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Lucian's legacy.

Byline: The Register-Guard

There is no disagreement that the death of Kelsie Koberstein's baby during a complicated delivery was a heartbreaking tragedy. But a chasm has opened between the people who support Koberstein's decision to have her baby at home despite known complications and those who believe her midwife was unforgivably irresponsible - maybe even criminally negligent - to proceed with the home delivery.

With passions high on both sides of the issue, it's essential to acknowledge that the loss of Lucian Koberstein has deeply pained everyone who fought so desperately to save him, none more than his mother.

But also affected were midwife Anita Rojas, the paramedics who frantically tried to assist the birth after they were summoned to Koberstein's home, and Sacred Heart Medical Center emergency room obstetrician-gynecologists Drs. Elizabeth McCorkle and Brant Cooper, who brought every ounce of their expertise to the frenzied and ultimately unsuccessful effort to prevent Koberstein's difficult breech delivery from going totally wrong.

McCorkle and Cooper are certain they could have saved Lucian had Koberstein either begun her labor in the hospital or made it there much sooner after complications emerged. They hold Rojas responsible for proceeding with a high-risk delivery, and Cooper filed a complaint against her with the state Board of Direct Entry Midwifery, which oversees licensed midwives.

The case also drew the attention of the Lane County district attorney's office, which investigated whether Rojas was criminally responsible for the failed June 15 birth. No charges were filed because the baby was born dead.

Kelsie Koberstein doesn't blame Rojas, and that should count for quite a bit. Koberstein wanted nothing more than to bring Lucian into the world in a natural, supportive home environment that she could control.

Rojas was determined to do everything in her power to help Koberstein have the best possible birth experience.

Koberstein has nothing but praise for the way Rojas worked with her throughout their association. Once Rojas determined that the baby was in the breech position, she told Koberstein her options included checking into a hospital and having the baby by Caesarean section.

Vaginal breech births are not performed at the Nurse Midwifery Birth Center in Eugene, and they rarely occur at Sacred Heart or McKenzie-Willamette medical centers, where C-sections are the option of choice because of the risks involved.

Rojas also said she had experience successfully delivering breech babies. Since reporter Andrea Damewood's story on Koberstein was published Sept. 16, a number of Lane County women have written letters to the newspaper saying they had successful breech deliveries attended by midwives at home. One said she had a safe and successful home birth with the same complication as Koberstein - a footling breech delivery where the baby emerges feet first.

Elise Hansen, regional representative of the Oregon Midwifery Council, wrote a letter co-signed by 15 midwives lamenting that home birth makes the news only when there are deadly complications.

She said the vast majority of home births, including vaginal breech births, have positive outcomes.

More than 95 percent of U.S. births occur in a hospital, yet the United States is in no position to brag about its infant mortality rate: 32nd among industrialized nations. Hansen makes an important point that mustn't be lost amid the emotion of an infant's death: Maternity care in Lane County needs improvement.

Koberstein's case offers an opportunity to reopen a dialogue between midwives and the obstetric community on enhancing safe birth choices for women.
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Title Annotation:Editorials; Infant's death opens an opportunity for dialogue
Publication:The Register-Guard (Eugene, OR)
Article Type:Editorial
Date:Sep 23, 2007
Next Article:Equip the Guard.

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