors that you'll hear bravely speak out this season. Pregnant persons, infants, and their families deserve to feel safe and secure no matter where or how they choose to give birth. I'm Tiffany Reese, and this is Something Was Wrong.
Thinking of me, you don't know me well Thinking of Until you die.
My name is Kristen. Me and my husband became pregnant in 2021. At the time, I wasn't one way or the other when it came to choosing a provider for my pregnancy. And honestly, when I was first looking for a provider, I wasn't really thinking about midwifery at all. I assumed that I would give birth in a hospital with an obstetrician. I didn't really even know that there was another option.
However, I was talking to a coworker who spoke about his wife's experience with a home birth midwife and how it was just a great experience, very easy. His wife recovered very quickly. I was like, okay, that's interesting. And then I was kind of looking into more personal how I wanted to birth, how I wanted to labor and deliver, and what I wanted my pregnancy to look like.
And I stumbled across what's coined now as natural birth or physiological birth. Ideally, I wanted to try to give birth without any pain management, things of that nature, just to give it a shot on my own. And when you begin to look into natural birth or physiological birth, you come across a lot of different types of content.
You come across bloggers, birth gurus and doulas and midwives and all these different types of accounts that talk about you don't need to give birth in a hospital. Historically speaking, women were built to birth. And so I started looking into more of how to quote unquote train for natural birth and delivery.
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Chapter 5: Why did Kristen choose Origins Birth Center for her pregnancy?
I do believe there is room for less hands-on intervention and to allow what is normally considered a natural process to happen under expert guidance and supervision to be safe keepers if things do go wrong. And I think America as a whole needs more of that in their awards. We need more respect for women's autonomy.
We need to allow women to make choices for themselves by giving them the safest options available to them and talking to them in ways that to help them understand the situations that they're in. Because oftentimes I see women who have gone through birth trauma, which occurs to more than you would think. And it was through an intervention that was necessary, but no one explained what was happening.
No one was holding her hand while these things were happening and telling her, this is what we need to do to keep you safe. This is how we're going to do it. Can we do this? The way that we talk to women inside of hospital rooms when they're giving birth can be at times dehumanizing. We forget about the woman and
focus solely on the safety of the baby, which more or less this is what this is about, but it is about the whole. It is about mother and the baby and how they begin to come apart and how we treat her in this process is going to affect everything about the mother that she is.
And that is kind of the key point of what drives me to tell my story because this misunderstanding and this mistreatment of women is not just happening in hospitals. It happens in out-of-hospital births, and I think that there is a lack of discussion with inside of the midwifery community about what can we be doing to bridge the gap, closing the parameters of risk.
That is what I'm hoping to incite here, is that I believe in this process. I really do. But I believe in it when it's done safely, when it's done ethically, and when it's done in a way that gives the woman that is taking these services in a way that allows her to see the full picture.
that isn't swaying her one direction or another is laying out the risk and really letting her understand and decide those things for herself. So that's really what I'm hoping to get here. In no way am I trying to discriminate against the midwifery community or signal that there needs to be an end of midwifery in the United States. What I'm trying to wave here is a red flag that says we need help.
This field needs help. There's a quote out there that says, at some point, we need to stop pulling people out of the river and travel upstream and discover why they're falling in the first place.
And I think that's what we need to do as a community, as a whole, as consumers and as midwives, is we need to start looking at why people are falling in the river in the first place and not just writing it off. We cannot write off these instances. For the most part, The community tries to focus on the good because mostly good happens. Mostly pregnancy and delivery go normally.
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Chapter 6: What concerns exist regarding midwifery regulations in Texas?
And I don't mean like the typical run-of-the-mill anxiety of, are they safe? The kind of anxiety I'm talking about is gripping. It is a direct fear of death. It is all-encompassing. It is an entire visceral feeling of my child is going to die at any moment. And that is something that is not normal. It is something that was done to me, how my body responds because of what happened to us.
And what happened to us was preventable. Several points within my care, my providers could have said, oh, hey, something is not right here. We want to make sure you're getting the best care that you can receive. And we want to refer you to an OBGYN to get checked out for more testing because the signs that you're presenting to us is outside of our scope.
There would have been nothing wrong with them saying that to me, and I would have had so much love and respect for them if that is what they chose to do, but they didn't for whatever reasons. Maybe they thought they could handle it. We could speculate all day long about the why, but reality is, they didn't. No matter what the reason, they didn't. Choices like that cost people everything.
Licensed or direct entry midwives, they are regulated by completely different systems than certified nurse midwives or even certified midwives, which certified midwives don't practice in the state of Texas. But either of those groups are regulated by vastly different foundations with vastly different ethical and clinical standards.
Direct entry midwives are nationally overseen by the North American Registry of Midwives, which is a institute or foundation for certified professional midwives. They suggest that direct entry midwives should decide on their own standards for care. So what that means to me is that let's say I'm a midwife and I won't take on anyone who has preeclampsia because preeclampsia is high risk.
So if I suspect that my client has preeclampsia, I will refer them out to an OBGYN. That doesn't stop midwife Jane over here from taking on that client. So it's left up to the individual to decide what is safe, what is not, what is acceptable, and what is not.
When you look at these medical systems that certified nurse midwives and certified midwives are involved in, their foundational institute is going to be the American College of Nurse Midwives. They all have to abide by the same exact standards. They specialize in low-risk birth and pregnancy and delivery as well.
So not only is there a huge variance in what standards are for care and what is acceptable for midwifery care, there's a huge difference in educational standards. Certified nurse midwives having to get a master's degree in nurse midwifery certified midwives going through a three-year collegiate level program to become a midwife.
direct entry midwives or licensed midwives or certified professional midwives. These are all within the same kind of group. And there's a lot more variation there. In the state of Texas, there are many ways to become a midwife. You can go through what is called the PEP portfolio ran by NARM, which is an apprenticeship model where a candidate for midwifery goes through a self-study method. And
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Chapter 7: What were Kristen's initial impressions of Origins Birth Center?
I was looking for the best birth center in Dallas. I wanted something that was close enough to a hospital that if I needed or if my son needed medical attention, we could get it pretty easily. That is where I stumbled across Origins Birth & Wellness.
I had read many, many stellar five-star reviews, not only on their Google page, but also by magazines, and I believe DFW Child, all recommending Origins being one of the best birth centers in the Dallas area. They are located on Swiss Avenue and kind of like a historical district of Dallas, literally a stone throw away from one of the best hospitals in Texas, Baylor University Medical Center.
You could actually run to Baylor from Origins Birth and Wellness if you wanted to. For context, my husband and I, we both work in the restaurant industry. At the time, he was a chef at a restaurant in Dallas. If you're familiar with service industry, you'll know that we work a lot of hours and odd hours at that. So he worked a lot of the time. He was like, you know, you pick out some places.
We'll talk about it. This is your body. This is your pregnancy. And I'm here to support you through that. So, you know, we can make these decisions together. But ultimately, I want you to choose where you're comfortable.
Hi, I'm Thomas. I'm Kristen's husband. We met in 2018. We actually worked together. 2019 is when things kind of switched from coworker to dating and our relationship moved really quickly after that. We moved states a couple of times. We went through the pandemic together in 2020, living together, and then got pregnant in 2021 with our son. We had talked about wanting to have a kid.
So I was very excited. When she really started diving into natural birth, I really didn't have any clue exactly what that meant. She was very happy to educate me in that. So we started reading things. We started listening to stuff. She started looking into birthing centers. And all this was as foreign as a calculus class would be.
Once I really started to understand that it was more than just not getting an epidural, I started to kind of maybe be a little bit skeptical. Once I started really diving into the information that she was reading, I saw really just how empowered she felt about doing this and how much she was excited about it. I got on board. I saw that she was taking this seriously.
We looked through numerous different birth centers online and read their reviews and plans and visits. And then that led us right into Finding Origins.
So I went in to do a tour at the Dallas location. They did have open houses every Thursday. The facility is beautiful. Imagine Victorian style house across the street being a beautiful park with a gazebo. It had a first and a second story. The rooms were absolutely beautiful. Huge porcelain tubs and large beds everywhere. I mean, all the amenities you can imagine.
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Chapter 8: How did insurance and billing work at Origins Birth Center?
Then I was given another consent document. It was basically a liability waiver. I would also like to state that while I was overviewing this paperwork, I was sitting in their waiting room. The front desk gave me this packet and said, just go through and sign. None of these documents were explained to me. There was no one there really to answer any questions for me if I had any.
So I was looking at this consent document and this was the first icky feeling I had about this place was looking at this liability document. It basically stated that me, my husband, and nobody who is related to us, no third party would sue Origins even in the event of neglect and death. I'm sure that there are going to be people who hear that and go, why would you ever sign anything like that?
At the time, I had been told and was convinced that they abided by these high standards. Well, they were in a hospital, so I guess this is just to cover themselves. This is just a formality. But me and my husband looked at that document and that was our first real, I'm not so sure about this. But we came to the decision. We signed it. We're like, well, it's just a sue.
And I'm sure that nothing like this would happen to us anyway. And so we signed the document and continued in care. My OBGYN, she printed out all of my paperwork that Origin sent over to her. And she said, Kristen, never sign anything like this ever again. She said, no physician would ever ask you to sign anything like this ever. This is unethical at best.
Looking back, what I know now versus what we knew then, and I say this in the kindest way to like the people we were then, we were very naive to a lot of that stuff. We assumed that these people were professionals that were being regulated by the state of Texas. They claimed authority. to be upheld to these really high standards of care.
So to us, certified midwife or licensed midwife was the equivalent of a nurse or a doctor. We trusted them because of the titles that they carried. I wish, looking back then, that we had consulted with an attorney to give this document a once-over. This put a bad taste in our mouths. And that's something that we thought about periodically throughout our care there.
But when things like in my first trimester were going well and everything, we thought it would be fine. And all these people who had all these great experiences were like, well, surely this is just a formality.
As you started going in for your visits and your checkups, who were you being seen by and what was that process like?
Origins Birth and Wellness used several different midwives in one practice. The idea was you would see all of these midwives. So by the time your birth and labor and delivery came along, you'd be familiar with whoever walked in the door. So I saw very many different people. At first, I saw a woman named Rachel. I believe I saw someone else named Danielle. I saw Jennifer Crawford several times.
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