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Atlanta doctor focus of natural birth controversy

Her babies were far along when her doctor gave the bad news: The twins were in breech and sideways positions. Prepare for a cesarean section, her doctor said. But she wanted a vaginal birth and moved to Atlanta to see a doctor who would give her one.

Another mom saw the same Atlanta doctor, known for shepherding riskier patients through natural births. She was 43, an age where pregnancy risks are increased, and three and a half weeks past her due date.

Both deliveries had complications, with consequences for a baby in one case, and for the mom in the other.

Yet the mother of twins is now among an avid following of women and men who credit Dr. Brad Bootstaylor for giving them options they can’t find elsewhere. The other mom is among women who have sued him. Her suit says she suffered severe injuries when a C-section wasn’t done until she’d been trying to give birth for 60 hours.

Despite good doctors’ best efforts, disability and death can happen to mothers and babies. Bootstaylor’s record has something extra, a question presented when a doctor offers women choices that other doctors resist: Is he a guardian of the natural power of birth, or a reckless practitioner who steers women from help they may need?

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Years of concerns from medical researchers and patients about high cesarean rates and birthing practices that seem to be for the physician’s benefit have sparked a wide-ranging movement toward “natural birth.” In metro Atlanta a fervent portion of those advocates sees Bootstaylor as its irreplaceable champion.

“I searched high and low; Dr. Bootstaylor was the only doctor to give me options,” said Erika Oliver, a Fulton County resident who gave birth vaginally to her fourth child this year after three previous C-sections. “This is our body, our children, and we should have a say in that.”

Bootstaylor said he fully informs his patients so that they can be responsible for their own decisions, and that it’s “never true” that there’s only one safe course. “Regarding birth and options, it’s a charged process here in the United States,” he said. “The question is who has the autonomy to make decisions about that.”

But others are concerned that a backlash over high C-section rates and doctor-assisted deliveries could be swinging the pendulum too far the other way, discounting science and physicians’ best judgments and shaming women who go the more traditional route.

Dr. Amy Tuteur, a Boston-based blogger who takes on what she calls the “natural birth industry” under the handle “Skeptical OB,” has railed about Bootstaylor online. She said that obstetrics may be paternalistic, but the natural birth movement has become a vehicle for some doctors who develop a cult following and engender their own brand of paternalism. “His supporters would prefer to see him as being discriminated against for his philosophy,” she told the AJC, “when he’s really being held to account for his skills.”

Dr. Kurt Wharton, who helped write national guidelines for decreasing doctor intervention in birth, said doctors should have enthusiasm for natural childbirth, but it is also their job to make some medical calls. “We want to make sure it’s safe for the mother and baby at all times…There’s no reason people can’t practice in that balance. There’s no excuse for being at the extremes.”

The debate is playing out in court cases, emotional posts on social media, and Bootstaylor’s own company web posts. But if medical authorities have an informed opinion that could help guide women, they are not sharing. The state medical board has been silent on Bootstaylor’s practice. A hospital where Bootstaylor no longer works says any information they may have about his relationship with them is confidential. A midwife practice that parted ways with him wouldn’t return calls.

That leaves patients to figure it out themselves, in situations that can have lasting implications.


Doctor “persecuted”

The parents of the twins, Jessica and Kevin Hake, raised their strong desire for a vaginal birth with their doctor back home in the Savannah area, to no avail. Then by chance they heard about Bootstaylor and his practice, SeeBaby, and moved to Atlanta for the final month to give birth with him. The practice employs midwives who promise women options and “empathetic, non-judgmental and informative” care.

Bootstaylor’s mantra is “Bring birth back.”

With him, they got a vaginal birth.

During delivery, the baby who was sideways broke her upper arm bone. “However, the See Baby doctor and midwife did a fantastic job of quickly and skillfully dealing with the complication,” the parents wrote in a long testimonial that SeeBaby posted online. The AJC has not reviewed the family’s medical records and could not reach the couple for comment.

“We wouldn’t have traded Dr. Bootstaylor for any doctor!” the post also says. “His expertise and skill and passion for what he was doing was like watching an artist work…At five weeks the bone is already fully knit back together and (the baby) uses both arms with equal ease and comfort. The surgeon assures us that by 6 months even an x-ray won’t be able to detect a fracture ever existed.”

They made their comments at a critical time for Bootstaylor. He was leaving DeKalb Medical Center, and they wrote they were horrified to learn their baby’s birth was the cause of problems for him at DeKalb Medical Center.

Bootstaylor was being “persecuted,” they lamented, for helping them.

It wasn’t the first time Bootstaylor’s supporters had his back. The website Decaturish reported how earlier, parents demonstrated to protest DeKalb Medical’s decision to temporarily suspend water birth, and, the protesters said, additional procedures such as vaginal breech births primarily or only provided by Bootstaylor.

At that time, Katie Kissel was preparing to give birth with Bootstaylor, and she was outraged. With her first birth her doctor, a woman, “completely disregarded and devalued me as a human,” she said. Bootstaylor made her feel heard. “They were the only way I could guarantee to get everything I wanted,” she said. “I wanted a water birth. I wanted to be in a hospital. I wanted to be someplace safe…And I wanted my baby to be delivered by a midwife if at all possible.”

After the suspension of the procedures was lifted, Kissel gave birth exactly how she wanted. “It felt great,” she said.

But she also said that she believes the women who came forward with traumas that they say resulted from Bootstaylor’s care.

“As mothers, as people, the fact that we don’t have access to legit investigated claims against doctors is absurd,” she said.

Among the women who see their experience with Bootstaylor differently is Christina Breitenfeldt, the 43-year-old who says she labored for 60 hours.

Her lawsuit against Bootstaylorhis practice, a midwife there and DeKalb Medical says when her team finally attempted to induce labor, well past her due date, the baby’s size added to her increased risks. While the average full-term newborn is between 7 and 8 pounds, her baby turned out to be 11 pounds, 9 ounces.

According to the suit, pending in DeKalb County court, induction was attempted over two and a half days until a C-section was done. Afterward, the suit says, she left the hospital with a hole between her uterus and bladder that allowed blood and urine to flow together. Until repaired, the condition can cause incontinence, menstrual blood in urination, lack of menstruation and infertility.

She and her attorney declined to comment.

Bootstaylor told the AJC that none of the lawsuit’s allegations are true, and he told the court that her injuries are “the result of matters beyond the ability of medicine, which is inherently an inexact science” and that her suit should be dismissed.

“Lawsuits are just that, claims,” Bootstaylor told the AJC. “Anyone can make a claim.”

DeKalb Medical declined to comment on Breitenfeldt’s lawsuit or suits by three other families involving Bootstaylor’s deliveries, though in court it called for their dismissal. The other suits also allege mothers and babies were harmed by mistakes, including allowing midwives to manage induced labor with a patient who’d had a cesarean, which the patient says contributed to uterine rupture and her baby being severely damaged; failing to evaluate and recognize signs a baby’s umbilical cord was compressed, leading to severe neurologic injuries; and unnecessarily prescribing a woman a drug that delays delivery, leading to magnesium poisoning for both her and the baby and seizures, kidney failure, respiratory failure and brain injury for the mother.

Bootstaylor no longer delivers babies at DeKalb Medical.

The hospital told the AJC that any records it may have of complaints or actions affecting his privileges to practice there are confidential by law. Asked why he left, hospital spokeswoman Cheryl Iverson said only that “We discontinued some services that our medical staff deemed to be not safe. The only person doing those services at the time was Dr. Bootstaylor.”

A Facebook page touts Dr. Brad Bootstaylor as a top doctor. He told the AJC that he wouldn’t have been voted a top doctor for maternal and fetal medicine “if one percent of what has been suggested out there in some secretive groups is true.” (The Atlanta Journal-Constitution)

Bootstaylor says he left of his own accord, to be in a more supportive environment.

“I want to correct,” he told a reporter. “There was no suspension.”

If anyone had filed complaints with the Georgia Composite Medical Board, they are confidential and have not led to any public discipline. Bootstaylor’s profile on the board’s website shows no malpractice settlements that meet the board’s threshold. Physicians are required to report them if they have four or more, or if they have three with one settlement over $100,000 or one over $300,000.

Bootstaylor lists privileges at six Atlanta-area hospitals, though he now primarily practices at Atlanta Medical Center, returning to a facility where he had practiced years earlier.


Father haunted

That’s where Dara Ashworth saw him, back in 2011.

She was different from other parents who seek him out because they want vaginal birth, no matter the risks that other doctors say they face.

Yes, she wanted a more natural birth experience. For most of her pregnancy, she saw midwives and only knew of Bootstaylor as their available backup if a doctor needed to weigh in.

But she would accept a C-section, if that’s what fate and her body presented.

A week after she passed her due date, she saw Bootstaylor for a checkup. During the office visit on a Friday morning, Bootstaylor showed her and her husband, Mark Ashworth, a computer screen with a troubling test. She was 37, “advanced maternal age,” when the risk of stillbirths starts to rise. Her baby’s score was six out of 10, showing full points for the heartbeatmuscle tone and amniotic fluid, but little or no movement, or reaction to stimuli, such as mild shocks and her jumping and rolling around.

“That haunts me,” Mark now says.

Mark asked Bootstaylor at what point they would induce.

They didn’t need to yet, he said. He suspected natural labor would come soon, even by that weekend. If it came to it, he told them, she could probably even go another week or two. “Holy moly,” Dara said she thought.

The couple went home, and, indeed, Saturday night Dara went into labor. But when she got to the hospital, the heartbeat detected Friday morning was gone. The baby had died. She still had to give birth, so after 30 hours of labor their daughter Ulli was stillborn.

Dara and Mark Ashworth hold a photograph of their stillborn baby Ulli at their home on Tuesday, October 20, 2018. Dara and Mark Ashworth lost their first baby, Ulli, in a stillbirth in 2011. One day she had a heartbeat, the next day she didn't. They say Dr. Brad Bootstaylor showed them test results indicating there might be a problem, but sent them home anyway to await natural birth. They are haunted by whether they could have pushed the doctor to change his mind. (HYOSUB SHIN / HSHIN@AJC.COM)

The Ashworths spent years blaming themselves. They never sued.

“In those moments of grief there was no bringing her back,” Mark said. “Suing someone for the loss of something that can never, ever be replaced is pointless…No lawyer. No.”

What he did, when he saw Bootstaylor a few days later, was to confront him. “You did this. You let us go,” he recalls telling him. “If there is anything good that will ever come out of this…you need to promise me that the next time it will be dealt with differently.”

Amy Wells, the midwife who worked with the couple, also was angry. “I remember when the baby was delivered — she looked at the baby and said, ‘My baby’s dead,’ just crying. It was terrible,” Wells said.

Wells, who spoke with the AJC with permission from the Ashworths, said she was amazed that Bootstaylor sent the couple home the day of the troubling test. After the baby’s death, she quit the midwife practice that used him as its backup physician, telling the owner she was not comfortable with him.

As luck would have it, the Ashworths later found themselves in a similar spot with a second pregnancy, when their new doctor’s practice gave the same test. This time, the staff returned with a wheelchair and said urgently it was time to go give birth. Their second daughter is 4, bright and rambunctious.


Cryptic announcements

Bootstaylor now seems to be at a turning point in his practice, in a drama he has helped to fuel in social media.

On Oct. 2, he posted on Facebook that SeeBaby was a “monumental undertaking” and instead of continuing “I’ve chosen to spend more time with my wife…and family, thereby as of October 31, 2018, See Baby Midwifery will cease to exist in its present iteration.”

He has also denounced a private Facebook group of women concerned about the care they got.

That group includes Amber Khan-Robinson. She said several unsuccessful forceps attempts left her daughter with bloody gashes on her scalp, and that her eventual C-section by Bootstaylor injured her bladder, which he immediately repaired, and required followup emergency surgery by another doctor to repair an incisional hole in her abdomen where more than a foot of her bowel slipped through. Bootstaylor had dismissed the lemon-sized bulge in her stomach afterward as scar tissue, she recalls, telling her, “‘You may want to see a plastic surgeon sometime later in your life.’” Pain lying down now disrupts her sleep, and her husband wakes her up in the night so she can ease it by going to the bathroom. She said that without telling her, Bootstaylor blogged in detail about her case on a Georgia birth group’s blog, using her actual initials. Internet acquaintances saw the post and let her know. Bootstaylor’s take was that “Patient A. K-R is healing well, both physically and emotionally; sharing with me that she would do it all again, if given the choice.”

Her take, in an interview with the AJC, was that nothing could be further from the truth: “For the first two years I cried every single day.”

Bootstaylor called the Facebook women a “hate group” guilty of “cyber-bullying.”

Dr. Brad Bootstaylor works with midwives at SeeBaby, which is in the process of being renamed Gifted Hands Midwifery. (The Atlanta Journal-Constitution)

After first hinting that he was shutting down his practice, Bootstaylor made another cryptic announcement later in October.

“When we announced that we would not be doing this after October 31 there was a wide outpouring of love and support and shock and amazement and hurt,” Bootstaylor said. “What we’ve done here at See Baby is rally around me to make sure that I’m whole and healthy, but also to figure out a way to continue providing a service to mothers and families.”

His fans rejoiced.

In late October, he said he would transfer his practice to one of his midwives and serve as their backup doctor. SeeBaby will now become Gifted Hands Midwifery. At a recent meet-and-greet, they assured prospective patients that little in how they practice will change.


C-SECTION RATES

Nearly a third of U.S. births are by cesarean section, a number that may be half again as high as it needs to be, according to researchers. The procedure is a surgery with its own risks. Experts are making some progress convincing U.S. doctors to back off of doing cesareans so often, but face headwinds. In 2016, the latest year available, U.S. hospitals performed 1.3 million C-sections. This is the trend over time among all U.S. births.

  • 1995: 20.8 percent
  • 2000: 22.9 percent
  • 2005: 30.3 percent
  • 2010: 32.8 percent
  • 2016: 31.9 percent

Sources: Centers for Disease Control and Prevention; the Journal of the American Medical Association

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