When the Oklahoma Attorney General charged Debra Disch with a felony in September for practicing medicine without a license, she became the first and only non-nurse midwife in the state to face legal ramifications for performing what many consider key functions of that job.
Specifically, Disch admitted to investigators that she administered drugs and performed an episiotomy during a home birth — both of which require a medical license, which as an unregulated midwife, Disch lacks.
But Disch is not alone.
GateHouse Media identified at least three other non-nurse midwives — Venessa Giron, Taryn Goodwin and Brandy Harris — who practice in Oklahoma and who admitted they personally do some of the same things that got Disch in trouble.
“We’re suturing women, we’re injecting lidocaine to suture, and we’re injecting anti-hemorrhagic drugs,” said Giron, of Tulsa, during a 2018 interview with GateHouse Media.
Giron did not respond to a follow-up request for comment.
Attorney General Mike Hunter said in a September press release that although midwives don’t need a license to practice, they do need one to “perform an episiotomy and administer Pitocin” — which the attorney general classified as performing a surgical procedure and dispensing prescription medication.
The agency’s determination could have implications for the state’s other unlicensed, unregulated non-nurse midwives who have been carrying drugs for decades in what they claim is a legal gray area.
But just one month after Disch’s charges, the Tulsa Birth Center apparently hosted a three-day workshop for midwives that included training on performing episiotomies, according to its Facebook announcement for the event.
The Tulsa Birth Center did not return a request for comment.
“Midwives have been carrying the stuff that we carry for 25 years, and no one’s ever gotten in trouble,” said Oklahoma City midwife Taryn Goodwin, referring to prescription drugs, during an interview with GateHouse Media in 2018.
‘She shouldn’t have left her with the medicine’
It was August 2018, and Goodwin had just delivered a client’s baby at a Mustang, Oklahoma, home.
A GateHouse Media reporter was present when Goodwin injected the newborn with vitamin K and gave the mother Misoprostol to slow postpartum bleeding.
Low levels of vitamin K can lead to dangerous bleeding in newborns and infants, prompting the American Academy of Pediatrics to recommend all babies receive a dose.
But in other states that regulate non-nurse midwives, such an act is restricted. In Arkansas, for example, licensed non-nurse midwives are prohibited from administering the vitamin by injection; they can give it orally only. In Texas, they must have physician supervision to administer the vitamin.
The medication given to the mother, Misoprostol — commonly known as Cytotec — is a prescription drug similar to the one Disch used in the case leading to her felony charges.
“I’m going to leave you with some medicine because you lost a little extra blood,” Goodwin told the mother. “If you feel like you need to use this call me first, and I can walk you through it.”
Goodwin also told the mother she would collect the medication when she returned to check on her.
Click to hear Goodwin’s own words.
Cytotec is a safe medication to give for hemorrhage, said Leigh Fransen, a former South Carolina midwife who now criticizes the profession through her blog, the Honest Midwife. But she said it can be unsafe to use outside of a hospital.
“It’s a terrible idea when you have the alternative of being in a medical facility where people can assess your bleeding,” Fransen said. “It’s very unsafe in a non-hospital setting.”
In a follow-up interview with GateHouse Media this month, Goodwin said she did not recall administering medication during that home birth.
“I follow the laws of my state,” Goodwin said.
Many non-nurse midwives in Oklahoma are credentialed as “certified professional midwives” — or CPMs —through the North American Registry of Midwives. But the state has no educational or training requirements of its own. Anyone can call themselves a midwife and practice as one.
Disch told state investigators that, as a certified professional midwife, she was trained to perform episiotomies. And Goodwin told GateHouse Media that, while she does not prescribe medication, her credential allows her to administer drugs.
But the North American Registry of Midwives lacks legal authority to give prescribing authority to its members.
Obtaining the drugs
Goodwin said in 2018 that she obtained medication “from states where they recognize midwives” but did not cite a business or provider name. She also said that if she has clients who need a prescription, Goodwin has providers to which she can refer them.
In the follow-up interview in October, Goodwin contradicted her earlier statements.
“If I have a client who needs or wants a prescription,” she said, “I encourage them to talk to their primary care provider.”
Click to hear Goodwin’s own words.
In Disch’s case, an affidavit notes she had obtained Pitocin online through a company called Precious Arrows. The company is based in North Carolina, where non-nurse midwives are barred from practicing. Like Misoprostol, Pitocin is a prescription drug used to slow postpartum bleeding.
During a public hearing last year, another non-nurse midwife in the Oklahoma City area also admitted to administering medication.
Student midwife Brandy Harris told the Oklahoma Board of Nursing at a November 2018 hearing that she administered medication to patients, including intramuscular injections of Rocephin — an antibiotic — mixed with Lidocaine.
“My statement there was speaking directly to what I’ve been trained to do as a CPM student,” Harris told GateHouse Media nearly one year later.
Harris herself is not licensed under the Board of Nursing, but she assisted then-nurse midwife Dawn Karlin in a fatal attempted out-of-hospital birth that contributed to Karlin’s nursing license revocation.
Harris testified that Karlin taught her “how to perform cervical examinations and how to administer medications,” according to board documents summarizing the hearing.
Karlin’s own testimony later contradicted Harris when Karlin denied having delegated the administration of prescription medications and said she personally administered Rocephin to the patient in that case.
Neither Karlin, whose prescribing authority lapsed in 2014, nor Harris, who did not say when she administered the medication, specified how they obtained the drugs, but Karlin told the board she “continues to administer medications without a healthcare provider’s order.”
Karlin declined to comment to GateHouse Media about anything discussed in the board hearing.
“I’m not willing,” she said, “to speak to anything about my certified nurse midwife license.”