The Register Guard (Eugene, OR)

Dilemma upon Delivery

Byline: Andrea Damewood The Register-Guard

The call to paramedics came at 8:10 p.m., the instant midwife Anita Rojas realized the head of the breech baby she was delivering was stuck.

Twenty-one-year-old Kelsie Koberstein was swept up by medics in a blur of pain and fear.

Rojas rode in the front of the ambulance, with Koberstein's mother and best friend rushing behind in their car.

"I felt kind of halfway outside myself," Koberstein recalled. "That was the only way I could cope with the pain, which was so bad, it was beyond pain.

"My nerves were shooting pain out of my toes."

On her back, her legs pushed up as high as they could go, she clutched the hand of a paramedic as if he were her only anchor to reality.

Those minutes, so frantic for so many, ticked by slowly for her. As paramedics tried to wrest the baby out, Koberstein said she could sense the small life, still partially within her, beginning to fade. She began "letting him go, in a way."

At Sacred Heart Medical Center, the on-call emergency room obstetrician-gynecologists, Drs. Elizabeth McCorkle and Brant Cooper, wasted no time.

As they instructed paramedics over the hospital radio, they learned this birth was going to be as difficult as they come: It wasn't just a breech birth, but a "footling" - where a foot emerges first.

Just a few centimeters in width, a tiny foot might not open the cervix wide enough to allow the baby's head and umbilical cord to pass through. If the head becomes trapped, the baby could quickly suffocate.

When medics pulled up to the doors, the doctors leapt into the back, refusing to squander precious seconds bringing Koberstein inside. The doctors had to turn Lucian's head 180 degrees in order to free him, a move that took at least 20 minutes.

By then it was too late.

The infant was dead.

"Everybody was just deflated," said McCorkle, an OB-GYN with 11 years of experience. "Everybody was sad, and kind of shocked. I didn't know what to do."

Differences in perspectives

Koberstein named her boy Lucian Blaize - a name that means illumination. And in his death, he has cast a spotlight on the mistrust between many doctors and midwives.

Lucian's breech birth was so risky that most doctors and midwives would have insisted he be delivered by Caesarean section. But Koberstein's midwife attempted a vaginal delivery, a move that the two emergency room doctors believe killed him.

The Lane County district attorney's office investigated whether Rojas was criminally responsible for the failed June 15 birth, but the case was not prosecuted because the baby was born dead. Cooper filed a complaint against her with the state Board of Direct Entry Midwifery, which oversees licensed midwives.

Koberstein stands by her midwife. Also lining up behind Rojas are experienced midwives who believe the decision about how to bring a child into the world rests solely with the mother and her care provider.

What doctors and midwives do agree on is that low-risk labor - generally defined as a head-first birth with no foreseeable complications - is equally safe when performed in a hospital or in a home.

The consensus ends there.

A mother-to-be's options

Koberstein, a mellow woman with short, choppy strawberry-blond hair, discovered the pregnancy two weeks after missing her period last September. …

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