Legal problems sent midwife to Utah, where another baby died

Valerie El Halta has attended more than 3,000 births. She has written oft-referenced articles and books on her trade and has been a mentor to many students. She has been described as "acclaimed," "veteran," and "a pioneer" in the midwifery community.

Now El Halta, 71, of Eagle Mountain, faces charges of negligent homicide, unlawful conduct and reckless endangerment in the home-birth death of a Moab infant. Investigators claim she used drugs and medical instruments that only physicians should use, on a mother whose medical history indicated high risks. The baby died, and the mother nearly bled to death, prosecutors say.

According to the court docket, El Halta is expected to settle the case Tuesday by entering a plea in 7th District Court in Moab.

This is not the first time El Halta has been accused of straying beyond her expertise. It is not her first encounter with the law, nor her first delivery that ended with a death.

But for decades she has remained committed to natural childbirth, and some clients say she has helped countless women avoid complicated surgeries and provided choice in births where hospitals may offer few options.

"They'll have to cut off my hands to stop me," she once told a Michigan newspaper.

—

'I have birthing hands' • "What is normal birth?" El Halta asked in a 1998 article for Midwifery Today. "I wonder if we really know anymore. The modern birth has been so managed, arranged, choreographed, augmented, drugged, sliced and diced that many of us have forgotten its very nature."

El Halta began practicing in California in 1970s after she delivered two of her own children at home, according to an online biography. In her writings, she professes a philosophy of trust in a woman's body to deliver babies safely. In contrast, she argues, obstetricians see birth as dangerous, and "the majority of young women have come to believe their bodies are incapable of giving birth without a physician by their side," she wrote in 2001, also for Midwifery Today.

El Halta attended home births for about seven years in California, at a time when lay midwifery was strictly forbidden. In 1983, she was charged in Manteca with two felony counts of practicing medicine without a license and a charge of illegally possessing a hypodermic syringe, according to an article in The Modesto Bee. El Halta pleaded guilty to reduced misdemeanor counts. She had performed more than 500 births without a nursing license — a requirement that since has relaxed.

After pleading guilty, she told reporters, "I'm going to move to Oregon as soon as possible, where I can practice legally."

"I have birthing hands," she said.

For years, Oregon and Utah were the only two states where licensing was voluntary, according to data from the Midwives Alliance of North America and The Big Push for Midwives, but Oregon passed restrictions for unlicensed midwives this summer. Thirteen other states neither license nor forbid non-nurse midwives. In 10 states, non-nurse midwives may not practice legally.

—

'Lia's not breathing' •

El Halta went on to attend home births in Oregon and then trained interns in Texas before opening The Garden of Life Birth Center in Dearborn, Mich.

"This birth center was unique in that it was completely unattached to a hospital, or a medical board of directors," El Halta wrote in a biography posted on a former client's website.

But one former patient says her baby died shortly after delivery at the center — possibly because she was not taken to a hospital quickly enough.

Rebecca Malloy was pregnant with twins in 1993 after having two other children via cesarean section. She said she wanted to deliver naturally but doctors deemed her pregnancy too high risk for a vaginal birth after a cesarean — known as a VBAC. El Halta, however, was willing to attend.

"She told me she had given birth to many twins and put me in touch with a number of people," said Malloy, of Macomb Township, Mich. "So, after a lot of flak from my family, I continued with her."

In May 1993, Malloy delivered the first baby, Lia Joy, after 27 hours labor. After a brief attempt to nurse, Lia "was whisked away," Malloy said.

"I kept asking to see her, but [El Halta] said, 'We want you to concentrate on delivering your next baby.' "

When the second twin was born, Malloy said she asked to get a photo with both babies, but El Halta delayed, saying Lia needed a vitamin K shot.

"The next thing I knew, my husband was putting on his shoes. He said, 'Lia's not breathing.' 911 was called. I started screaming. I didn't know what was going on. I couldn't sit up or anything."

Lia was taken to a hospital, where she died after three weeks on life support. Lia's twin thrived. Doctors told Malloy they couldn't know whether Lia would have lived had she been born in a hospital. Malloy said she will always wonder.

"Valerie ... wasted, like, a whole hour," Malloy said."She played god. She had this ego: She was the guru of birth. Valerie knew there was a problem, and she withheld the information from us."

Malloy sued El Halta and said she received a $1 million default judgment, but attorneys deemed El Halta to be "uncollectable," Malloy said. Non-nurse midwives generally are not required to carry malpractice insurance.

"It wasn't in my nature to sue, but I wanted her to close her shop," Malloy said. "I wanted a formal apology."

El Halta has declined to comment on this story, and her attorney did not return calls.

—

'Auntie Val knows best' • El Halta continued to deliver babies — or "catch" them, in midwifery parlance — and train students in Michigan. Her practice grew in profile, and she rose as an expert in dealing with abnormal fetal positions. Her methods for assessing risk in breech deliveries and rotating babies remain broadly recommended for midwifery students today. In 1998, she was quoted in the landmark women's health book "Our Bodies, Ourselves," saying:

"When a new client comes to me and asks about what kind of instruments or tools I use, I smile and hold up my hands. ... I am grateful for my hands and for the knowledge that they have all by themselves."

The claim that medical technology is overused in modern births is a hallmark of midwifery. Patient Kya Rose, of Lansing, said she went to El Halta for her son's birth in 1996 precisely because she wanted to avoid instruments and drugs.

But rather than the "natural" childbirth she expected, Rose said El Halta subjected her to unwanted interventions. Without warning, she "stripped the membranes" — a procedure to separate the amniotic sac from the wall of the uterus and stimulate labor, Rose said.

"It was rough and painful, and she brings her bloody glove back out. 'I figured I'd just help you along,' she said. That was her attitude: Auntie Val knows best."

Rose said labor progressed slowly.

"When it wasn't fast enough, [El Halta] pulled out her vacuum extractor," Rose said. "She said that ... she'd been taught to use it by a doctor friend of hers. She was really proud of it. She was the only midwife who had one — probably for good reasons."

Rose said El Halta placed the cap of the vacuum on the baby's head to help suck him out, but part of Rose's cervix got caught in the vacuum.

"It was the single most painful thing Val did during my birth," Rose said. "She had both of her hands inside me. I was yelling at her to get them out, but she refused because she was helping. If someone has two hands in you, and you're telling them no, and they don't stop — that's why I call it a rape."

It would not be the last appearance of El Halta's vacuum, according to court documents.

—

'Burned at the stake' • "I have often come under harsh criticism for continuing to attend what many consider to be 'high-risk' deliveries," El Halta wrote in a 1996 article. "I remain adamant in my belief that these deliveries, while demanding great respect, do not necessarily portend greater risk to either mother or her baby."

What midwives should be allowed to do is a matter of heated debate among birth workers, doctors, legislators — and parents.

Utah allows three types of midwives. Nurse Midwives have the equivalent of a master's degree and typically work alongside doctors in hospitals or in birth centers.

Certified Professional Midwife is a title bestowed by the North American Registry of Midwives.In Utah, licensed home birth midwives must be CPMs. They may use certain prescription drugs but may take only low-risk clients — no breech births, no multiples and only certain VBACs.

Unlicensed, lay midwives are not regulated by any professional body but may conduct home births in Utah under a 2005 law.

Some midwives say licensing and regulation offers legal protection and credibility. Others say pregnant women have a right to choose how much risk to assume, and regulation only limits their freedom to decide where and with whom they wish to deliver their babies.

El Halta wrote that laws to license midwives actually were designed to prosecute them:

" 'Come out, little midwife, and we will give you your heart's desire,' they tell us. And we have come out, in our innocence and naiveté, only to be burned once more at the stake."

Believing that "midwives should be governed only by midwives," El Halta became a CPM in 1996.

But the North American Registry of Midwives revoked El Halta's certification in 2001. A panel found that she had strayed outside of her "Scope Of Practice" — a set of guidelines each CPM must write for herself according to her own expertise and state laws. Registry officials would not release details of the complaint but said El Halta has not attempted to regain her credential.

Instead, she moved to Utah and continued practicing as an unlicensed midwife, which allowed her to attend births that otherwise would likely result in C-sections.

—

'She was meant to do this' • "I want to be there for the woman who is told she is 'too old' to have a baby, wants a home VBAC, or who wants a vaginal breech birth, or has had six previous births," El Halta wrote in 1997. "When midwives allow their right of self-determination to be taken away, they seriously diminish the opportunities for women everywhere to determine their own child-birth destinies."

Eagle Mountain resident Liz Knight said she felt her options slipping away as her second baby's due date approached in 2010. Her first child was delivered via C-section after a failed induction. During the C-section, her son's face was cut by a scalpel, and Knight felt powerless.

"You're at the mercy of whatever [doctors] decide," Knight said, "even though you're paying for it."

For her second child, Knight found a doctor who agreed to let her attempt a VBAC. But at 38 weeks of pregnancy, Knight's blood pressure rose slightly, and her OB scheduled another C-section for the next week. Knight felt cornered and began to look at other options. She found that El Halta, a member of her church, had attended a number of home births in their ward.

"I had heard so many good things about Valerie from so many friends and neighbors — that she was so personal, so helpful, so knowledgeable," Knight said. "I looked her up online, and I didn't see anything bad at all."

At the last minute, El Halta offered the freedom to choose, Knight said.

"When you hire someone who's not a licensed midwife, you take on a risk. That's all there is to it," she said. "Some are so radical, they won't ever call 911. [Valerie] is not that person. ... She said, 'I know what I can and can't handle. If it's a circumstance I know is out of my hands ... I will get you to the hospital as soon as possible.' "

El Halta was inspiring and capable, Knight said — especially when the baby needed to be shifted into a better position for the birth.

"She was able to turn him a little bit, and he popped right where he needed to be," Knight said. "I think she was meant to do this. It's her gift."

—

'Profound trauma' • Court documents filed in connection with El Halta's criminal case allege how things went fatally wrong last year for a Moab woman's newborn:

In August 2012, a 41-year-old woman identified as C.B.W., began labor in her Moab home with her fourth child. Her previous three children were delivered by C-section. The mother had met four times with El Halta, who "held herself out to the mother as a midwife with substantial expertise in performing VBAC deliveries in the home."

El Halta arrived at the mother's home Aug. 17 and inserted a vaginal pill that she said she received from her son, a pharmacist. El Halta had "boasted ... that she used real 'medicine,' not herbal medicine." Investigators later concluded the pill was Cytotec, a drug used to induce labor despite warnings that it can cause uterine rupture and other complications. The mother received three more doses.

The next evening, El Halta "seemed to have become anxious that the mother's labor was not progressing." She allegedly performed a painful vaginal exam on the mother, saying, "Let's get this show on the road." El Halta explained she was "breaking scar tissue" and "just moving things along."

A few hours later, El Halta checked the baby's heartbeat, which slowed and sped up again. As the mother began to vomit and have diarrhea, El Halta became "agitated and snapped at the mother and her husband." The mother pushed for about an hour, but the baby slipped back into the birth canal. No heartbeat could be heard.

"[El Halta] panicked and grabbed a ... 'vacuum,' attached it to the newborn's head and pulled the newborn from the mother with one pull." The baby's arm was close to his head with the umbilical cord wrapped tightly around his body. His skin was blue, and he was not breathing.

El Halta performed CPR on the baby while 911 was called. She allegedly told the parents to "pray to whatever god they believed in." The mother, still at home, hemorrhaged about four cups of blood.

El Halta gave the mother injections of Pitocin, a prescription drug, to lessen the bleeding. She then tried to suture the mother, which she was not licensed to do, while 911 again was called, charges state.

The mother was taken to Moab Regional Hospital. The vacuum had caused "profound trauma" to the mother's vaginal area, causing "such severe bleeding that the mother would have died had there been additional delay in transporting her to the hospital," according to court documents.

The mother received multiple units of blood and plasma and was flown to a hospital in Grand Junction, Colo., for further transfusions to save her life. The baby died a week later at Primary Children's Medical Center of oxygen deprivation.

El Halta is charged in 7th District Court with unlawful conduct, a third-degree felony for which she could serve up to five years in prison. She was also charged with negligent homicide and reckless endangerment, both misdemeanors that carry a jail sentence of up to one year.

ealberty@sltrib.com