Boy. I can imagine a set of facts where I'd think the pediatrician had done the right thing calling CPS, and CPS had done the right thing getting the baby treatment. But why the baby isn't back with her parents immediately makes no sense to me at all.
The baby jaundice/tanning bed thing still gives me anxiety to think about. I can't imagine going through it if I had to be afraid of legal action.
My wife is to this day ready to stab any lactation advocate who seems pushy.
People sometimes talk about big government / incompetent boogeyman CPS like they take about the DMV. It seems like CPS has rigid procedures to err on the side of getting kids out of dangerous situations that end up with bizarre and inhumane results in some cases. I don't know about TX specifically but I've heard of overzealous CPS actions in other states.
This weekend our 10yo had a couple sporting events with an hour gap between and we had other things to do. We just let her hang out at the park between games and do what she wanted. She had a phone with her, and there were so many events going on (8 youth soccer games per hour slot) that there were probably a dozen other families we know who were around. But say she fell off her bike while we weren't there- does that activate CPS because we left her at a park without formal supervision?
A local social services friend of mine characterizes the CPS problem as thus: young, up-beat sheltered female college graduates who are really quick to pathologize any deviations in family structure and continuously underestimate the damage of breaking up families. They get put in these frontline situations where they're horrified by the poverty they see, and aren't properly supported in how to analyze and evaluate the nuances of the situation.
(Plus racism and savior complexes.)
So things like: you'd better have a bed for each kid, or else CPS will use that as an indicator of an unfit home.
5: There are a lot of these kinds of people in CPS but they're not the ones who make the decision to remove a child. That is usually done after a higher level social worker completes an investigation and the final decision requires petitioning the court (this varies by state). The upbeat, sheltered ones don't stay long enough to get to the investigation level or they become wearied and cynical by the time they do.
I wonder if it's more like "if you check certain boxes, automatic processes will make the bureaucracy biased toward taking kids away, unless someone takes special effort to avert that - for example, because they see the family as particularly sympathetic, which typically means white."
5: around here, some of them are like that and some are veterans. I know they are super strict about removing newborns if a mother has opiates in her system so much so that many pregnant women are afraid to seek treatment which is good for neither mother nor baby.
7: I think birth parents can get away with kids sharing a bedroom. My priest and her husband adopted 3 kids from Korea. They were required to have a bedroom for each kid, even though most Korean kids don't get that as young children.
8: In MA, DCF can act very quickly without a judge for a very temporary removal.
I think a lot of it is just that they don't have the time to do a good job. And so everything becomes horrifyingly random.
On the first article the top comment is from a Black physician who seems to basically be echoing 1. Decent chance that forcing the baby to go to the hospital over the objections of the parents is the right call here, but then things escalated out of control from there and have ended up in a bad situation.
I also wonder whether the name mixup for the mom is playing a huge role here. Someone mixed up two names or two cases and that resulted in CPS treating this case differently. Which is itself horrifying, you'd think that once it became clear that the name was wrong they would reconsider the decision, but when things are understaffed there's just no one with the time to undo errors before the court hearing.
And that sort of thing is where racism can also play a part. It might not cause the initial error, but it very plausibly slows down getting it straightened out.
There's just so much security in maternity wards today. CPS is pretty much the only way to get a baby if need one fast.
14, 15: If Temecia Jackson didn't have anything to hide, why did CPS get the paperwork wrong? Riddle me that, Batman.
Yeah, at some point you need someone to be helpful in a way that's beyond what their job requires, and that's a situation where it really matters how much empathy people have for you specifically. It also matters whether you have a sense for how to navigate systems until you find the person who actually listens.
Obviously in no way the same, but we spent part of today showing up at the airport to try to see if we could locate our bag that was lost a week ago. It's a weird situation where the airline only flies one flight a day here, so they have no local staff. So the plan was to just show up in person and talk to the people in all the baggage offices for other airlines and hope one of them knew what was going on. And there were four offices for four airlines, none of which is ours. But by luck exactly one person who was knowledgeable and inclined to be helpful, and told us what room the bag would be in if it were there. Sadly that room belongs to Spirit and there were no staff to let us in, so no bag yet. My point is just that when you end up dealing with a big bureaucracy, you need to know weird things like that showing up will give you different info than the phone, but even then there's just tremendous luck in who you talk to and whether they're interested in helping you or not. And racism plays a role both in whether you've been taught how to deal with those kinds of systems and whether people are inclined to help.
But now imagine if your luggage was only one month old!
I also wonder whether the name mixup for the mom is playing a huge role here.
From the two articles, it does sound like one possibility was that the doctor who reported never hearing back from the family was trying to contact the wrong number/family. If that's what happened, maybe CPS wouldn't have been involved since "doctor requests kid to be brought in for treatment" seems like something they potentially could have worked out, while "CPS demands kid be handed over" doesn't.
Will be really bad if it turns out it was the baby's name that was mixed up, rather than the parents, and there was a different baby with jaundice who didn't get treatment.
22: I think it's more likely that they were choosing not to answer the pediatrician's calls because they had made the choice to have the baby treated by their licensed midwife's practice, knew that the doctor disagreed, and didn't want to deal with him any further (which strikes me as a choice that parents are allowed to make if they are, in fact, following up with a different but qualified practitioner).
Regardless of whether the pediatrician was right to call CPS, every other step taken appears to have been for the purpose of punishing the parents as opposed to protecting the baby.
There may also be some disagreement about whether the midwife was qualified to treat the child in this case, but the situation is still messed-up regardless.
Reminiscent of the Shasta Fair sending police for the girl's goat when it was a civil property dispute (and it was never even the fair's property).
This is horrid. It also feels like a case study in how once a label is applied to someone, it's hard to get anyone to see past it. The doctor's actions are defensible, I think; high bilirubin is a time-sensitive problem, and trusting that the home birth midwife (who is an unknown quantity) has the right equipment isn't going to happen. But once the call is in -- and then the name mixup - there's no way for them to prove that everything's fine, because any evidence they can provide is suspect, because they're now suspect.
Thinking about this today after a friend's toddler ended up in urgent care twice within 24 hours for stitches. Just a clumsy adventurous baby but how would you prove it?
In practice, a I find myself going out of my way to be helpful to black people (and especially families dealing with disability) and have to work hard not to snap at entitled white people.
26: That was just gross and gratuitously cruel - especially since the state rep who bought the goat was ok with letting it live.
trusting that the home birth midwife (who is an unknown quantity) has the right equipment isn't going to happen.
I'm guessing here, but it seems unlikely she had any relevant equipment -- more likely they were relying on exposing the baby to sunlight. Which can be appropriate, but maybe not with the test results this baby had. I do think there's a good chance the midwife was being very irresponsible here, and giving the family bad advice.
From what I read, the plan was to supplement the baby's feeding and use a light blanket, whatever that is.
To quote one of the doctors in comments (who could of course be lying about being a doctor):
"I've seen the news in Dallas reporting that the child's bilirubin level (the stuff that causes jaundice) was 21! Which was high enough to cause brain damage. The doctor told the family to urgently go to the hospital. The family declined and follows advice of the midwife. Im a black pediatrician myself. I would also call CPS (but tell the family I would do it too) if they continued to not follow advice that could literally kill their child."
I think there's a lot pointing towards a light blanket being pretty clearly insufficient here.
A light blanket is standard in Texas, in the springtime.
A light blanket is presumably some kind of UV source. The NICU will have more powerful UV devices. The UV breaks up the bilirubin and more fliuds wash it away or keep it from forming or something.
30: ayup. I don't necessarily have a problem with midwife care but it can mean everything from the CNM I had (in the hospital) to someone who is basically a hobbyist in "normal birth" who relies on 911 in emergencies, and if I were a pediatrician and had a midwife who didn't say "infant care is actually beyond my scope of practice, so let's talk to the pediatrician" I think I'd have all sorts of alarm bells going off. Especially if the 'oops I didn't know' results in brain damage. None of this I think ought to result in taking away the baby from an otherwise safe environment but it's not like this was an argument over footie pajamas.
Maybe I missed it, but it wasn't clear from either of the articles whether the baby ever did get hospital care.
34: for a baby who isn't in danger, ordinary sunlight plus eating and peeing/pooping solves the bili problem.
Getting a baby to eat and knowing the baby is eating isn't easy.
Not always! But if baby's levels are a little elevated and they're eating, it will be OK. (I had a stupidly easy time with both kids with respect to feeding so when Pebbles was a teensy bit jaundiced it was gone by the next in hospital follow-up.). They're just so damned tiny and fragile.
I bet. My sister had some struggles and five lactation consultants later the kid got some formula.
The number quoted in this article is 21.7. Here's a chart of what normal levels are for infants. It really seems like the doctor did the right thing here. Now CPS should still return the baby after the treatment. It's not clear to me how much at fault the widwife is here, but it sure seems like the parents and the midwife thought this was a normal situation where it was a little bit elevated, and that's not what the doctor was saying at all.
Another point I find confusing is why the NP sent them home in the first place. Reading between the lines it seems like they did a blood draw during the appointment but weren't worried enough to keep them there until the results came back, and then when the results came back elevated that's when the doctor started calling. Which doesn't make sense with the quote "He didn't even see Mila when I went to his office. His nurse practitioner saw Mila. And so, when he's making all of his statements and everything, it's third party from his nurse practitioner." But maybe the mom just doesn't understand what happened? But at any rate surely he's just reading off a test result from the lab and it has very little to do with anything the NP observed.
The link in 42 also confirms that the doctor was contacting the right family.
My wife is to this day ready to stab any lactation advocate who seems pushy.
More recently and across the ocean, the experience hasn't changed much.
Anyway, can't imagine going through this kind of hell. Pregnancy and raising a newborn is hard enough. Even if it was the wrong call over this medical thing--which reading more comments sound like it was--that shouldn't lead to not having your kid for so long.
The CPS equivalent here is probably awful--and I was irrationally afraid when we first had our home health visitor, who is the nicest person in the world, come by as The State is scary--but I see so many kids roam wild that I'm not too worried about the take-your-kids-away-for-being-unsupervised thing.
I know someone at the embassy there if you have trouble. She's with the department of agriculture, but babies are like crops in that you grow them.
I guess the difference for the government is that crops get a check and babies get only a tax deduction.
it's not like this was an argument over footie pajamas.
Wait, is that a thing?
It's probably not easy to find in adult sizes.
I don't necessarily have a problem with midwife care but it can mean everything from the CNM I had (in the hospital) to someone who is basically a hobbyist in "normal birth" who relies on 911 in emergencies
The articles say the midwife was "licensed" but don't say CNM. It looks like Texas has a state licensure level (Certified Professional Midwife) that piggybacks on North American Registry of Midwives accredited programs, which usually involve getting a certificate or an associate's degree; there is also a state exam on midwife-related law.
It's not obvious to me that the midwife was ever told the test results. The doctor called the parents about the test results, the doctor called the parents (who didn't answer) not the midwife. My working model here is that the they talked to the NP, the NP was slightly concerned but thought it was a more normal level of problem, and so ordered a test but let the parents go with their preferred treatment with the midwife in the meantime, but then the test results came in and it became an emergency, but at that point the parents were locked in and uninterested in hearing about the test results. Reading between the lines the parents may not really believe that blood tests have any value that isn't overruled by actually being in a room with the child.
I'm just stuck on why the midwife is providing infant care at all. That's not midwifery. I don't think it's really possible from the stories we have to tell if it's the midwife's fault for presenting herself as being competent to provide medical care to an infant, or the family's fault for assuming she was.
And of course the big issue is that whatever went went wrong in the family's judgment call about medical care, it's still insane that the baby isn't with the parents. If I understand the story, while it seems to justify overriding the parents' medical judgment, there's no reason the baby should have been removed from their custody.
Wellness checks are a common part of midwifery, but yeah, that's the limit: either the baby is well, or it needs medical care. There's no such thing as a midwife/pediatrician*.
*there's family care doctors who do childbirth as well as GP care--that's who took care of our family through 2 pregnancies/births/childhood/elder care--but that's completely different
Isn't it pretty typical for these kinds of birthing centers to provide infant care support like lactation consulting after the baby is born? I don't think the line between "supporting the parents in doing normal parenting stuff" and "providing medical care" is always clear. It looks like you need a prescription for a biliblanket, but it's common for parents to just use them at home without help. If it's fine for the parents to do it themselves, then getting help from the midwife to do the same thing isn't "medical care" it's just support.
That said, the midwife practice getting involved in the lawsuit does point towards maybe they're purposefully crossing the line into medical care...
Certainly agree with 52.2. I suspect the case of mistaken identity is playing the key role there, but in a way that makes it more horrifying rather than less. How does getting literally the wrong parent not prompt some sort of timely reassessment?
50: odds are good that she's a CPM, because CNMs IME are very clear about the scope of practice. CPM really varies in quality of licensing. But "treatment for severe elevated bilirubin" isn't a home treatment situation where we could construe the licensed professional as a friend, either.
My CNM didn't count as delivering the Calabat because she pulled in the OB to rotate his giant head with forceps (instrumental delivery is not in her scope), so she wasn't officially the attending, and while she checked up on us both and offered generic advice about IIRC pacifiers, the pediatrician was in charge of the bili stick and all the other checks babies get. Also IME, whether the baby looks jaundiced is not always a reliable indicator of their bili status.
In any case, I think the baby ought to be with the parents and delaying the hearing until the 20th is barbaric. Without more to the story, I can't say whether the pediatrician was wrong to refer it to CPS (did the parents understand the severity? Did the pediatrician exhaust alternatives?) but the baby needed medical treatment.
19th News has a lengthy article on this, but unfortunately it really handwaves whether the baby was at any risk: the midwife is quoted saying that there were signs that the bilirubin was clearing up, but of course that's a self-serving statement--not necessarily false, but you can't put much weight on it.
Of a little more value, it also states that home birth babies tend to have higher bilirubin because of higher breastfeeding rates (?), and then suggests that the doctor was either unaware of or unaccepting of that tendency. Doesn't say anything about the light machine.
I dunno. Nobody's a bigger supporter of midwifery than me*, and I'm a HUGE believer in the benefits of midwifery for Black mothers in particular--as I mentioned here some time ago, the center here has better outcomes (in terms of c-sections and newborn health) with Black clients than hospitals do with white mothers. But I've really become disenchanted by this form of advocacy journalism that spends 1000 words on the historic and systemic injustice behind the story and 50 words on the conflict at the center of the case.
Obviously the CPS part of this is insane and racist, and the pediatrician was absolutely motivated, consciously or not, by prejudice. But "was the baby at risk?" is actually an incredibly important question, and it's one that the journalist IMO assumed the answer to rather than investigated.
*13 years on the board, including an extra year to help transition to the next Board President.
The full quote from 56.1 is "But the midwife told reporters she did a video call with Temecia and noticed Mila's jaundice clearing up. Edinbyrd also did assessments of the baby's stool that indicated the bilirubin was leaving her system."
I can't see how this is anything other than wildly inappropriate behavior from the midwife. You have a blood test saying one thing and you're overruling it based on looking at stool over video call? When you're not a doctor? I don't know the law here in any detail, but surely this is at least bordering on criminal behavior?
Anyway, the bad actors here are the midwife and CPS. I think the parents and the doctor are all pretty sympathetic here and doing what they thought was best. (And contra 56 I didn't see anything here to indicate "the pediatrician was absolutely motivated, consciously or not, by prejudice." Could be true, but could not be.)
I don't know the law here in any detail, but surely this is at least bordering on criminal behavior?
Well, practicing medicine without a license is a crime on the books, yes. I feel like usually it gets handled short of criminal prosecution, but in Texas it can be up to 10 years.
This bit really jumped out at me:
"As the day progressed, however, the doctor's tone changed, Temecia said. The pediatrician contacted the family at least 10 times through phone calls, texts and voicemails, growing more insistent that the couple take Mila to the hospital."
I haven't ever had a sick newborn to look after, but I feel that if I did, and I was getting panicky phonecalls from the paediatrician every half hour throughout the day, I would probably not conclude that he was being silly and everything was going to be fine. Doctors tend not to call their patients every half hour if everything is going to be fine. The difficulty with most of them is to get them to call their patients at all.
Also, ugh, I can never get used to people talking calmly about "their doula" when I know what the word means. (We don't really have them very much over here.)
61: I once encountered one, with a custom numberplate proclaiming her subjection.
TIL. I wonder what made the woman who coined the modern term think it was appropriate.
63: Per Wikipedia, seems to have been done quite knowingly.
The term doula was first used in a 1969 anthropological study conducted by Dana Raphael, a protégée of Margaret Mead, with whom she co-founded the Human Lactation Center in Westport, Connecticut, in the 1970s. Raphael suggested it was a widespread practice that a female of the same species be part of childbirth, and in human societies this was traditionally a role occupied by a family member or friend whose presence contributed to successful long-term breastfeeding. Raphael derived the term from modern Greek (δούλα, doúla (Greek pronunciation: [ˈðula]), "slave"), as told to her by an elderly Greek woman, Eleni Rassias, and described it as coming from "Aristotle's time," an Ancient Greek word δούλη meaning "female slave."
Apparently (wiki) she asked an elderly Greek woman and just thought "ooh, sounds nice".
Raphael derived the term from modern Greek (δούλα, doúla (Greek pronunciation: [ˈðula]), "slave"[21]), as told to her by an elderly Greek woman,[22] Eleni Rassias,[23] and described it as coming from "Aristotle's time," an Ancient Greek word δούλη meaning "female slave."[24]
There's no ambiguity about it, either. It's not like "servus" in Latin which has been used for "servant", as in a paid free subordinate with rights, as well as for "slave", and you have to know which it means from context. Greek, ancient and modern, has various different words for "servant". "Doula" means only "woman who is owned, as property".
From her entry a bit ore detail:
She learned the word "doula" from a woman in Greece who told her that it fitted the role that Raphael was describing to her of a woman who helps a nursing mother by taking on other work in the home; Raphael then used the term in her 1966 dissertation on cross-cultural practices of breast-feeding before making the term more public in a magazine article in 1969. She gave it more widespread currency in "The Tender Gift: Breastfeeding" in 1976.
If you have to use a Greek-derived term for female servant, "deaconess" is right there and would be preferable, as would the following: LITERALLY ANY OTHER TERM. You could say "I couldn't have got through childbirth without the help of Margaret, my amazing Wobbly Algerian Penguin" and it would still be better than "doula".
Are you saying I'm drunk
I've been lurking for six years.
Are you drunk, Penguin? It's me, Margaret.
56, 57:. I don't know that the doctor was "motivated by prejudice." Plenty of evidence for the harms of systemic racism that led the family not to trust the doctor, and it's reasonable to believe that the doctor probably didn't take kindly to them taking the midwife's dangerously bad advice over his. Also reasonable to think that he might not have been adept at explaining the issue to the parents for the usual bag of historical injustice kinds of reasons. But it doesn't sound like he called CPS until after many attempts to get ahold of the parents.
According to the doctor's statement, the first worrying incident was before the light therapy incident. The parents had refused to clamp the umbilical cord because they believed that "the more placenta, the more stem cells and immune cells will go to the baby" - however this is apparently also a good way to give your baby a stroke. This was noticed at a postnatal clinic checkup which also spotted the jaundice and recommended hospital light therapy.
If anything the classic prejudice situation here would go the other direction, a doctor failing to notice a baby was going to have permanent brain damage because they never paid attention to how jaundice presents on black skin. My assumption was that worse health outcomes for Black infants are surely driven primarily by under-treatment not over-treatment? There's lots of evidence on doctors discounting pain and other symptoms in Black people, right?
The doctor here is also dark-skinned, for what that's worth.
I think the effect is not limited to white doctors; it also comes through training, for example.
61 et seq reminds me of an American-born person of Greek descent who spoke no Greek but wanted to give her dog an ethnic name. She asked her aunt for the Greek word for a female dog, which turns out to be skýla. The aunt was later surprised to hear her niece, in Greek, calling the dog "bitch."
(And contra 56 I didn't see anything here to indicate "the pediatrician was absolutely motivated, consciously or not, by prejudice." Could be true, but could not be.)
I guess. I have trouble developing a theory of his* action that doesn't, at minimum, rely on infantilizing the Black parents and discounting the Black midwife in ways that I am very doubtful would apply in an all-white space. I mean, we know that Black maternal health is a disaster in this country, no matter what SES factors you include, and a huge chunk of it is because doctors treat Black women differently.
As I say, I think the article is glib on the central conflict, but I also don't think you can view this situation without the lens of "doctors do not treat Black and white women neutrally."
*do we know this?
My assumption was that worse health outcomes for Black infants are surely driven primarily by under-treatment not over-treatment?
I think that's an oversimplification. I would characterize it as "not listening/respecting what they have to say." Which, yes, is going to present most often as things like ignoring "I'm in pain," but it's also insisting on treatments patients don't want or need. Which I'm sure is exactly how it presented to the parents.
And over-medicalization of American childbirth is absolutely a problem--this isn't hippies vs rational medical professionals, it's a medical culture that says intervention is preferable as a rule, regardless of what the evidence says. American birth centers get comparable results to other first world countries, while American hospitals get much worse results even after you take out Black outcomes and adjust for SES.
67: did she...get the opposite of the point Mme Raissas was trying to make?
"So yeah, childbirth is much easier if you get someone to do all your other work for you." "Hm, sounds like a slave." "Yes, exactly! Slaves for everyone!" "Wait, what?"
Birth centers risk out the complicated cases, which diverts them to the hospitals. They ought to have a better set of outcomes!
Admittedly, my prejudices run the other way of JRoth's, as my sister's attempt to have a low intervention birth led to the midwives missing a very probable COVID infection (they had it, sis had symptoms but didn't want to test), labor didn't start naturally, so they risked her out at 42 weeks. She wanted to wait till 43 weeks (this is the point where we had Words.) Baby delivered through crash section at 42w1d when the placenta failed in labor, but that's not the hospital's fault. Placenta was a crunchy mess. Baby was purple and post term but fortunately fine and now is the toddler terror of story time.
The birth center's near disastrous management of her case doesn't show in their stats, though!
The last time I looked at the stats, I thought something like that would show up in the birth center's outcomes; once they've accepted a patient through pregnancy, the outcome is an outcome for a birth center patient, even if the situation developed such that the birth center couldn't safely do the delivery.
Oh, maybe not -- I'm looking for stats and what I'm finding is for patients who began labor still planning to give birth in a birthing center, which would exclude your sister. I could have sworn I'd seen stats calculated the other way -- tracking outcomes for anyone who was a patient at a birthing center during the pregnancy -- but it's been ten years since I've thought about the issue and I might easily be wrong.
The baby is getting sent back to their parents, thank goodness. https://www.cbsnews.com/news/temecia-rodney-mila-jackson-returned-home-birth-jaundice-texas/
It's still a travesty that it took this long, but it might be over for now.
86: Good, but they arrested the dad in the process of taking the baby, so that will redound if they aren't pressured to drop.
Birth centers risk out the complicated cases, which diverts them to the hospitals. They ought to have a better set of outcomes!
That's taken into account in all the stats I quoted, sorry I wasn't explicit.
Birth centers aren't reliably able to track outcomes for people who leave the practice for fairly obvious reasons, but it's not (at least at ours) systematic: if they know the outcome, it goes in the stats.
Birth centers risk out the complicated cases, which diverts them to the hospitals. They ought to have a better set of outcomes!
That's taken into account in all the stats I quoted, sorry I wasn't explicit.
Birth centers aren't reliably able to track outcomes for people who leave the practice for fairly obvious reasons, but it's not (at least at ours) systematic: if they know the outcome, it goes in the stats.
"Greek word for a female dog, which turns out to be skýla. The aunt was later surprised to hear her niece, in Greek, calling the dog "bitch."
I COULD HAVE TOLD THEM THAT.
84, 85: I suspect even that wouldn't help because, at least over here, they select out high risk pregnancies quite early on and when the time comes they get hospital deliveries. So a diabetic or overweight or COPD mother would always be designated for a hospital birth, because she's high risk (more than two thirds of our births in the region are high risk).