Danielle Yeager once believed she would never be able to have children.
In 2012, she was diagnosed with stage 1 cervical cancer and feared she would never become pregnant due to treatment and possible complications that could affect fertility.
When the casino employee became pregnant in 2013, she and her husband Michael were overwhelmed with joy.
She never imagined that her first-born child, Gavin, would die a few months later after the midwife who delivered her son saw no signs that his heartbeat was slowing.
While Ms. Yeager, then 28, was cared for throughout her pregnancy by midwife Christy Collins, she was unaware that the supposed birth expert was actually practicing midwifery without a license.
Ms Yeager told : “If she had sent us.” [to the hospital] Just a little sooner he would be alive. But instead… she sort of played God with us.'
Danielle Yeager at her baby shower in 2014. The Las Vegas casino worker had wanted a natural birth at home to give birth to her first-born child
Ms Yeager said her midwife Christy Collins repeatedly dismissed her concerns until it was too late for doctors to save her newborn
And experts say that unfortunately, Ms. Yeager is far from the only expectant mother who hired a midwife and later found herself in this tragic position.
Midwives are specialized health professionals who care for mother and child during pregnancy, during birth and for several weeks after birth. They are not licensed doctors and have a limited scope of practice.
The Florida Council of Licensed Midwifery, which meets only three times a year, has taken disciplinary action on only 36 of 170 midwifery complaints over the last decade, USA Today reported.
At least 10 of those complaints involved fatal incidents.
A Washington Post investigation into the Maryland Board of Nursing, which oversees midwives, faces a backlog of more than 6,200 unresolved complaints filed against thousands of nurses and midwives.
There are very few statistics on deaths of babies cared for by midwives because state laws vary, reporting methods vary, and investigations are incomplete.
According to experts, the problem lies in the different qualifications of midwives across the country.
The American College of Obstetricians and Gynecologists (ACOG) acknowledged that a lack of standard rules for midwifery could lead to unnecessary harm to mothers and babies.
The organization told : “ACOG is committed to implementing the International Confederation of Midwives standards in all states.”
“All midwives – regardless of their title or designation and regardless of where they practice – should meet the ICM standards. Patients in every state should be guaranteed care that meets these important minimum standards.”
Midwifery practice tends to take a more holistic view and supports natural approaches to pregnancy and birth. There are three types of midwives: certified midwives; certified midwives; and certified professional midwives.
Certified nurse midwives are trained nurses with college degrees and medical training. Certified midwives have a college degree but do not have a nursing license. And certified professional midwives rarely have advanced medical training or skills and usually learn through training with more experienced midwives.
A Healthgrades profile for Ms. Collins says she is a certified professional midwife (CPM).
After struggling to find an obstetrician she felt comfortable with, and on the advice of a friend, Ms. Yeager considered hiring a midwife. When she found Ms. Collins, she decided to be her sole doctor for the duration of her pregnancy and a home birth.
Home births accounted for 1.4 percent – 51,640 – of the 3.6 million births in the United States in 2021, a 12 percent increase from the previous year and the highest since at least 1990, according to data from the Centers for Disease Control and Prevention showed.
A 2017 report from ACOG found that planned home births were associated with a two-fold increased risk of perinatal death and a three-fold increased risk of neonatal seizures and severe neurological dysfunction.
Although midwifery services have increased, ACOG recommends that hospitals are the safest place to give birth.
Many home births are attended by midwives, although the exact number is not known.
A 2020 analysis of infant death registries found that the neonatal mortality rate for all planned, midwife-attended home births was 13.66 per 10,000 live births. A separate study found that the neonatal mortality rate for physician-managed hospital births was 5.9 per 10,000 deliveries.
Experts have called these “tragic” deaths “preventable situations,” but the increased risk could be due to wide differences in the training and regulation of midwives across the country.
In the United States, 13 states have no regulation of certified professional midwifery practices. Of those, five—including Nevada, where Ms. Yeager gave birth—are actively considering legislation that would require CPMs to be licensed, and five are currently drafting licensing laws.
Three states – Nebraska, Kansas and Mississippi – have no regulations in effect and are not considering or planning legislation.
When Ms. Collins was caring for Ms. Yeager from late 2013 to February 2014, she was practicing at the Las Vegas-based home health clinic Sweet Birth – but she had moved to the city sometime after her probation in California.
A Los Angeles court sentenced her to three years probation and a nearly $10,000 fine in January 2012 after the California Board of Medicine caught her practicing midwifery without a license.
The ruling placed Ms. Collins on probation, meaning she could not practice without a license, but it did not prohibit her from crossing state lines to provide her services. Shortly after moving to Nevada, where midwifery care doesn't require a license, she slipped through the legal cracks.
Nevada's “Wild West” nature, Ms. Yeager told , allowed Ms. Collins to repeatedly lie about her medical background and obscure the fact that she and her baby were in danger when an ultrasound technician failed to detect amniotic fluid found near the baby and shirking responsibility by moving to another state.
Ms. Yeager also said her midwife repeatedly discouraged her from going to the hospital.
She told : “When I met my midwife she actually made me think.” [we] I hired a nurse midwife. I didn't know the difference between a certified nurse midwife and a certified midwife.
“And of course when you hear the term ‘certified professional,’ you think, ‘Wow, they have letters like a doctor.’ You don’t think that means nothing. It's a made up title. So I was totally like, Oh, she's doing ultrasounds and tests and she's more medically minded. She is perfect for us
“But no, she wasn’t a midwife. She was CPM and most of what she told us was a lie.'
In February 2014, at 42 weeks pregnant, Ms Yeager was already overdue – a full term pregnancy is between 39 and 41 weeks – and she became increasingly concerned when Ms Collins told her it was “no big deal”. beyond their due date.
But when Ms. Yeager's mother kept insisting that something was wrong, Ms. Collins sent her patient for an ultrasound.
Ms Yeager said: “To reassure me that everything was OK, she sent me for an ultrasound to physically show me that my baby was fine. “Then we can go ahead and proceed with the home birth as planned.
“And so we went for an ultrasound, but my son said no [amniotic] Liquid. Everything else was fine. “Everything was good, but there was no liquid in it at all.”
But the mom-to-be said the ultrasound technician didn't tell her – he just said the results would “go to your midwife.”
Amniotic fluid acts as a protective barrier around the fetus, regulates the temperature in the uterus, provides the fetus with important nutrients, and helps ward off infections.
Without this crucial cushion, a baby's lungs may not grow properly, which can lead to breathing problems at birth.
Ms Yeager said her midwife told her to drink more water, go for a walk and then go home and take a bath. She gave her an “herbal mixture” and sent the couple home with a portable ultrasound machine to monitor their baby's heart rate. Ms. Collins said to call her if the heart rate dropped and didn't rise again.
When asked if they should see a doctor, Ms. Collins said no.
Speaking to USA Today in 2018, Ms. Collins told the publication that she had repeatedly urged Ms. Yeager to seek medical attention, but that her client had refused.
However, according to the USA Today investigation, text messages, medical records and interviews with other sources confirm the family's account.
Ms Collins did not respond to a request for comment from .
Meanwhile, the midwife had asked a colleague to post a public inquiry about her client's health on Facebook and was waiting for other doctors to comment on the post.
She told Ms. Yeager she had contacted her “mentors,” but Ms. Yeager said the post had spread like wildfire and received hundreds of comments. All calls for Ms. Collins to send her client to the hospital were deleted almost immediately after they were posted, she said.
A follow-up examination revealed that Gavin's heart rate had dropped to 90 beats per minute, well below the healthy range of 120 to 160 beats per minute.
Finally, Ms. Collins suggested going to the hospital, but not the one nearby – a facility 30 minutes away. After arriving and a brief examination, Ms Yeager was rushed into an emergency caesarean section to deliver Gavin.
The little boy was born alive but was not breathing and the medical team found he was covered in meconium D, or feces. He had sucked it back into his airway and was in great distress. Doctors were unable to revive him.
Ms Yeager told this website: “You did your best but you just need more time… If she had called that morning he would be alive.”
“But instead…she kind of played God with us and said, 'It's no big deal.'”
When a midwife-assisted birth results in the death of a baby, grieving parents typically have little recourse.
Lawsuits against CPMs are rarely pursued because midwives are not required to carry medical malpractice insurance, and complaints against midwives remain in several states that do not have laws.
CPMs are certified by the North American Registry of Midwives (NARM).
NARM told the Post that it had revoked the licenses of 10 of the more than 4,300 midwives it has certified over 30 years, but the reasons were not disclosed.
Because CPMs operate without established national standards, there is little, if any, accountability if a home birth goes wrong.
In Ms. Yeager's case, her midwife fled the state after she gave birth.
She said: “She disappeared when my family started asking her questions, like where did she go to school, where is she from?” They wanted to know a little more. And it turned out she was from California because she was on probation as my midwife. She was practicing there without a license.'
Ms. Yeager, who now has a six-year-old son born by planned cesarean section, added that her family had asked California authorities for help but received none.
She said: “They said, 'If there was even a law in Nevada about midwives, we would pick her up and she would go to jail because she was on probation.'
“But because you have absolutely nothing, all I can do is present it to a judge and do it [her probation] go a little longer.'
Ms. Collins moved to Florida, where she currently resides. Her Facebook page, under a different name, previously said she was a midwife and had studied midwifery at the National College of Midwifery, but this has since been deleted.
Determined to help other women avoid their tragedy, Ms. Yeager has been vocal about changing the laws surrounding midwifery and frequently posted on a Facebook memorial page for Gavin.
Gavin would have turned 10 this week.
She wrote on his birthday: “I have spent almost ten years doing my best to warn others not to end up like this. “I have witnessed so many families lose a child over the years… I have listened to every story and felt all their pain and trauma. They know exactly what they've been through and what their lives will now look like forever.
“I've tried so damn hard to change laws in my state and other states, but laws are not for good people.” There are laws that allow the bad guys to tiptoe around.
“As these years passed and I watched the world continue to turn, I realized that there was only one thing I could give Gavin for his 10th birthday. Since I couldn't give him justice or change, I wanted to give him love.
“We don’t mourn Gavin for negative reasons or bad feelings.” We mourn Gavin out of love. True, pure love. That's where the pain comes from. How much love we feel for him, even without him here. Anger is my passion because my love flows so deeply through my veins and into my soul.'