The midwife charged with practicing medicine illegally after a baby died in a 2012 Hoboken home birth has completed a pretrial intervention program designed for first time offenders, according to Hudson County Prosecutor’s Office spokesman Gene Rubino.
On Sept. 18, 2012, Olivia Kimball, a 31-year-old resident of Great Meadows in Warren County, assisted in the delivery of a baby in a home on Garden Street. At 6:30 p.m. that day, the baby was pronounced dead at Hoboken University Medical Center, Hudson County Assistant Prosecutor Michael D’Andrea told the media at the time.
The state medical examiner later determined that the baby had been stillborn due to an infection, according to Rubino. He declined to specify whether or not Kimball was at fault for the death.
Kimball was arrested on Sept. 21 and charged in a Hudson County court with unlicensed practice of medicine. The crime is a 3rd degree indictable offense, the state equivalent of a felony.
According to Rubino, the maximum penalty for this crime is five years in state prison.
Pretrial intervention in New Jersey operates in a similar fashion to probation. Inductees must report to a probation officer, and may be subject to house visits. They have to obey all laws and answer any question posed to them by their officer, and they may be required to perform community service.
After a year-long postponement of proceedings, Kimball entered the pretrial intervention program on Sept 16, 2013 and successfully completed it on May 21, 2014. As a result, no conviction will appear on her criminal record.
“Women have their choices taken away and we’re vilified for it because we’re believers in choice.” – Vicki Hedley
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Rubino said the prosecutor in Kimball’s case had no objections to her entering the program.
Kimball’s story and others have been used as fodder in a growing debate between hospital obstetricians and home birth midwives over which approach to pregnancy and birth is safer.
Dr. Michael Bimonte, the OB/GYN Department Chair at Jersey City Medical Center, said he advises against home birth because the risk of being unable to deal with an unforeseen complication in a non-hospital setting is simply too high.
As home birth has become more popular, websites have sprung to catalog home births that allegedly led to infant deaths. In one prominent case reported in the Washington Post in 2011, a midwife pleaded guilty to child endangerment after the death of a high risk breech baby she had delivered.
But Vicki Hedley, a midwife with Seventh Moon Homebirth Midwifery Services who practices in Hoboken, said the vast majority of home birth patients are low-risk, healthy women. For these women, she said, home birth is as safe as hospital birth and significantly more comforting and natural. “For a high risk pregnancy,” she said, “I don’t want to have that person at home.”
Next step for midwife
Since her indictment, Kimball appears to have moved to the southern United States and adopted a new working last name. A professional website lists a person with the new name as director of site development for an international pro-midwifery non-governmental organization, the same position Kimball was credited as holding in a February 2012 profile in the Warren Reporter.
According to the website, she is “currently relocating to” the area and offers services as a doula, a non-medical companion who supports pregnant women during the birthing process. The website does not advertise midwifery services.
Multiple calls to a phone number listed on the professional website received no response. An email to the non-governmental organization also went unanswered.
Rubino said enrollees in a pretrial intervention program would have to inform their supervisor of any change of residence, but an out-of-state move would not necessarily be precluded.
How the license was lost
In her Warren Reporter profile, Kimball said she first realized she wanted to be a midwife while serving as an apprentice to a Native American healer in Mexico. According to the story, Kimball has helped to deliver around 1,000 babies since graduating from midwifery school in New Mexico, many of them overseas in Haiti, Peru, and Atiyak, Uganda, where she established a birth center with her organization.
Kimball first received a license to practice midwifery in New Jersey in August 2005. Sometime between then and 2007, the Midwifery Liaison Committee of the State Board of Medical Examiners opened an investigation into her practice after learning that she had allegedly assisted in a vaginal birth for a woman who had previously received a cesarean section—also known as a VBAC—in a home setting, according to a consent order issued by a New Jersey attorney general.
Under Title 13 of the New Jersey Administrative Code, licensed midwives can only assist in VBAC if they are at a hospital.
Bimonte said he saw the sense in this regulation.
“As much as an advocate as I am for doing VBACs,” he said, “you need to be prepared for complications” like a uterine rupture, which could kill the mother or the baby.
Hedley said home birth VBACs were an unfortunate side effect of hospitals’ cesarean-first outlook. She said hospitals like Jersey City Medical Center that offer VBACs are the exception and most hospitals automatically give cesareans to pregnant women who have already had them. For those women seeking another option, she said, “either they’re going to be doing their births by themselves at home or you’ll find a practitioner who is willing to risk herself for that woman and that baby.”
In February 2007, Kimball testified before the Midwifery Liaison Committee that her patient had not informed her of her previous C-section, and that she did not perform a physical examination at the patient’s request.
Ultimately, Kimball “decided to discontinue her practice of midwifery in New Jersey and…sought permission from the board to surrender her license,” according to the consent order.
On March 19, 2007, Kimball was granted leave to surrender her license “with prejudice to any future reapplication.” According to the deputy attorney general that represents the Midwifery Liaison Committee, Kimball is not barred from reapplying, but any reapplication would require a review of the terms of her consent order.
A spokesman for the New Jersey Division of Consumer Affairs said three weeks ago that Kimball had not reapplied.
Questions about death remain
When news of the Kimball-assisted home birth in Hoboken broke in 2012, the cause of the child’s death was not clear. NJ.com reported that the child Kimball delivered allegedly had a breech presentation, meaning its buttocks or feet were pointing out instead of its head. Delivering a breech baby vaginally can be dangerous because it puts pressure on the umbilical cord, among other potential complications.
However, the state autopsy reported that the child was stillborn, and put the sole blame on an infection, making no mention of alleged breech complications.
Rubino would not provide information about the specific type of infection that caused the Hoboken baby’s death. According to Our Sisters In Chains, a pro-midwife online organization that features Kimball, the child in Hoboken died of an undetected Group B Streptococcus (GBS) infection. The validity of this claim could not be independently verified by the Hoboken Reporter.
Our Sisters in Chains calls itself a “network of individuals who have been persecuted for standing up for the human rights of mothers…”
Bimonte said GBS is a common type of gut bacteria found in 30 to 40 percent of all women. If it is present in the vagina during labor, the bacteria can infect a newborn, causing complications and death. But women are usually screened for it and given medication if necessary.
At Jersey City Medical Center, said Bimonte, every mother in pre-natal care is tested for GBS and treated if necessary. He said babies that are infected during birth can be saved through immediate use of intravenous antibiotics.
However, a recent review of relevant medical research produced by the Cochrane Collaboration did not find conclusive evidence that the use of antibiotics in labor prevents death due to GBS.
Window into larger debate
The 2012 Hoboken tragedy cannot be separated from the context of America’s burgeoning home birth movement. After years of decline, the percentage of babies delivered at home has reached record highs for the modern era, increasing by a third between 2004 and 2009.
In 2009, there were 29,650 home births in the U.S. according to the Centers for Disease Control and Prevention. That total still comprised less than 1 percent of all deliveries, but thanks to recent movies like “The Business of Being Born,” the practice is becoming more popular.
Hedley said she has seen good demand for her service in Hoboken, where she holds office hours once a week.
“There’s a great group down there of Seventh Moon moms,” said Hedley, referring to her practice, “and they research with each other and a lot of them actually hang out together and it’s really quite lovely.”
Hedley said home birth is key because it offers an alternative to a hospital model that is impersonal and quick to intervene with epidurals, episiotomies, and cesarean sections, regardless of necessity.
“Women have their choices taken away and we’re vilified for it because we’re believers in choice,” said Hedley.
Bimonte admitted that C-sections were sometimes a knee jerk reaction aimed at avoiding a potential lawsuit. “Obstetricians are top three as far as malpractice costs,” he said, “so they’re afraid, and they’re afraid of a bad outcome.”
Bimonte said he monitors the monthly C-section rate at Jersey City Medical Center and reviews every C-section to make sure it was sought appropriately. The hospital has also hired certified nurse-midwives that can assist births, including those trained in water births.
Carlo Davis may be reached at cdavis@hudsonreporter.com.