Birth Rights and Wrongs

In the spring of 1999, Donna Cromie-Nguyen first visited with midwife Debra O'Conner. Cromie-Nguyen, a credit manager for a pharmaceutical company, and her husband, Truc Nguyen, an electrical engineer, were expecting their first child. Cromie-Nguyen chose the care of a midwife because she was interested in a water birth, which wasn't possible at the hospital where she had planned to deliver. She thought a water birth would be peaceful, having seen a video of one, and planned to have O'Conner attend her delivery at the midwife-run Puget Sound Birth Center in Kirkland.

O'Conner came recommended by other midwives as the best, Cromie-Nguyen later recalled. In practice for nearly 30 years, O'Conner was once named Midwife of the Year by the Midwives Association of Washington and teaches childbirth classes at the Seattle Holistic Center and Bastyr University. Over the years, O'Conner has also become known as a staunch advocate of what she considers "true" midwifery: natural, woman-centered care, as she sees it, which stands in sharp contrast to the "interventionist" model of the medical establishment.

Cromie-Nguyen's pregnancy dragged on past her due date, which O'Conner had first estimated to be July 25. When that date came and went, O'Conner changed it to Aug. 6, consistent with Cromie-Nguyen's first-trimester ultrasound examination at a medical facility. After that date passed, too, Cromie-Nguyen began to worry. On Aug. 10, having been off work for more than two weeks while waiting for the baby, she met with O'Conner. But the baby still wasn't coming. Cromie-Nguyen asked O'Conner about the possibility of being induced. According to Cromie-Nguyen, O'Conner told her that if "the baby wasn't coming, the baby wasn't ready." She suggested a natural remedy for bringing on labor consisting of castor oil, vodka, and orange juice.

O'Conner also photocopied for Cromie-Nguyen a chapter on induction from the book The Thinking Woman's Guide to a Better Birth by Henci Goer, a well-known critic of conventional childbirth medicine. In the chapter "Mother Nature Knows Best," Goer discusses the practice by some doctors of routinely inducing at 41 or 42 weeks of pregnancy because of an increased risk of stillbirth that kicks in a couple of weeks past a woman's due date. "Very rarely, a normally formed baby suddenly dies in the womb," Goer writes. "If it happens after the mother's due date, it appears that a routine induction would have prevented the tragedy. However, hindsight doesn't take into account the risks of induction. Because of these risks, while a routine induction policy would save some babies, other babies and even mothers would be lost."

Cromie-Nguyen chose not to seek induction. More than two weeks later, when the baby still hadn't come and Cromie-Nguyen had felt what she described as a swooshing movement of the baby and a leak of fluid, she had an ultrasound and discovered that her baby had died in the womb.

Feeling that O'Conner was to blame for her baby's death, Cromie-Nguyen filed a complaint with the state Nursing Care Quality Assurance Commission, which oversees nurse midwives like O'Conner and is part of the state Department of Health. After investigation, the commission agreed that O'Conner's care was negligent. Its findings of fact stated, in a footnote, that it was not alleging that O'Conner caused the baby's death. But the commission noted that O'Conner gave Cromie-Nguyen literature discouraging induction and said that O'Conner had "created an unreasonable risk" by failing to consult a physician and to properly monitor for fetal well-being as Cromie-Nguyen's pregnancy reached a critical stage. Cromie-Nguyen's case, along with another stemming from complaints against O'Conner, led the Nursing Commission to apply some of the strictest restrictions it has ever levied. O'Conner is required to have supervision over a three-year period; for the first year, she is forbidden from practicing independently as a midwife and must have a supervisor present at all times in the room.

Midwife Debra O'Conner (lower right) as featured on the Seattle Holistic Center's Web site. (Suzy Wood)

It was not the first time the commission had disciplined O'Conner. While she was treating Cromie-Nguyen, O'Conner was on probation from another sprawling investigation that resulted in a finding of unprofessional conduct relating to four other cases. Two of them involved babies who had died, although, again, the commission did not blame O'Conner for the deaths.

O'Conner is unbowed. She has fought the state at every turn and is appealing the latest restrictions in King County Superior Court. Judge Anthony Wartnik has yet to issue a ruling in the case. As fervent in her beliefs as her Christian missionary parents were in theirs, O'Conner is an elegant 50-year-old with dark hair falling to her shoulders and an intense focus that alternately bestows great warmth and outrage. She passionately argues that she provided appropriate care in all cases, if not care that conforms to conventional obstetric management. She believes she is being persecuted for following the midwifery model of care that caters to women who opt out of a medical model that they believe causes more harm than good.

"You know what, I'm going to always be different than they are," she says in one of a series of interviews, her voice rising with agitation after discussing the details of several cases for which she has been sanctioned. "You know why? Because the patient comes to me and I have a fiduciary duty to give them something different. They didn't come to me because I'm an obstetrician. They didn't come to me because I'm a nurse. They came to me because they wanted midwifery care. . . . They didn't want what they offer in the hospital. And until people start getting this through their thick brains . . . " She begins to enunciate each word slowly and sharply: "The women do not want what's being offered there."