Baby battle

Kalispell midwife surrenders to doctor complaints



When Jackson Merklinger was born May 28, 2006, his parents, Cherokee and Tim, and their midwife, Elizabeth Emmert, say everything appeared normal. According to his parents, Jackson was a healthy pink and passed his APGAR tests, the first health tests typically done on newborns.

But less than an hour after Jackson was born, Emmert says, something seemed off. She tested the infant’s breathing and found he was having difficulty.

Emmert says that after 50 minutes (the parents say it was closer to two hours) Jackson was carried from Emmert’s private practice, Kalispell Maternity & Birthing Center Inc., across the street to the Kalispell Regional Medical Center (KRMC) emergency room.

There, Jackson was found to have a bacterial infection in his lungs. He had arrived at the hospital, according to Emmert, in the nick of time. After seeing doctors at KRMC and being flown to Community Health Center in Missoula for further treatment, Jackson, say Tim and Cherokee, has recovered well.

“It was a rollercoaster,” says Tim. “One minute he’s fine, the next, we’re boxing him up and flying him to Missoula.”

But while Jackson may have come out of a scary situation unscathed, the close call just added to problems Emmert was already facing.

Four days earlier, on May 24, Emmert had facilitated a birth in which the child was born with a heart defect. That infant also had been rushed to the emergency room. Of the 40 to 50 babies she has delivered, Emmert says, she had never had problems like these before.

“These were my nightmare babies,” she says now.

In both cases, complaints against Emmert were filed with the Montana Board of Alternative Health Care, the state body that licenses midwives and other alternative health-care providers. According to Darcee L. Moe, legal counsel for the board, two doctors and a nurse who worked with the babies alleged that Emmert took too long to diagnose problems with both babies, and that she should have called an ambulance to take them to KRMC instead of walking them across the street.

These are the only complaints against Emmert involving deliveries, but she was also put on probation by the board in March for not filing quarterly progress reports, which she was required to do as an apprentice midwife. Under board rules, midwives spend one year as apprentices under the supervision of a mentor. Emmert’s probation required her to spend a second year under supervision before completing her apprenticeship.

When a midwife, or any alternative health-care provider, is accused of violating the board’s rules, board members consider the complaint, decide if it warrants further investigation, hold hearings, and determine if or how the midwife is to be disciplined.

The parents of the newborns did not file the complaints against Emmert; health-care workers in the emergency room made the complaints. In the case of the Merklingers, the parents have disputed the complaints and spoken to the board on Emmert’s behalf.

The parents in the May 24 case declined to speak with the Independent. Jackson’s parents, however, were willing to talk.

“There was nothing she could have done,” Cherokee says. “We are firmly on Elizabeth’s side.”

Cherokee says she and her husband have remained close to Emmert since the birth, and still send her baby pictures. Both say they spoke in favor of Emmert to the board and the board’s investigator. Cherokee believes the complaints were the result of “a bunch of docs who didn’t like a midwife coming into town.”

Dr. Douglas Nelson, the Kalispell pediatrician on call in the KRMC emergency room when Jackson came in, and who filed a complaint in that case, declined to comment. The Independent was unable to reach Anne Gray, a nurse who also filed complaints against Emmert in the Merklinger case. Moe says their complaints were nearly identical.

Dr. Wallace Wilder, another Kalispell pediatrician who was on call when Emmert’s May 24 baby came in, and who filed the complaint in that case, was out of town.

Emmert agrees with Merklinger’s assessment of the complaints.

“It’s a turf war,” she says.

She says she decided to open her birth center, in April 2004, next to the hospital so that if she ever had to transport an infant to the emergency room, it would be quick.

She now believes that opening her practice so close to the hospital made doctors feel competitive, leading to the complaints.

But Emmert ultimately decided not to fight the complaints.

“I’m just not willing to fight the system,” she says. Instead, she closed her birth center this summer. At the same time, the board has now recommended that her license be revoked.

“My feeling is that licensed midwifery in the state is going to die out,” because of pressure by physicians, Emmert says.

Missoula midwife Dolly Browder served as Emmert’s mentor, and says Emmert was a fine midwife. She says the complaints against Emmert are unwarranted. Browder has been a midwife in Montana since 1977. She helped establish the Montana Board of Alternative Health Care, served on the board for 14 years, and is currently secretary of the National Association of Certified Professional Midwives.

She, too, has faced challenges from the medical establishment.

Back in 1988, a Montana physician tried to have her prosecuted for practicing medicine without a license. Browder went to court, where her case eventually established that midwifery fell under the laws governing medical procedures, and that she therefore needed a license to practice. She was unable to practice as a midwife for another year, until she had lobbied the legislature to change the law to exclude births from the regulatory category of medical procedures.

“There are a lot of physicians who do not like homebirths or midwives,” she says. “There are some that will do anything to shut down midwives.”

But Browder doesn’t agree that pressure from doctors is going to shut down midwifery in Montana, saying that what’s happening to Elizabeth Emmert is nothing new.

“Midwifes have always had trouble with the status quo establishment,” she says.

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