Cary birth center's staff, standards facing third investigation

A third state agency is now pursuing an investigation of staff conduct and safety standards at Baby+Co., the natural birthing center in Cary where four newborns have died since the facility opened 3 1/2 years ago.

Raleigh pediatrician Mary-Cassie Shaw said a investigator from the N.C. Medical Board called her last week to discuss Baby+Co., and followed up by email this week with additional questions. Shaw said she spoke for an hour with the investigator, Don Pittman, describing her concerns about what she considered to be substandard newborn care at the birthing center.

The N.C. Medical Board, which licenses doctors and other health care professionals, does not confirm or deny pending investigations. But those like Shaw who are interviewed by the board's investigators are not bound by the confidentiality rules and are free to discuss the matter, said board spokesman Jean Fisher Brinkley.

Brinkley confirmed that Pittman is a senior investigator for the Medical Board.

Shaw said none of the issues she and her colleagues at Oberlin Road Pediatrics noted were life-threatening. Rather, they indicated sloppy record-keeping about the newborns' health and lack of communication with first-time parents about infant health records. In some cases Oberlin Road Pediatrics had to send newborns from Baby+Co. to a local hospital for hearing tests to complete their records, Shaw said.

Shaw said Oberlin Road Pediatrics did not experience such frustrations with babies born at Triangle hospitals or at the Women's Birth & Wellness Center, a natural birthing center in Chapel Hill. After repeated requests to provide complete infant health records, the concerns about Baby+Co. became so prevalent about two years ago that Oberlin Road Pediatrics stopped accepting babies born at Baby+Co.

"There was no pediatric information going on," Shaw said. "The families would be completely clueless."

The Medical Board's investigation comes as other state agencies are looking into the Cary center's staff and standards, and as several state lawmakers are saying it's time for the state to regulate natural birthing centers like other health care facilities. North Carolina is one of a handful of states that allows natural birthing centers to operate without a state license and without regulatory oversight.

Family wants answers

Democratic Sen. Mike Woodard, a Duke University administrator and one of the members of the Joint Legislative Oversight Committee on Health and Human Services, told fellow committee members on Tuesday that one of the recent infant deaths at Baby+Co. involved one of his constituents.

On Wednesday, Woodard said in a phone interview that the woman, who lives in Durham, contacted him and explained the circumstances of her delivery. The newborn went into cardiac arrest almost immediately after birth in October, Woodard said, and Baby+Co. staff were unable to revive the child.

Woodard said the family has not received satisfactory answers about the circumstances surrounding the death of their child, according to emails the woman sent to Woodard, portions of which the lawmaker read to The News & Observer with the woman's knowledge.

"We are still struggling to find the answers we need to explain his very short life," she wrote. "I was led to believe that I chose a birthing center capable of serving my low-risk birth, my healthy baby, and using emergency medical care expertly."

Other investigations

Last week, at the urging of Rep. Nelson Dollar, a Wake County Republican, the N.C. Department of Health and Human Services sent a letter to the company asking it to voluntarily allow the agency to conduct a safety review. The results of the health department's review would be released to the public, as if the agency were reviewing allegations or complaints against a hospital or nursing home.

In addition, the N.C. Board of Nursing is investigating a complaint against a nurse midwife who is currently employed at Baby+Co. Nursing board spokesman David Kalbacker said the March 23 complaint did not come from a woman who gave birth at the center or arise from the midwife's work at the center.

The Medical Board also has no authority over birthing centers but licenses and disciplines physicians, including those acting as medical supervisors for nurse midwives at birthing centers. The board's oversight includes authority to issue warnings to doctors or suspend their licenses for professional misconduct.

Natural birthing centers accept low-risk pregnancies and deliver babies without pharmaceutical pain killers and without continuous fetal monitoring equipment. Baby+Co. is accredited by the Commission for the Accreditation of Birth Centers, in Pennsylvania, and the Cary site has an agreement with WakeMed Cary hospital to transfer delivering mothers and newborns who develop medical complications.

Baby+Co. has reported three newborn deaths in the past six months, and four since the facility opened in October 2014. The company suspended deliveries last month as it conducts an internal review of its procedures, and reiterated on Wednesday that it intends to reopen as soon as it is assured that its policies and practices are safe.

Baby+Co. has indicated it will cooperate with the Department of Health and Human Services, whose review will take two to three days, but first wants to hold a meeting to learn about the process and "to set a framework for evaluation," according to its response to the agency. State health secretary Mandy Cohen said Tuesday, after a state legislative committee hearing in Raleigh at which she updated lawmakers about Baby+Co., that her agency would review the Cary birthing center like any other health care facility regulated in the state.

"I don't want to be negotiating on the terms on what kind of investigation we do," Cohen said. "Doing part of an investigation is not an option here."

The meeting between Baby+Co. and the state health department has not yet been scheduled.

Shaw is the first doctor to publicly speak out about Baby+Co. She said Oberlin Road Pediatrics typically receives documentation on about 20 newborn screenings and tests. But instead Baby+Co. "documented everything and nothing at the same time."

"It was 40 pages of nothing you need," she said, describing the records as data pertaining to the mother's heart rate and labor, which is irrelevant to a pediatrician.

A typical post-birth pediatric visit for a newborn takes about a half-hour, Shaw said. But Baby+Co. moms required considerably more time to be brought up to speed on infant health. Shaw recalled one visit requiring two full hours.

She added that some new parents were "floored" to learn things that she considered standard care instructions they would have learned at any area hospital and obstetrician. "Literally these patients would look at me like I had two heads," she said.

This story was originally published April 11, 2018 at 5:43 PM with the headline "Cary birth center's staff, standards facing third investigation."