PERSECUTION OF HOMEBIRTH MIDWIVES IN FRANCE

In France, the pressures exerted on midwives practising homebirth became

ferocious in 2000. They led to criminal and disciplinary trials targeting independent
midwives or/and involved in the creation of out-of-hospital birth centres.
We will investigate how the French state is bringing this official or unofficial
pressure, by the mean of its legal or disciplinary institutions, how it does not hesitate
to disregard human rights, mainly by disrespecting the defence rights, leading biased
investigations, disappearing evidence and limiting access to pieces of the case.
This is all happening in a context of criminalisation of homebirth initiated by the
law 2002-303 passed on the 4th of March, 2002. This law obliges midwives to be
insured for homebirth at the prohibitive rate of 22,000 € per year.
We give prominence to the features shared by all the trials and we bring out the
hidden will of some French health professionals to control independent midwives - and
through them, women - asking for as high a price as their private rights in childbirth.
This paternalistic behaviour leads to obstetric violence whose victims are midwives
and women.

Tags: midwives, home birth, professional suspension, disciplinary chambers, special

courts, persecution, human rights, private law, control of women’s bodies, obstetric
violence
INTRODUCTION ...................................................................................... 3
I.WHAT LITERATURE SAYS ABOUT REACTIONS OF OFFICIAL SYSTEMS FACING
HOMEBIRTH: .......................................................................................... 4
II.THE DOCTORS' ROLE: AGENTS OF THE SOCIAL CONTROL: ....................... 6
III.PRESSURE EXERTED ON MIDWIVES: ..................................................... 7
IV.WHAT COMPLAINT CASES ARE DEMONSTRATING: ................................... 9
A.Collusions between physicians, lawyers and judges ................................ 9
B.Justice denial by State institutions: the disciplinary chamber and the
Council of State ..................................................................................14
C.Obstacle to justice: The European Court of Human Rights. ....................18
D.Infringement of human rights by disrespecting the users' rights to
informed and free consent: ..................................................................19
E.Protection by the Midwifery Council in favour of obstetricians or hospitals:
... 21
F.Collusion between the Agence Régionale de la Santé(ARS) and the
midwifery regulatory body: ...................................................................22
G.Collusion between the ARS and obstetricians .......................................25
V.WHAT INTERNATIONAL CASE-LAW IS TELLING US ...................................27
VI.HOW DISCIPLINARY PROCEDURES ARE NOT RESPECTING THE DEFENCE
RIGHTS: ...............................................................................................28
VII.HEARINGS IN DISCIPLINARY CHAMBERS: A PARODY OF JUSTICE: ..........29
VIII.LAW INFRINGEMENTS SHARED BY THE DISCIPLINARY AND CIVIL
PROCEDURES: .......................................................................................30
IX.HOW FELLOWSHIP BETWEEN HEALTH PROFESSIONALS IS SCORN: ..........31
X.THE DISSOLUTION OF THE DISCIPLINARY CHAMBERS: A REALISTIC CHOICE
FOR MIDWIFERY: ...................................................................................31
CONCLUSION ........................................................................................32
INTRODUCTION

In March 2014, Bruxelles Laïque1 started a think-tank and a campaign about the
stakes and effects of the criminalisation of protest or dissident expressions or
practices, offering to focus on the penalisation of alternative birth and the impediment
to these practices. Their definition of criminalisation goes as follows: "[...] the process
by which the criminal law is enforced electively to some conducts. This process has
three steps: 1) adoption of the law forbidding certain types of behaviour; 2)
surveillance of such behaviour; 3) punishment of those behaviours when detected."
We recognize this process in the homebirth field in France. In 2002, a law 2
passed setting on midwives working in private practice the obligation to be covered by
professional third-party insurance. The Conseil National de l’Ordre des Sages-
Femmes3 (CNOSF) ascertains it is enforced and penalizes any breach of this law. In
May 2014, a new decree 4 strengthened its power by allowing it to control the
professional inadequacies and dangerousness of midwives. When they receive a report,
3 experts examine the theoretical and practical knowledge of the midwife in question.
They state on the found insufficiencies and on their dangerousness. Then, they give
recommendations on how to compensate by theoretical or practical training if
necessary. In case the professional inadequacies cause the practice to be dangerous,
a temporary suspension, partial or complete is applied by the Regional Midwifery
Council (CROSF); it can be renewed if needed. The midwife cannot avoid this
expertise and there is no way to appeal the decision!

This criminalisation gives the finishing touch to the known picture of

professional precariousness for homebirth midwives; precariousness due to
administrative battles for the reimbursement of acts or trips and also social security
rates increased towards acts needing a physician's prescription and reduced for the
ones falling into the autonomous competence of the midwife.
The penal and disciplinary legal systems are mostly hearing complaints against
independent homebirth midwives. Disciplinary law5 heard 42 cases since 2007, 69%
are dealing with independent midwives. Half of the accusations are against homebirth
professionals when they only represent 2% of out-of-hospital activity. They are over
represented: 37.5% of the cases judged by the courts of First Instance concern
homebirth midwives.
In 3 years, in South-Western France, we found 7 midwives in total who were or
are still facing now those persecutions: 6 midwives had their right to practice removed,
the one who did not joined a maternity hospital during her procedure.
The demography of the homebirth midwives in France was never subject to
exhaustive studies. Cross-checking data given by the CNOSF and by midwives and
users' organisations only allows us to make a very rough estimation: 50 to 100
midwives. With reference to the most realistic number, the 6 midwives banned from
practising represent more than 10%.
In the 3 regions we studied (Aquitaine, Midi-Pyrénées and Languedoc-
Roussillon), this cross-checking gives numbers twice as big - and over for 2 regions –
as the ones given by the CNOSF and the main association of independent midwives.
Homebirth professionals are practising with an absolute discretion, which we can
wonder if it is reflecting the fear of the oppressed. Silence and calmness are some of

1
Non-profit organisation promoting the Brussels laical movement since 1979
2
Law n°2002-303 dated March, 4th 2002 on patients’ rights and the quality of the health system.
3
French Midwifery Regulatory Body
4
Decree n°2014-545 dated May, 26th 2014.
5
N. Richard-Guerroudj (2014). Comment l’Ordre vous juge.Profession Sage-Femme, issue n°208. pp 14 to 20.
the negative effects of oppressions: they are signs of survival.
If we consider all the testimonies of administrative complications with the social
security - sometimes going as far as trials before administrative courts - the
percentage of midwives practising homebirth persecuted by the official system as a
whole is again increased.
A simple analysis of the combined cases reveals that those persecutions are
being specifically exerted on midwives which practice includes requests of mothers
having twins, breech births or previous caesarean section and/or midwives who are
carrying now or had carried off out-of-hospital birthing centres projects. In 6 cases
out of 7, home to hospital transfers are also pretexts to harassment.

I. WHAT LITERATURE SAYS ABOUT REACTIONS OF OFFICIAL SYSTEMS

FACING HOMEBIRTH:

Already in 1988, World Health Organisation experts recognized those issues in

complaint cases where penalties were applied to doctors or midwives practising
homebirth. Trials were then acknowledged as a negative reaction to their practice.
In the report Having a baby in Europe6, we read on page 53:
Response of official system
It seems self-evident that this tide of alternative activity should have had some
impact on the official system, but what degree and kind of impact has it had?
One mode of response is incorporation [...]. This is one of the main forms of
official response in the countries surveyed. It points to a relatively benign
attitude on the part of the planners and providers of official perinatal care to the
challenge. Convincing illustrations of this attitude occurred into the countries
visited, where the research midwife was actually given by the ministries of health
some of the literature produced by the alternative service user organizations in
those countries.[...]
The opposite reaction is considerably less benign and consists of a range of
sanctions applied to those who use and provide alternative perinatal services.
Some examples are:
– official efforts to get new legislation to control maternity care practices (two
countries);
– prosecution (threatened or actual) of lay midwives or trained midwives
practicing without the back-up of a physician (four countries);
– prosecution of couples having a birth at home without a professional attendant
(one country);
– the “legal abandonment”7 by physicians of women requesting home birth (three
countries);
– the sending out by health authorities of “letters of invitation” to use official
services to couples wanting home birth (one country);
– threatened loss of employment/security for physicians who actively support
domiciliary midwifery, domiciliary birth or lay midwifery (three countries) ;

6
Report on a study, Copenhagen, WTO. Regional Office for Europe; 26. 1988
7
Author’s note: physicians are denying women’s right to homebirth.
 – exclusion of home birth midwives and their clients from hospital when
conditions requiring hospital transfer develop (four countries).
These are examples of how deeply threatening the alternative services may be
perceived to be by health care administrators, policy-makers and established
obstetrical opinion. At its most radical, the movement 8 questions most of the
basic canons of the official system and pushes the defenders of that system into
a highly defensive and increasingly obdurate position.

In the studied cases, we recognize

5 negative reactions out of 7 recorded by the WHO.

We recognize the same climate in 2013 and 2014 in this correspondence

between a French midwife practising homebirth and an obstetrician. She shared it
anonymously on-line:

“Dear Doctor,
I am taking the liberty of writing to you because I am facing a difficulty with the care
of a patient: I follow pregnant and birthing women in their home. I tried several times
to register these patients in your service (given the geographical proximity), and I
faced the refusal of the head nurse I was dealing with. I am coming back to you today
because one of my patients has reached her due date of 41 weeks and I am afraid I
will have to transfer this patient to you either because she is overdue or because
pathology is detected through care. I would like to know the best way to proceed in
order to assure this lady and her child, the best possible access to the care she might
need in your maternity hospital [...]”

Answer of the obstetrician head of the service:

“We do not conceive the medical follow-up of patients registered in the
Maternity hospital of T. like a last resort situation when they were not lucky enough to
give birth at home. When a patient is registered at T., the “contract” is that she will
give birth in the hospital unless a medical outcome demands that she is transferred in
another establishment within the perinatal network.
The care you are offering, including the possibility of homebirth, is not under
any circumstance compatible with the one we are offering in our urban network. I
believe there is no satisfactory way to proceed and reach a collaborative way to
operate adapted to both your conception of pregnancy and birth care and ours.
We could not accept the principle of transferring a patient to T., in labour or not,
who had not been taken care of according to the follow-up we set up with the whole
team and our network partners, prior to her admission [...]”

Answer of the midwife:

“Thank you for your answer.
However, the care I am offering is not departing from the regular care usually
given, including in your maternity hospital. Working within a network implies that a
lesser equipped structure transfers to the qualified one. I consider a patient who
wishes to birth at home and the midwife in charge of her and her child, form a weak
structure.
In practice, if pathology occurs, the refusal to receive her would be an
endangerment and I am confident that your structure would, on the opposite, do its

8
Author’s note: of parallel activities, ie: homebirth
best to avoid any danger. I am lively wishing not to test this hypothesis, but I find
interesting that the present situation is underlining a difficulty that could occur one
time or the other. Then, wouldn't it be preferable that a minimal file is kept with you
when the patient is close to yours? Until a potential transfer you would not engage
your responsibility in any way.”

Last answer of the Head of Service (not answering the possibility of transfer for
pathology!)
“The answer is NO.
Contrary to what you are saying, we would take a responsibility operating the way you
are describing; we would implicitly support your practice. We do not wish to give your
patients, in registering them, a sign that would let them think that we are in
agreement with the homebirth practice. It is yours to honestly inform them that your
practice is not supported by the structures that could take care of them in case of
difficulty and let them make a choice regarding their childbirth.
It does not seem useful to me to carry on this false debate.”

II. THE DOCTORS' ROLE: AGENTS OF THE SOCIAL CONTROL:

This opposition of some practitioners is well known. Paediatrician Marsden WAGNER,

graduated in epidemiology and public health, Responsible Officer of the Women's and
Children's Health for the WHO for 15 years, wrote9:

On the other hand, there are several issues in the controversies over the birth
machine that are fundamental but have remained largely hidden. The first and most
important is the issue of freedom. Does the women and family have the freedom to
have the experience of their choice during one of the most important events of their
lives? Who has ultimate control over what happens to a woman's body? Who
controls human reproduction? Who controls reproductive services? Who is
responsible for the control of the care of the foetus, the new-born? Who controls
the information on the birth services, on individual's birthing? In a recent article,
Stephenson (1993) discusses these questions and the role of physicians as agents
of social control. The reason why discussions of home birth are always so heated is
simple – in the hospital the doctor controls all of the above while in the home the
family has the control. A patriarchal society, in order to control women, must
control their bodies, their reproduction, their birthing. Health professionals are often
agents of this control. But politicians in democratic countries recognize the
importance of the freedom issue. This is why, for example, the German government
would not agree to the demand of their Obstetrical Society to outlaw home birth.
This is why the birth consumer groups who recognize this issue often have been
successful. No one can argue against the freedom of the individual and the family in
such a personal matter, particularly when no compelling scientific evidence can
refute its relative safety.

9
Wagner M. (1994). Pursuing the birth machine, the search for appropriate birth technology, Sydney and London,
ACE Graphics. pp 326-327
III. PRESSURE EXERTED ON MIDWIVES:

Testimonies of the medical pressure deployed on midwives abound. In order to assess

its scale, we are sharing the reactions received by my support comity during my
procedure (studied in the chapter IV, sections A, B and C):
I worked 2 years in private practice to do homebirth. I had an “accident” and I was
lucky there was no follow-up for me. Reading your letter in Les dossiers de
l'Obstetrique 10 , I realised I avoided horrible things. [...] As I have myself given
birth to my children at home (10, 7 and 3 years old), I am convinced that this
possibility should be given to couples, but it has become a too demanding activism.
As for me, I went through it feeling very isolated, I hope it was not the case for you.
The most awkward seems to be that in this tiny world of homebirth practitioners,
we never talk about accidents; I've always heard that “there is no such thing” if you
are doing your job properly. The net result is that if it happens to us, it means that
we are working badly and therefore we don't talk about it. I find this serious.

“I am easily getting the measure of such an ordeal for you, I am myself a midwife
since 1981 and I happily practiced homebirth from 1987 to 1990, but under pressure,
like you. I feel I don't have the strength for this fight against “the counter-current to
eutocy”, but I keep the common sense of global and continuous care.”

“I wish to express my support and my esteem for you, as colleague, woman and
mother. I assisted homebirths for 7 years. I stopped and explained I had enough
working with the sword of Damocles above my head: systematic condemnation of
homebirth in our over hierarchical medical world!”

“When I educated myself and then started assisting homebirths, I never heard any
story from colleagues of medical difficulties or incidents they had lived; each of them
“never had any problems” and yet I was learning from other sources that this one had
to be transferred, that child went to the hospital [...] It is not easy to evolve in these
conditions. [...] This being said, in hospitals, it is the same thing: recently a child was
stillborn; there was no discussion with the team on the case”

“I am doing global and continuous care on a technical platform and rarely at home. I
am sending you all my support. I think that before coming to extreme solutions, the
“fault” must be proved. If all the gynaecologists and midwives who delivered stillborn
babies were arrested, we would all have our licence removed. Die in a hospital is
clean; at home, it is indecent. I hope that you will prove your innocence, that both
your patients' and your choices will be respected.”

“[...] Working as a midwife in private practice, [...] I am acquainted with the

tragedy you are living. I am astonished. We think we live in a “civilized” world when
only the varnish changed colour. If people were bold enough to burn us, they would.
I worked for 16 years as a hospital employee, changing from part time to full time
but still doing 1 to 6 homebirths a year. Now retired, I still practice privately [...]
the colleague who also practices homebirth ceased this aspect of her activity
precisely by fear of medical repression. I am now alone for the Neufchatel area in
Jura (around 400 000 inhabitants) doing a dozen of births a year (the demand is
not so high in this part of the country) waiting for the relief team. I am aware that
if something bad were to happen to me, I would be treated like you. But on the
other hand, this is not fair for things to be that way, how many children die in

10
Monthly publication of medical and professional information for midwives since 1974.
 hospitals without any finger being pointed at us? Only with a fight and a collective
reaction - the number, the strength - doctors and judges will admit the legitimacy
of our work and even during tragic situations, like the one you are living, the
concept of guilt be examined from a completely impartial standpoint. [sic]

“Daughter of a midwife practising mainly homebirth from 38 to 45, and midwife

myself, I think being kept in police custody is scandalous.”

“Private midwife practitioner, I would like to send you my support and admiration for
your work. Here, in Marne [French department], we cannot do homebirth because
minds are so narrow; I am in awe for midwives who accompany until birth, maybe
one day we will be able to do it too.”

“Midwife, Quebec. [...] I am shaken, outraged by the way you have been treated. I
only realised then […]. From 1981 to 1989, I worked in hospitals. I never saw a doctor
put to jail, even when death occurred. There really are double standards.”

Pressure, on midwives working in private practice or in hospitals, is the issue I am

tackling now in Ireland. I am writing a report about the medical monopoly on
maternity services [...]. It is the core of your trial, where medicine – obstetrics- is
persisting in keeping its grip on the birth market. This market is important; in
Ireland, it is worth, 30 million Euros a year at least, shared between 100
gynaecologists…! How much is it in France??? [...] In the end, it is a matter of
abuse of a position of superiority on behalf of medicine, which is opposed to the
founding Treaty of the European Union.
Marie O'Connor, sociologist, Ireland.

Before I had children, I was a criminal lawyer, and I am with you when you say that
this sentence has no scientific ground but relies only on common places and
prejudice. I am preparing the birth of my 4th child at home. And it really moved me
to learn that this judge seemed to think that maternity midwives are bond by an
obligation of means, whereas for homebirth, this obligation becomes one of
outcome. It is true, you have been through a tragic event with this baby's death,
but was this risk, which is always there, aggravated by the fact that parents chose
a natural birth?

[...] mother of 3 children, 2 of them were born at home with a midwife who was
practising in my region [...]. I am using past tense because as I am writing, she
ceased to work as an independent midwife. Among other things, she was looking
for a more even pace in her life[...] but there was also – and mostly - “stress”,
pressure from medical “authorities”. [...] A very reputable doctor of Tours' hospital
once called her a “witch”! She knew well, as she used to say, that “on the slightest
misstep” (sic) [...]. Working with this Damocles' sword above one’s head is not
necessarily serenity and enthusiasm inspiring for the future...

We can even identify them with the former president of the CNOSF, Mrs
BICHERON. On April, 24th 2004, in Orthez, the CNOSF organized with her an
informative meeting. She was then president of the CNOSF and retired, she shared
about the procedures held against her, 3 in total! Here is the advice she gave to
midwives to protect themselves from trials when they need to call an obstetrician:
- Take pictures of the contentious cardiotocography prints;
- Keep your mobile phone with you to contact the duty obstetrician directly and avoid
the hospital switchboard;
- Ask your phone operator for written evidence of the emergency call made to the
obstetrician;
- Notify a complaint to the police!

IV. WHAT COMPLAINT CASES ARE DEMONSTRATING:

The climate of hostility towards midwives and among them homebirth midwives
is set. It truly exists, testimonies are there. The cases of the suspended midwives are
only confirming, if still needed, how this hostility borders on ferocity.
5 cases were available for this study. The first 3 sections of this chapter are
covering the same case. The following ones sum up the situations of the 4 other
midwives.
The first procedure is mine. It went on for 13 years until complete exhaustion of
remedies.
Nurse since 1982, I then graduated as a midwife in 1987. After 7 years
attending homebirths out of 12 years of midwifery practice, I attended the pregnancy
and home birth of a mother despite the pressure of her own mother, a lawyer at the
bar of Bayonne. Opposed to this home birth, she spread cult rumours about me after
threatening to press charges. Unfortunately, in December 1999, the mother gave birth
to a stillborn baby. My colleague and I stayed overnight to carry on with the care of
the mother.

A. Collusions between physicians, lawyers and judges

What happened the day after the birth?

1) The illegal set-up of the criminal procedure:
We mentioned with the parents the interest to carry out an autopsy to try to find out
the cause of the death. They agreed and let me engage the process. I called the
service of paediatrics of the hospital: the resident on duty told me to join the family
doctor who will issue a death certificate to allow the transport of the body. The father
took care of it.
Immediately after that, the maternal grand-mother arrived at the parent's, followed
by the family doctor's replacement. Together, they agreed on:
-the fact that the grand-mother already “took measures”, the latter confirming she
saw the district prosecutor of Bayonne at 8 am that same day;
-the decision to take the mother to the hospital, as agreed with the family doctor;
-the fact she already contacted the head of the maternity service of Bayonne with the
family doctor.
This edifying way the situation was handled is incomprehensible because they
had not yet spoken with the 2 professionals present: my colleague midwife and I.
Therefore, they did not access the medical file and did not know how the delivery
went.
 Even before they arrived and examined the new-born, the doctor already
deemed the death suspect and decided to ignore our competences. This contempt for
our profession is confirmed by the complete absence of professional interest for the
medical follow-up of the mother: the general practitioner did not ask for my medical
file or the mother's nor did she ask me for a transmission form for the maternity
service.

Moreover, the decision to go to the hospital was made

on behalf of the parents,
who had not made such a request.

Upon the insistence of both the grand-mother and the doctor, the parents gave
in. When I am asking for a medical certificate justifying the hospitalisation, the
replacement declared: “No, I won't do any form, the parents are asking for a
hospitalisation; I am not taking any responsibility for it.”

The confused actions of the doctor then succeeded one another:

 She signed the transportation warrant on the mother's behalf without

mentioning the stillborn baby.
Officially, the baby's body was never moved to the hospital.
The doctor was called to write the death certificate she finally refused to do. She was
hiding behind the necessity to take the mother to the hospital for psychological
reasons, using her personal experience: “My mother never recovered from the death
of a baby in a clinic, 30 years ago.”
By not openly saying she considered the death of the new born suspicious, she hid
serious legal consequences for all of us, parents and midwives. Here what the law11
says:

The physician can oppose to the transport only for the following reasons:
1° Forensic investigation is needed;
2°One of the contagious diseases listed by the Ministry of Health was
diagnosed prior to the death and in accordance with the High Public health
hygiene French Council;
3° The state of the body is not allowing this type of transportation.

 She decided not to call a forensic medical examiner, the only professional
qualified in case of suspicious death.
She did not inform the district prosecutor or the police although it is a legal
requirement12 in this case of suspicious death.
Where a corpse has been discovered, whether having died by violence or otherwise,

11
Code Général des collectivités territoriales, article R2213-9 (our translation)
12
Code of Criminal Procedure, article 74
 and the cause of death is unknown or suspicious, the judicial police officer who is
told of it immediately informs the district prosecutor, and goes forthwith to the
scene to make initial findings. […]

 She participated to the illegal transportation of a dead body.

When a forensic investigation is to take place, transportation without a coffin needs to
be authorized by the district prosecutor or the investigating magistrate and the city
mayor to go through towns.

 She asked the grand-mother for legal advice, in front of us and before she even
saw the baby.
The French Code of Medical ethics13 specifies:
A doctor may not alienate his professional independence in any way
whatsoever. Independence, trust, responsibility are the ground stones of
the unspoken contract that bonds the patient and its doctor. The contract
would not be loyal if doctors were not driven by their patients’ best
interests. […] A doctor cannot accept a subordinate position which allows
its freedom of judgement and actions to be oriented or limited.

This replacement doctor was never questioned by the police or the

district prosecutor: the criminal file shows no sworn testimony she signed.
This situation did not prevent her from coming to the hearing and testify
before the court!

As I asked what the following examinations were planned by the obstetrician,

the grand-mother threatened me: “Listen Mam', now is not your time!”
As I finally spoke on the phone with this obstetrician, he stated: “If there is a midwife,
there is no forensic investigation needed; I was told a woman birthed alone.”
The replacement doctor intervened and told him: “I am not able to examine a mother
who just gave birth and a dead baby, I never did that.”
The obstetrician replied: “Take them to the hospital, and if they refuse, you call the
police.”

An ambulance was already parked in front of the house. But, the transportation of a
dead body must comply with precise criteria14:
“The vehicles must not be white and must observe sanitary conditions (cooling
of the funerary box, condition of manipulation of a body outside the vehicle, cleaning
and decontamination of the box) […]”
The ambulance that transported the mother and her baby was white and had no
cooling system, as I saw when I got in to say goodbye and give the placenta to the
mother.
Who contacted the ambulance driver and when? Why did the driver accept to
transport a dead body without any document notifying it? Why wasn’t she questioned?

13
Doctor’s General Obligations, article 5
14
Decree n°76-435; Arr.18 mai 1976, JO 20 mai
The form for the “Transportation of an injured or ill person” is not, in any way,
mentioning “Transportation of a dead body”. The ambulance rode without
authorisation from the local authority but still stopped at the council house for the
father to give my birth certificate of a still-born baby.
On the arrival, the illegal transportation was notified to the district prosecutor of
Bayonne by the head nurse of the hospital. The legal proceedings started then. The
day after, a midwife working in the same service gave me through the phone the
laboratory results proving the presence of group B streptococcus germ on the mother.

Despite this information giving a possible explanation of the death, the

penal procedure for second degree manslaughter started in December, 11th
1999 with a 26-hours long custody and the night spent in cell.

The combined attitudes of the 2 doctors and the grand-mother had serious
consequences in provoking illegal and illegitimate proceedings against me.

A few years later, during the disciplinary proceedings, I learned that a doctor
working in my department contacted the CNOSF in to report my “dangerousness” the
year my penal procedure started. When asked by the Departmental Council (CDOSF),
he refused to press the charges he reported.

2) The incidents and obstacles to the defence rights during the procedure:
- during the custody, I was asked purely obstetrical questions, transmitted
over the phone to the police agents. I still don’t know where those questions
came from;
- policemen acknowledging the existence of “pressure”;
- the falsification of the conclusion of the custody report: their
conclusion was in my favour (they offered me to read it at the end of the
custody). The ones found in the investigation file are different: it is a
falsification;
- the replacement who came at the parents' house was not questioned;
- no charges were pressed against the 2nd midwife present at the birth;
- the search conducted at my house, with no representative of the
departmental council;
- the case was not relocated for legitimate suspicion despite the facts that; 2
family members of the litigants (the mother and the sister of the mother) are
lawyers at the Bayonne bar; and that the district prosecutor received the
grand-mother for a private interview before the hospital made its official
notification;
- the disappearance of the sealed file containing the results of the
bacteriological tests made in the hospital on the mother and her baby;
- the CNOSF was not represented for the seizure of the medical files of the
mother and the baby whereas the medical council was;
- the disappearance of the hospital medical files of both the mother
and her baby;
 - the investigating judge refused any additional exams or second
opinion despite the fact, according to the policemen, that all necessary
actions were taken during the post-mortem examinations (double samples);
- the autopsy findings of “brain anoxia 15 ” for the baby when the brain was
never examined ;
- appointing an expert-midwife was refused;
- the incomplete file given to the expert-obstetrician – missing medical
files and placenta, incomplete autopsy – did not prevent him from saying he
“formally rejects all pathological causes of the death”;
- the expert report starts on page 19. The pages 1 to 18 were never seen;
- the placenta disappearance, after traveling with the mother and her baby
in the ambulance, came out 1 year after the procedure started and 5 months
after the expertise ;
- the request during the procedure to partially practice (birth preparation,
perinea re-education) was rejected ;
- the raising of the probation, even partial, was rejected 6 times, which
extended to 2 years and 9 months the “temporary” suspension turning it into
a condemnation before judgement ;
- postponing the trial to allow one of my witnesses to come was refused and
the ones who were present (Dr Maria, Marie O’Connor, Dr Rick Porter, Leslie
Page) were not heard: only the opposing party's witnesses were heard!

3) When judges fall into confusion:

The above list would not be complete without the 2 following criminal court
orders.
One month after the baby's birth, the Court of First Instance of Bayonne met as the
council chamber: 3 judges and the district prosecutor created a legal document
stating on the birth and death of the baby. This document proclaims that the birth
occurred at 10:50pm - 10 minutes before the actual time - and the death at
11pm!
In spite of the autopsy findings of a still born baby, those judges created a civil
document based on false data leading to believe the new born lived and then died.
The second court order was issued by the Court of Appeal of Pau. They feared
no inconsistency when they wrote, 2 years after the facts: “the transportation of the
new-born in an ambulance to the hospital was made in order to try and bring it back
to life”. May we remind it took place 13 hours and 30 minutes after the delivery!

Despite the unexplainable fact essential evidences went missing –

placenta, laboratory results and medical file of the mother and her baby – the
investigating judge deemed the charges sufficient and sent me to court on
July, 12th 2002. The procedure led to a criminal discharge with civil
conviction and damages to pay to the parents, both grand-mothers and the
aunt, who all took civil action for damages.

15
Condition characterized by an absence of oxygen supply to the brain’s cells.
 As soon as they announced my discharge in September 2002, the CODSF
started working on this “Case”. Following the advice of the clerk of the National
Disciplinary Chamber, the CNOSF president contacted the First Minister office for the
Miviludes16 to gather information on the out-of-hospital birth centre of Pau, which I
co-founded. The CNOSF acknowledged receipt of these documents in March 2003.
In the meantime, I made an appeal to the court decision to get my birthing material
back. In September 2003, I got discharge for the second time and my equipment was
given back to me. In January 2004, the parents pressed charges before the CDOSF.
The latter joined the complaint and carried on with the investigation.

B. Justice denial by State institutions: the disciplinary chamber and the

Council of State

The hearing took place 5 years and 9 months later in Toulouse: 10 years after the
facts.
In March 2009, the association Coeur de Famille (of which I was the president)
registered the brand "parenting and associative birth centre"to the national institute of
industrial property. It is protected for 10 years.
In October of the same year, I lost my licence before the court of first instance. I
made an appeal before the National Disciplinary Chamber in Paris and raise a priority
preliminary ruling on the issue of constitutionality (QPC 17 ). I am redirected to the
Council of State, the only instance able to deal with QPC.

1) Ground for the submission of the QPC before the Council of State:
a) The line-up of the National Disciplinary Chamber and the way the
departmental midwifery councils operate is raising an issue of equality
before the law:
The articles of the Health Code 18 describing the chamber line-up are
unconstitutional. They are harming the rights guaranteed by article 16 of the
Declaration of the Rights of Man and of the Citizen and article 6.1 of the European
Convention of Human Rights.
The following facts led to the conclusion of a lack of impartiality:
- the National Disciplinary Chamber of the Midwifery Council emanates from the
departmental councils: the CNOSF is made of 5 midwives elected by the
departmental councils. Four of them sit in the National Disciplinary Chamber
with four other midwives current or former members of other councils;
- within the disciplinary body, the CDOSF of the Pyrenees Atlantiques department
is a litigant to the case;
- the CDOSF also investigated the case.
The issue of equality before justice recurred during the appeal to the National
Disciplinary Chamber decision to cross me off the register. The Council of State could

16
Inter-ministerial mission for the monitoring and fighting of sectarian aberrations.
17
Question Prioritaire de Constitutionnalité
18
Public Health Code, articles L4152-6 and L4122-3.-
not refer me to another national disciplinary chamber because of its uniqueness.
Consequently, it is the only court of competent jurisdiction for national disciplinary
judgement. To understand how this way to elect and operate is abusive, we can
simply compare it to the common procedures regular citizens go through.
In the usual procedure, the judges sitting at the trial are studying a case they
did not investigate on. They access a case build by another judge, the inquiry judge.
This judge must look for as many exculpatory elements as incriminatory ones. Pieces
are gathered to constitute the court case and the judge must "impartially proceed to
the establishing of the truth".
In an abusive situation, we would see an inquiry judge pressing charges against
a colleague (another judge) and then build the court case with selected evidence and
testimonies. This way, a case exclusively incriminatory would be transferred to both
trial and appeal judges. What is more, the judge who issued the complaint elected the
judges of both jurisdictions.

It is a closed circuit justice that infringes the most elementary rights of the
defence. Already in 198819, the European Court of Human Rights (ECHR) condemned
"some practices of the Medical Council equally opposed to the State rule of law and to
the principle of justice, confirming the idea that all justice systems must abide by the
same obligation of protection of private individuals". The Court described "the quite
archaic system" of a professional council taking on both the judge and the accuser
roles in disciplinary matter.
Then in 2005, the judge Mulanori 20 described the structure and operation of the
disciplinary chamber of the French National Medical council:
[...]the Court claimed several times that it was necessary to consider the selection
process and the lenghth of the mandate, the existence of a protection against
exterior pressures and also the issue to determine whether there was an
appearance of independence.
[…]
Consequently, none of the criteria listed by the Court precedent and suspected to
lead to the conclusion of the absence of breach of article 6.1 of the Convention
seemed to be respected in this case:
-members of the disciplinary section of the National Medical Council are elected by
their colleagues
-they remain fully-fledged members of the National Council during their mandates,
and
-are taking part in the other activities of the Council.
It appears clearly to me that the situation cannot guarantee even the “face of
independence”.

b) The disciplinary handling of my case was neither fair nor contradictory:

The Regional disciplinary Chamber is holding against me that I did not assist the birth
in "optimal safety conditions" nor “respect[ed] the legislative and statutory duties for
midwives". The midwifery council is using those arguments without justifying them
precisely. Without saying what the optimal conditions for homebirth are, they still
19
ECHR, case Gautrin and others v. France, arrêt 38/1997/822/1025-1028.
20
ECHR, case Gubler v. France, request n°69742/01
consider I did not respect them! They also overlooked the sentence of the Criminal
Court of Bayonne dated September, 17th 2002 21 "Considering there is no law or
specific ruling for homebirth [...]"

The National Disciplinary Chamber used another method: to state on my professional

failures, the facts established by the criminal procedure that led to my discharge and
the return of my equipment are re-interpreted.

c) The slow process of the disciplinary proceedings caused an unreasonable

delay for judgement:
The procedure started in 2004 and was still on 11 years after the facts. The
Midwifery Council interpreted the questioned facts as follows: "very serious risks she
might put patients and unborn babies at; risks likely to threaten their vital prognosis."
Because of this aggravated dangerousness, they had to act quickly. This alleged
dangerousness must have induced a quick intervention as unborn babies' lives were at
stake. This was not the case. This only proves the purpose of the belated decision of
my suspension was not the prevention of medical mistakes but the moral censorship
of the disciplinary body. Moreover, I had been working again since 2002.
Article 6.1 of the European Convention for Human rights stated: "[…] everyone
is entitled to a fair and public hearing within a reasonable time by an independent and
impartial tribunal established by law." All the more when the professional situation of
an individual is at stake22. Equally, the European Court said23: "Delays in this process
threaten to let the facts decide before the judges on the issue brought before the
court."
Disciplinary chambers obey public law rules as administrative judges preside
over. Administrative actions lapse within the four-year prescription period, 4 years
after the facts in question.
The facts took place on December, 8th 1999 and the case was referred to the
CDOSF more than 4 years later on January, 29th 2004. The admissibility form of the
complaint was illegal. This irregularity is against the elementary rules of contentious
procedures. The domestic authorities are liable for this legal violation of the article 6.1
of the European Convention.

d) The appeal must be submitted to professional magistrates:

As for other regulated professions, professional magistrates are in charge of
appeals to disciplinary sentences. The midwives sitting in departmental councils,
regional and national disciplinary chambers are not legal professionals but still
investigate on cases and join complaints. They are not following any legal training but
sit in positions that require specific competence and knowledge that midwifery studies
do not grant. As a result, without questioning their own competence to act in this
matter, they distorted the conclusions of justice professionals undisturbed by the
obvious contradiction.
A health professional, a midwife is elected legal professional of disciplinary law
and holds the outrageous power to take away her colleague’s right to practice.
Their lack of legal knowledge was again obvious when the National Disciplinary
21
Case n°99 011148.
22
ECHR, Delgado v. France, request n°38437/97.
23
Precedent dated July, 8th 1987, HC/United Kingdom §85 serie A n°120.
Chamber ignored the principle of non-cumulative sentences (disciplinary and civil
ones). The European Convention of Human Rights itself guarantees the "non bis in
idem" principle insuring that victims benefit from fair procedures.

The Council of State deemed the raised QPC had no serious grounds. I came
back before the National Disciplinary Chamber who confirmed its sentence in
December 2010.

Just like the criminal judges, these birth professionals overlooked the
missing evidence: placenta, medical files of the mother and child and the
laboratory results.

The Disciplinary Chamber justified its ruling as follows: "[...] Mrs Pérarnaud persisted
with practicing homebirth regardless of the safety requirements enacted by the
"Homebirth Charter" published by the National Fellowship of Independent midwifes
[...]".
I was unaware of this charter as I was not a member of this fellowship. The
grounds of this judgement did not come from law. Charters or guidelines have no
binding value. Plus, deciding on the texts setting guidelines is outside of a disciplinary
body’s assignments.

I appeal this sentence before the Council of State. This appeal does not suspend the
sanction; I can no longer work starting March, 7th of 2011.

2) Issues brought before the Council of State:

a) The denaturation of the facts:
It is through a denaturation of the facts that the Disciplinary Chamber deemed
the sanction was proportional to the offence.
The Court of Cassation gives the definition of denaturation: "The grievance of
denaturation is held if the appeal judge interpreted a law contrary to its clear and
precise terms." 24 The Disciplinary Chamber did not follow the principle of
proportionality. Disciplinary texts ignore it and do not offer links between offence and
sentence25. The suspension was delivered despite:
- written testimonies of the quality of my work from health professionals I cared
for;
- in a similar situation and on the same hearing day, a colleague was reprimanded,
not banned26.

b) The National Disciplinary Chamber did not conduct a verification of every

piece of evidence:

24
https://www.courdecassation.fr/publications_26/rapport_annuel_36/rapport_2012_4571/livre_3_etude_4578/partie_1_
objet_preuve_4579/preuve_fait_4581/chapitre_2_denaturation_26208.html
25
Council of State, June 8th 2005, Mrs Agnès, request n°271538. G. Braibant, Le principe de proportionnalité,
Mélanges M. Walline, LGDJ 1974, p.297; J.-P. Costa, Le principe de proportionnalité dans la jurisprudence du Conseil
d’Etat, AJDA 1988, p.434.
26
Regional Disciplinary Chamber of Toulouse, case n°2009-01
 The disciplinary judge of first instance stained his decision with aggravated
disproportion ignoring numerous testimonies in my favour (every single parent I
worked with made a certification) and a petition gathering 1045 signatures. These
positive elements were mentioned nowhere in the court-reports of both chambers
decisions to strike me off.
Despite these pieces of evidence, the Disciplinary Chambers persisted and
declared that I did not apply the precautionary measures specific to homebirth.
Several testimonies highlighted "the address, the prudence and the application", "the
respect of safety rules", "the professional character, the high quality of the continuous
care and monitoring" of my practice. The National Disciplinary Chamber did not retract
the previous decision and also decided to ban me.

My lawyer demanded the "necessary control of the Council of State over the
proportionality of the penalty" because of the denaturation and the fact pieces of
evidence were not checked.
The Council of State rejected the appeal on the grounds that "none of these
means seems by nature to allow an appeal to be received."
I have 6 months to drop a request before the European Court of Human Rights.

C. Obstacle to justice: The European Court of Human Rights.

In October 2012, my lawyer added the following points to the statement of case.

1) The infringement to the right to access an independent and impartial court:

The Council of State should allow, by constitutionality control to punish the
irregularities of procedures that led to the cancellation of my licence. By rejecting
appeals without solid grounds, the Council of State created a constitutional denial of
justice and somehow refused us the access to the competent jurisdiction.
The European Court, in addition to this, deemed in Gubler case 27 that "when the
Council of State is judging an appeal of a decision of the disciplinary section of the
French Medical Council, it cannot pretend to be a “fully fledged legal body”, notably
because it is unable to appreciate the proportionality of sanctions." In other words, it
is not within the Council of State competence to evaluate if a sanction is
disproportional.

2) The complaint of the parents' lawyer was legally inadmissible in 2004:

When the lawyer pressed charges, the only applicable law was the decree n°48-1671
of the 26th of October 1948 about the operation of the regulatory bodies of doctors,
dental-surgeons and midwives. This decree did not allow the CDOSF to record the
parents' complaint. Indeed, before 2007, the council could not transfer a patient's
accusation to the first instance disciplinary court.

27
ECHR, Case Gubler v. France, request n°69742/01
 3) Default of independence and impartiality of the disciplinary instances of the
Midwifery Council:
Members of disciplinary bodies are elected by their peers. Therefore, the
Disciplinary Chambers are professional emanations of inter-regional and departmental
councils.
This strictly professional architecture is shaping a system that does not
guarantee independence when disciplinary actions are engaged. Members elected to
sit in disciplinary bodies remain fully fledged members of the councils. As a result,
members of administrative and disciplinary structures are necessarily and regularly
rubbing shoulders sharing about their practice and council related experience. This
interweaving is granting a moral authority to the elected ones that can lead to
authoritative relationships. This closeness between administrative and disciplinary
functions is a source of capillarity and reveals serious and legitimate doubts about the
genuine independence of those institutions. Consequently, the disciplinary council of
first instance, the regional council, did not react when it received the illegal
submission of the case from the CDOSF.

Respecting all admissibility criteria and deadlines, my case was

declared non-admissible within the record-breaking delay of 3 weeks, the
regular delay being one year and a half!
“Never the decision to reject a case has been communicated that quickly!”

This statement of my lawyer was confirmed by the British lawyer,

Elisabeth Prochaska. Founder of Birthrights 28 , she is used to procedures
before the European Court.
I received the decision on December, 11th 2012: the day of the 13th anniversary
of the beginning of the procedure...

D. Infringement of human rights by disrespecting the users' rights to

informed and free consent:

Midwife since 1998, first practising in private clinic and later in small maternity
homes, Carine Lefebvre opened a private practice for homebirth in 2012 in the
Pyrenees Atlantiques department. She made an agreement with the maternity
hospital of Orthez to use its technical platform.

During a homebirth, she wanted to transfer the mother to the hospital because
she couldn't hear the baby's heartbeat, which was normal until then. The parents
refused 3 times in a row. When they finally accepted the transfer, the ultrasound
made in the hospital confirmed the death of the foetus. The birth of the baby dead in
utero occurred 3 hours after their arrival at the maternity home.
The cause of death of the baby remained unknown: the results of laboratory
and post-mortem examinations were not communicated to Carine Lefebvre.
As in the midwives' testimonies quoted earlier, the pressures are exerted
directly onto the midwife even before the cause of the death of the baby is known.

28
http://www.birthrights.org.uk/
Here is what Carine Lefebvre wrote:

A few days later, I was summoned to go to the hospital of Orthez, informed of the
story by the hospital of Pau, for an interview with 2 doctors and the intendant
midwife. The head of service blamed me for having accepted to assist this childbirth
even though it was overdue, decided to put an end to the agreement made
concerning the access to the technical platform and asked me to stop assisting
homebirths!

This is how the departmental council joined the parents' complaint considering that:
“the midwife lacked firmness, insight and assiduity to ask for the assistance of more
competent persons.”
The grounds mentioned in the decision of cancelling her licence were the following:

the allegations of [the midwife], according to which Mrs. [the mother] and her
partner refused the transfer to the hospital, could not in any circumstance release
the midwife from the obligation of taking all necessary actions in order to insure the
safety of the mother and the baby [and] that the factual findings demonstrate an
absence of decision leaving the control of the situation in the hands of the
complainant and her partner.

The law dated March 4th 200229 stated that: “No medical act or treatment can
be done without the free and informed consent of the person and this consent can be
withdrawn at any time.” Her lawyer said: “In practical terms, the midwife could not
have carried on regardless of the explicitly expressed refusal to go to hospital, unless
she used force.”
Suggesting that the midwife had to force the parents to accept the transfer (by which
mean?) can be seen as adultism and constitutes a breach of the law.
Doctor Barry Checkoway30 from the Ann Arbor University, Michigan, defines adultism
as:

[…] all of the behaviours and attitudes that flow from the assumption that adults
are better than young people, and are entitled to act upon young people in many
ways without their agreement.
[…]
The essence of adultism is that young people are not respected. Instead, they are
less important and, in a sense, inferior to adults. They cannot be trusted to develop
correctly, so they must be taught, disciplined, harnessed, punished, and guided into
the adult world.

We recognize this adultism in the way the departmental council and the disciplinary
chamber looked upon the parents and the midwives assisting them: they consider
them like people less important than them; they cannot be trusted and must be
taught, disciplined, harnessed, and punished. Midwives of the Council rely on the
assumption that they are better than homebirth midwives because their physiology
criteria are the best. These organisms think they can behave with midwives any way
they like and that the latter can do the same with the parents, without asking for their
opinion.
For these institutions, it is normal for the midwife to impose herself in the
private sphere of the couple and exert control with contempt for humanity and private

29
Chapter II: Rights and Responsibilities of users: Information of health system users and expression of their will. (Our
translation)
30
Barry Checkoway, Adults as Allies, W.J Kellogg Foundation, July 5, 2010, 13.
life; she knows how to control and feels confident about treating the parents like
children. Respect for the parents' choice is seen as negligence.
The midwife becomes an agent of social control just like doctors. Marsden
Wagner's words finds relevance in this situation.
“The first and most important is the issue of freedom. Do the woman and family
have the freedom to have the experience of their choice during one of the most
important events in their lives? Who has the ultimate control over what happen to a
woman's body? Who controls human reproduction?”

Carine Lefebvre was suspended in June, 24th 2013 and did not appeal the
sentence; she was discouraged by the length of my procedure and the fee of lawyers.
It is needless to add that she runs workshops - wrapping babies in woven and
prenatal singing - in the out-of-hospital birth centre in Pau.

E. Protection by the Midwifery Council in favour of obstetricians or

hospitals:

Graduated in 2006, Yamina Guendouze settled in Montauban in the Tarn-et-

Garonne department and started attending homebirth in 2008.

In 2012, she organised a transfer to the emergency department of the hospital.

The baby was coming in breech position at complete dilatation and the cord was
visible. The baby's heartbeat was positive when the midwife arrived. Sending an
ambulance became complicated because of the intervention zones for emergencies:
the parents' home is further away from the ambulance starting point than from the
neighbouring maternity home. The midwife informed that she was going to transfer
the mother to this maternity home but the emergency service forbade her to. She had
to wait 50 minutes before the obstetrician's arrival, whose intervention was not out of
the midwife's own competence. He did a vaginal examination and asked the mother to
hold on the labour. Eventually, he decided to transfer the mother to the closest
maternity home. On the way there, the obstetrician did not ask to monitor the baby's
heartbeat and did not stay by the mother but asked the midwife to do so while he
went back with the emergency doctor in a different vehicle. As she was watching over
the mother, Yamine Guendouze informed the obstetrician that the baby's foot
appeared at the vulva. He took note and replied that they must keep riding to the
maternity home. On arrival, the ultrasound showed that the baby was dead; a
caesarean section was practiced in vain. The Disciplinary Chamber never asked for the
obstetrician's report.
The second obstetrician who performed the surgery shared his comment on the
midwife's behaviour with the parents: “Nowhere on the French territory, could
anything like that happen!”
The complaint from the parents was investigating on by the CDOSF who joined
the grievance. The Disciplinary Chamber did not question the professional behaviour
of the obstetrician: called on an emergency for a breech birth, he did not ask for the
foetal heartbeat to be monitored. In case of foetal distress, this monitoring would
have obliged him to perform an obstetrical manipulation. If it is common knowledge
that obstetricians no longer master this manipulation of turning the baby, this default
in training on our domestic territory cannot be used as an opportunity to drag the
whole responsibility of the unhappy issue on midwifery. When one calls for an
obstetrician’s intervention, the latter is trusted to be able to do manipulations the
midwife does not have authority to perform.
Yamina Guendouze is more than a homebirth midwife: she is taking part in the
creation of an out-of-hospital birth centre with the parental association she founded.
When the procedure started, this project had already been made public. At the
Montauban hospital, her association met with the director and administration
representatives from the ARS and the Mother and Children Centre 31. The local deputy
was informed as well. They all support of the project, all the more so as the birth
centre will be outside the hospital: the actual premises of the Montauban maternity
home cannot welcome a birth centre.
Even so, the president and vice-president of the CDOSF requested an interview
with the deputy. They defended the necessity for the birth centre to be inside the
hospital’s walls.
Yamina was suspended on October, 17th 2013 and she appealed against this
decision.

F. Collusion between the Agence Régionale de la Santé 32(ARS) and the

midwifery regulatory body:

Krista Guilliams graduated as a midwife in 2005. She is working in Bazens, in

the Lot-et-Garonne department and assists on average 40 childbirths a year. No case
of mortality or morbidity occurred to her.

1) At the departmental level:

The complaint case was built by the departmental council; no charge were
pressed against her by parents, obstetricians or any other health professionals.
To put this case together, they constituted a whole ploy in order to create the first
administrative document of the complaint.

In 2011, Krista Guilliams received a written invitation from the departmental

council. The purpose of this meeting was to know better the modus operandi of all
independent midwives working in the department.
In actual fact, this meeting turned into an interview led by the board with the
president and the whole departmental council joined together for a plenary session.
The invited midwife turned out to be summoned. She was trapped. She ignored that
her words were written in a proces-verbal. The tone of her voice adapted to an
interview situation was used against her during the procedure (casualness, flippancy).
The written report is titled “Proces-verbal of the council's deliberation,
during a plenary session with the president”. All of 5 pages are initialled and
signed by Krista Guilliams and every member of the departmental council. This was
how the CDOSF put together a paper shaped like an official document without the
midwife’s knowledge. When 2 years later the departmental council pressed charges,
the notification will have the exact same title.
This is a manipulative way to operate that infringes the defence rights. It was

31
In French hospitals, this service covers paediatrics, obstetrics, reproductive and maternity care.
32
Regional Public Health Authority
revealed by the testimony of her colleague working in private practice and substitute
for the council. She shared with Krista the following information: we could read in the
proces-verbal of the “interview” that she was “the 1st midwife to be summoned” but
she remained the one and only! No other independent midwife in the
department was asked for an interview.

March 2012, after Krista transferred one of her patient an obstetrician made a
report to the departmental council. This report, which is not a complaint, has a special
character given the bonds between this obstetrician and the members of the council.
On the one hand, the 4 council midwives are working in the same maternity service
under this obstetrician's command; on the other, the latter is married to one of the
member of the council. With such a degree of closeness the independence of the
authority is unrealistic.

The hierarchical subordination of these hospital midwives disqualifies them

for the investigation of the complaint.

This recalls the motives to appeal before the European Court in the first case:
question the impartiality and independence of the council’s institutions.

It was in vain that the departmental council insisted and pushed the
obstetrician to press charges. The same month, a second report was made by another
obstetrician working in another hospital where Krista Guilliams also transfers patients.
It was addressed to the President of the National Council, also member of the National
Disciplinary Chamber.

This time, the departmental council officially summoned the midwife.

Considering the absence of official complaint, she declined the appointment as she
was unable to attend it.

Dissatisfied by the hospitals' reports the departmental council asked for the
help of one doctor working at the ARS on the phone and by mail.
“With no complaint officially expressed, we have been verbally warned of the non-
conventional practice of this midwife. The four structures contacted us; only one
hospital issued a written document. At the moment, we are waiting for mails from two
hospitals about worrying facts [...]”

The answer, signed by a Doctor Inspector Of Public Health on behalf of the ARS board:
“Further to your letter, I questioned the heads of the four Mother and Children Centres
As agreed on the phone, I am sending you the obstetricians’ letters, made anonymous.
I wish these mails can help you through the different steps before the Disciplinary
Court of first instance [...]”

The line-up of the Regional Disciplinary Chamber includes one public health
doctor from the ARS. This doctor has a consultative voice but has also the right to
question the defendant when he has no midwifery or obstetrics competence. By
questioning the obstetricians and sending these mails to the departmental council, the
ARS contributed to process the complaint file. He filled the role of the examining judge
while member of the Regional Disciplinary Chamber.

2) At the national level:

In the 2 following situations, the President's answers illustrated the extent of

the pressure exerted on this midwife.
Treatment of the report of the obstetrician:
The President sided with her: “You are then considering the behaviour and
practice of this midwife is endangering the safety of mothers and babies.” and
reminded her that she could lodge a complaint. Then again, the president was mixing
up her administrative and disciplinary functions.
She went on and thanked her in her letter: “Thank you for passing on to us such
information.”
It was not “information” but libel because the facts stated were not checked.
Moreover, it appeared that the president is a member of the National Disciplinary
Chamber. In case of trial, this chamber would be the court of appeal. Again, the issue
of the impartiality and independence of the disciplinary bodies arises.

Treatment of the report of the midwife:

Krista Guilliams reported the situation of parents persisting in having their baby
at home despite contraindications. The president replied:

[...] First, it is your own mission and responsibility to refuse such a request and
even more so to clearly inform the parents of the serious risks incurred [which was
already done] and impress upon the parents that the birth takes place in a hospital.
What is more, about patients' safety, it is important to recall the obligation for all
independent midwives to subscribe a professional insurance [...]

She is pressurizing the midwife by holding it is her responsibility to insist and

make the parents go to the hospital. Contempt for the parents' desire is complete. It
constitutes a violation of private rights.
The pressure exerted on the midwife, who must abide by the law for fear of
punishment in case of insurance gap is blackmail. The president knows full well that
such insurance does not exist at a competitive rate in France. Krista Guilliams found
herself threatened when she was reporting a risky situation.

The departmental council investigated the complaint

and accused Krista Guilliams of
“deliberately endanger[ing] others' lives […]”;
a very serious accusation of first degree man-slaughter.

Finally, it is significant to add to this picture the creation of a physiologic space

in one of the maternity services mentioned earlier. The press33 described a birth place
“just like home”. The doctor responsible of the Women and Children centre quoted in
this press article is no other than the obstetrician who made the report against Krista
Guilliams. The article is published one month before the hearing and the problematic
transfers are discussed.
Moreover, Krista Guillaims is interested by the out-of-hospital birth centre project of
Montauban initiated by Yamina Guendouze.

What can we read in the sentence of the Disciplinary Chamber of Toulouse

issued on April, 11th 2014?

The disciplinary chamber followed the departmental council footsteps and

misused the obstetricians' reports like official plaints. As a result, the decision writing
suggested: “that medical staff […] put into question the conditions in which [the

33
www.ladepeche.fr/article/2014/02/08/1813707-auch-peut-maintenant-accoucher-hopital-comme-maison.html
midwife] was carrying homebirth care.”
In the absence of official accusation, the regional disciplinary chamber played around
with synonyms of these terms:

put into question and lodge a complaint are synonyms of accuse and press
charges!

We are no longer dealing with a simple report. Not only the disciplinary chamber
suggested the idea of a complaint but it is not taking responsibility for its maternity,
hiding behind the medical staff presented as the author of the “questioning”.

Only the obstetricians’ mails are mentioned as grounds of the decision to

suspend Krista Guilliams.
No element of her file were held in her favour.

Even when she argued for her defence that she could not access the medical
files, the disciplinary chamber will not fear to value the facts “denounced by the
medical staff” and to call her words “allegations”.
It comes in not surprising either when the Disciplinary Chamber interpreted the report
in which she is asking for advice: “[…] this is not enough to attest that [she] is willing
to put into question her working practice.”

G. Collusion between the ARS and obstetricians

Midwife since 1981, Françoise Servent settled her private practice in 1993 a few
kilometres away from Montpellier, in the Herault departmental. She assisted 1450
homebirths.
November 2012, she contacted the emergency service of the Montpellier
hospital after the baby's birth because the placenta was retained without bleeding.
While waiting for the ambulance, the midwife got the mother ready for the transfer
and put her on the drip. The first emergency team to arrive is made of a student
midwife and a nurse-anaesthetist. Without an emergency doctor, the safety of the
transfer is at stake. A second team is sent with an emergency-doctor. When the
emergency service finally took over, the mother was tired, her blood-pressure was
dropping and she started bleeding. In the hospital, the delivery occurred under
anaesthesia, after vital signs were stabilised.
One month later, the head of the maternity department of the hospital is writing to
the director of the hospital. This letter is the starting point of the procedure.

How the report was processed

In his first letter, the obstetrician Dr. B made strong recommendation for the
director of the hospital and indicated the necessary following steps: "[...] I am
bringing to the awareness of the Board a situation that deserves to be reported to the
Prosecutor of the Republic. It is about a homebirth that a midwife assisted deliberately
[...]". He is not bringing himself to formally accuse her but he is clearly insisting on
the Director to do it for him.
I insist on the necessary action the hospital must engage with the Prosecutor,
possibly by lodging a complaint, because it is not the first time this midwife, who is
 working together with a group of midwives known for their non-complying practice,
is transferring patient in serious condition after attempting a homebirth.
The evasive description the obstetrician made is libel, included other midwives and
presented homebirth like a crime. He wrote about an attempt and implied these
midwives’ practice is illegal. He concluded by reminding some studies made by the
ARS, without giving their content or results. He felt confident enough to say he
personally knew the Doctor Inspector of Public Health (DIPH) in charge of those
studies and used his name to validate his argument.
The case was heard: the director of the hospital followed the steps and
contacted the ARS director the next month. We recognize the same distortion of the
facts: "Professor D. [...] happened to take charge, in an emergency, of a patient
oriented towards homebirth by a group of midwives known by your services."
While the report was on its administrative way and the ARS director had already
been informed, the obstetrician decided to contact the latter directly. He added in the
heading of his mail, the first name of a second person, very casually: "Dear Michel".
Research showed this person is no other than one of the two ARS DIPHs on oath in
charge of this investigation. Dr. G and the Dr. B have known each other for 12 years
and are working together on the publication Actualites Perinatales du Languedoc-
Roussilon.
We are facing the same situation of lack of independence and impartiality as in
section A: the ARS joined the plaintiffs while an acquaintance of the author of the
report was investigating the complaint. Such tight bonds cannot but undermine
objectivity. The inspection report only proved this point.

 The parents, the nurse of the first ambulance, the hospital switchboard team –
the assistant and/or the doctor – were not questioned. On the other hand, the
inspectors considered valid the testimony of the student midwife sent with the
first ambulance. Still in her last year, she is not graduated. In fact, her
testimony had no legal value.
 The description of the midwife made no mention of her expertise: numbers of
births, testimonies of other parents, disciplinary and criminal records. When
their report informed that it is the second time she is facing a bleeding, her
statistics were silenced: 2 out of 1450 births!
 A diagnosis of post-traumatic stress for the mother was not made by mental
health professionals (psychologist or psychiatrist). The DIPHs accepted
testimonies of “hospital practicians” without giving their identity or occupation.
They validated second-hand and spoken diagnosis.
 On the one hand, the report dwells on the authors of the guidelines for the
treatment of bleeding issued by the Haute Autorité de Santé 34 (HAS); on the
other, the authors of the medical management protocol used as a reference35
were omitted and for a reason: Dr. B, the obstetrician who wrote the report and
Dr. M the anaesthetist on duty the day of the transfer.
 The inspectors are building the report to be exclusively incriminatory by listing
all the articles of the Midwifery Code of Ethics the midwife had supposedly
infringed. They did the part of the Regional Disciplinary Chamber, very clearly
manipulating this court, competent to deal with their complaint. This influence

34
High Authority for Health
35
Hémorragie du post-partum immédiat, La lettre des Actualités Périnatales du Languedoc-Roussillon, n°ISSN 1634-
3506 n°20-21, December 2005-March 2006
 is aggravated by the presence on the day of the hearing of a DIPH in the
Regional Disciplinary Chamber. His consultative role allows him to ask questions
during the hearing. Also, his administrative function is turning him into the
agent of social control of all the midwives at the hearing. This status could not
leave them indifferent.
 The Doctors-Inspectors of Public Health are not specifically trained in obstetrics.
Nonetheless, they claimed the midwife lied when she did not mention any
bleeding when she called the emergency services. They ignore the possibility of
a placenta being retained without bleeding.

This denial is the core of the ARS argumentation.

This is how they tried to justify the missing emergency doctor in the first
ambulance which is a serious default to the safety requirements described by the HAS.
Its guidelines on the “Methods for the follow-up of incoming calls for unscheduled care
in medical regulation situations” 36 specify that in the team sent there must be an
emergency doctor, a nurse anaesthetist and two ambulance drivers.
This information cannot be ignored by the Public Health Inspector D.G., who wrote in
the editorial of an issue of the Actualités Périnatales: “The medical team must have a
SMUR37 doctor, even an anaesthetist-resuscitator and a nurse [...]”. D. G distorted the
report by not highlighting this default. Facts were misrepresented in order to make
believable a professional misconduct of the midwife. It is held against her that she
called the emergency too late while the calling times given by the emergency service
records are different from the ones from the hospital switchboard.
Their report concluded that; they consider legitimate the charges the ARS were
about to press before the CDOSF; and they notified the Prosecutor of the Republic.
The complaint was registered on September, 4th of 2013.
The proceedings against Françoise Servent presented with a combination of all
the abuses seen previously: petitioner handling his own complaint, using his own
references and creating false evidence. Her disqualification on April, 11th 2014 is all
the more unjustified and disgraceful.
The only rational explanation lies in the fact Françoise Servent took part in the
project of a birth centre outside of the hospital in Montpellier a few years earlier. To
work on the protocols of transfer, she had an interview with the obstetrician Dr. B and
the Public Health Inspector D. G.

V. WHAT INTERNATIONAL CASE-LAW IS TELLING US

In the childbirth field, the ECHR decision 38 is a test case: "Pregnancy belongs to
private life, the women have the right to decide where, how and with you they will
give birth”.

36
http://www.samu-de-france.fr/documents/actus/129/677/regulation_medicale__recommandations.pdf
37
Service Mobile d’Urgence et de Réanimation
38
ECHR, Ternovsky v. Hungary, request n° 67545/09
 The Hungarian mother who introduced a request before the ECHR, Anne
Ternovsky, deemed her rights were harmed after her midwife Agnès Gereb was sent to
jail. In December 2010, the ECHR claimed the legal authority and choice issues in
childbirth have to do with a person’s rights. The relevant law was private law, source
of other rights in the reproduction field. The Court based its ruling on article 8 of the
European Convention of Human Rights that stipulates that "Everyone has the right to
respect for his private and family life, his home and his correspondence. The Court
added that “private life” is a broad term encompassing, inter alia, aspects of an
individual's physical and social identity including the right to personal autonomy,
personal development and to establish and develop relationships with other human
beings and the outside world.” This includes the right to respect for the choices of the
future and present parents. The autonomy principle is the core of article 8. The Court
made clear that "[…] the right concerning the decision to become a parent includes
the right of choosing the circumstances of becoming a parent."
This judgement is important because European countries that signed the
European Convention of Human Rights (written in 1950!) are now obliged to make
sure pregnant people have the possibility to choose the circumstances in which they
wish to give birth (birth place, people attending, etc.). Besides, the judgement
highlighted the fact that governments cannot press charges on health professionals
who support women's choice, especially to birth outside of hospital centres.
Above all, it brings out that the persecution of midwives helping women giving
birth outside of hospitals constitutes a violation of rights for people wishing to use
their services.

VI. HOW DISCIPLINARY PROCEDURES ARE NOT RESPECTING THE DEFENCE

RIGHTS:

During a procedure, an inquiry judge is in charge of gathering the pieces of the

case, incriminatory and exculpatory; hearing all witnesses and putting together the
evidence of a possible cause to effect bond that provoked the damages in question.
This file is transmitted to the court for the trial if the inquiry judge considered the
charges pressed against the defendant sufficient. The case can even be judged before
a different court as it would be relocated when conflicts of interests or local collusions
exist. After the court decision is out, the defendant can appeal and take one’s case to
the Court of Appeal. The applicable law must respect the last domestic and
international precedents.
Very recently, Sylvie Simon 39 wrote: “The progress of procedures before the
French Doctors Council is not fair: the council tolerates that a file is not issued by the
opposing parties, it only hears the arguments it chooses to, and, in the report
presented during the hearing, its decision is already taken. Besides, the Order has
been condemned for this practice by Juan Miguel Petit, rapporteur for the children’s
rights at the United Nations Organisation.”(our translation)

Out of all the cases we studied, only one lawyer denounced

the illegal operations of the disciplinary chambers.

39
Sylvie Simon, Ordre et désordre, Edition Mosaïque Santé, Donnemarie-Dontilly, 2013, p.202.
 As a result, the disciplinary chambers accepted files built by the litigant parties
on the one hand and exclusively incriminatory on the other hand. The set ups leading
to the legal pursuits were prepared months or even years before the official start of
the procedures (3 years in one case, 4 years in another). The grievances went beyond
the pressed charges and spread to the practice of the midwife as a whole in a
defamatory way even when no complaint was ever heard.
The disciplinary chambers do not have any case law of their own: they were
using the civil or penal case law and also arguments from other professions (mostly
obstetricians-gynaecologists) or health organisation (the HAS). The precedents used
were obsolete or limited to domestic cases, ignoring the standards of other European
countries with a better experience in homebirth field.
We noticed a complete lack of scientific reasoning: no medical explanations
were given and laboratory exams of anatomo-pathology, radiology or other were
never mentioned. The same way, exculpatory medical and scientific evidence were
ignored whereas incriminatory documents created by the complainant parties were
accepted.
In the worst situation, the disciplinary chambers were abstaining from
questioning the behaviour of the others professionals (cf. chapter IV; section E). An
obstetrician, called for an emergency, a breech birth, is not monitoring the baby’s
heart during the transfer. In case of foetal distress, he would have been obliged to
perform an emergency obstetrical act. The report of this obstetrician was not required
by the disciplinary chamber.
The cancelation of the professional licence is applied systematically unless the
midwife ceased to practice homebirth and joined a hospital or if she practiced
homebirth according to hospital references (episiotomy for example).

This last resort sanction of suspension becomes inexplicable

when enforced in situations where the transfers were legitimate and
medically appropriate.

We can reasonably wonder if the purpose of striking off all midwives asking for
transfers is to reassure the emergency department of the maternity units whose staff
is no longer used to obstetrical emergencies (cf chapter IV; section G). For some
others, it can also be about clearly showing they do not support homebirth in any way
and that their last wish is to be associated with it (cf. chapter I).

VII. HEARINGS IN DISCIPLINARY CHAMBERS: A PARODY OF JUSTICE:

Inside of this no-go area resembling a theatre play, the role confusions were
repeating themselves.

Plaintiffs were leading the investigations themselves, building incriminatory cases and
creating their own evidence.
The ARS doctors, Public Health Inspectors, suddenly became knowledgeable in
obstetrics but also in law and decided on their own what a serious offence is.

The lawyers could turn into law professors, teaching the chamber members about civil
 and penal law or obstetrics experts and even ended up sharing their own experience
as a parturient. They were talking even when not authorised to do so.

The midwives of the disciplinary chambers acted as experts and make the defendants
pass their midwifery exam again turning a blind eye on their experience (cf. chapter
IV; section G): Françoise Servent was accused after 33 years of practice and 1450
homebirths.
They imposed their own definitions of birth physiology and disqualified homebirth
while they are all working in hospitals or private practices without offering homebirth.
They carried on with the investigation during the hearing asking for further
information; they accepted to hold the hearing even when a party associated to the
complaint was missing and had no replacement; they allowed the reporter to ask
questions.

About this last point, we remember the medical disciplinary chambers changed
their ways after the European Court declared that the intervention of the reporter was
against the law.

In her book, Ordre et désordre40, Sylvie Simon wrote:

As Montesquieu was saying in The Spirit of Law: “Again, there is no liberty if the
judiciary power be not separated from the legislative and executive. Were it joined
with the legislative, the life and liberty of the subject would be exposed to arbitrary
control; for the judge would be then the legislator. Were it joined to the executive
power, the judge might behave with violence and oppression.” But, the [medical]
Council is holding all three powers: it establishes the rules, applies them and judges
the offenders – just like a totalitarian system.

VIII. LAW INFRINGEMENTS SHARED BY THE DISCIPLINARY AND CIVIL

PROCEDURES:

Penal law is a reaction of defence from the society against breaches of its
organisation. It guarantees social peace. The penal procedure is the body of rules
organizing the repression of those breaches of peace or crimes by the means of
penalties. It makes links between the crime and the penalty, through intermediate and
necessary steps which are: the recording of the breach, the gathering of evidence, the
prosecution of the criminal offender and the judgement by the competent jurisdiction.
Here, those rules are not respected because:

- Cases were never relocated despite known local collusions and/or conflicts of
interest in every case: medical, legal and disciplinary bodies were involved as well
as hospital administrations and ambulance staff;
- Even the most obvious pressure and obstacles against the defence midwives were
facing were never denounced: disappearance of evidence like the placenta,
inaccessible medical file and post mortem examination results, hearing of
witnesses and second opinion rejected and falsifications;
- The investigations on the causes of deaths were always partly handled
and as a result, impede the parents’ grieving process;
- Contempt was blatant for the positive testimonies of the parents those midwives’
worked with as the deliberate absence of publication of their attestations showed;

40
Simon Sylvie, 2013, op.cit., p19. (our translation)
 - Professional skills of midwives were denied in every procedure:
- No reference was made of their experience (years of practice, different
working methods, trainings completed, approval by other professionals,
integration to health networks);
- Contempt for the social dimension of the profession: criminal and disciplinary
judges ignored the fact that the midwife is part of a community of users in
spite of their testimonies;
- No nomination of an independent and impartial expert-midwife (the
requests were rejected).

IX. HOW FELLOWSHIP BETWEEN HEALTH PROFESSIONALS IS SCORN:

Despite articles about the fellowship duty in the medical and midwifery codes of
41
ethics , ill-intentioned manners are found throughout all the cases.
The complaint files of the departmental councils showed their intolerance. The
midwives issuing the accusations made statements that lacked verification. They
ignored the defamatory feature of their speech. “Libel […] harms the honour and
self-consideration of individuals”42. Allegation of facts is a crime.
The subjectivity while choosing facts and establishing links between them also
appeared in the chambers' decisions and the conclusions of the DIPH. On this
hazardous field, intolerance and criticism are popular. For a scientific practice, this
attitude is dishonouring. Here are a few examples:
 Serious and groundless accusations of first and second degree manslaughter:
“deliberately endanger one's life”;
 General and non-scientific statements: “Nowhere on the French territory, could
anything like that happen!”
 Distortions of the truth and influenced judgement to dramatize the situations: “a
mother victim (sic) of spontaneous membrane rupture” ; use of the word “child”
instead of new-born ; “punished by the judges” ;
 Humiliating value judgement instead of professional faults: “[...] thoughtlessness
[…] casualness […] recklessness”; “the midwife lacked authority, insight and
assiduity [...]”; “Madam, are you so naive?”

The midwives reactions showed to which extent we are contaminated by

slander and libel, summary judgement, bias, lack of respect and malicious gossip. We
can no longer keep our objectivity untarnished and we are confused about what fair
judgements and fair decisions are.

X. THE DISSOLUTION OF THE DISCIPLINARY CHAMBERS: A REALISTIC

CHOICE FOR MIDWIFERY:

The dissolution of disciplinary jurisdictions is a response to the awareness

shared by other professions in France.

As soon as 1982, a law43 abolished the permanent courts and the permanent

41
Midwifery Code of Ethics, article R4127-354
42
http://vosdroits.service-public.fr/particuliers/F32079.xhtml
43
Law n 82-261 of July, 21st 1982 on the investigations and trials of State safety and military related crimes changed
the criminal procedures and military justice.
High Court for Armed Forces in peacetime. After this law was enforced, the crimes
against the military law as well as crimes against common law committed by military
people during their service no longer falls under the military jurisdiction but common
law jurisdictions.

Closer to us, on June, 13th of 2012, the main interunion association wrote the
following letter44 to the Ministry of Health, Madam Marisol Touraine:

The interunion association […] never stopped claiming the uselessness of the
Nursery Regulatory Body, which repeatedly attacked nurses since its creation. We
are against this demand made to nurses not only to register to a regulatory body
but also to pay a fee to be able to work as nurses. The legitimate right to practice is
granted by a state diploma and its registration at the territorial ARS board of their
place of work.
Nurses, with their massive abstention for the election of the departmental councils
of their regulatory body (less than 14%), expressed that they considered it neither
representative nor desirable.
We cannot accept imposed subscription and fee for a regulatory body for nurses
whose practice conditions are already framed by professional rules. They have no
need for the extra disciplinary and ethical pressures the regulatory body is
intending to set.

During a session of questions addressed to the government at the National Assembly

on May, 13th 201445, the same minister, called out by a deputy, said: “I am being very
sincere and very firm, the nurses’ regulatory body is challenged, has no legitimacy
and therefore its future is clearly at stake.”

We have the right to raise the issue of the legitimacy of the disciplinary chambers.
Sylvie Simon46 concluded as follow:

Medicine cannot remain the property of the Council or of the political power. Facing
serious abuses unfortunately becoming habits, the Order lost all legitimacy and
should be, unless being deeply reformed and deprived of its kingly right to hold
sway against those who don’t share its concepts, dissolved like the special courts
and their arbitrary methods they shared for too long.

CONCLUSION

France, by the means of its institutions, does not respect Human Rights in
childbirth. Through homebirth criminalisation and the persecution of midwives helping
women birthing out of hospital centres, the French state violates the pregnant
women's rights and harms their civil rights. The control over places of birth is
maintained with violence, cutting the wrongly accused and judged midwives from
income. The ban on creating out-of-hospital birth centres that already exist in most
European countries and in the World, just like making home birth illegal is sending an
archaic image of our health care system. The opposing party's motivations rely on
common place and by definition on a complete lack of scientific ground. The midwives'
persecution is not an unlucky adding up of individual stories. It is about illegal and

44
www.cgtlaborit.fr (our translation)
45
www.actusoins.com/21935/anti-ordre.html. (our translation)
46
Sylvie Simon, 2013, op.cit., p 220. (our translation)
abusive penal actions aiming at their mental integrity through intimidation and
sanctions. May it be by the obstetricians' report or the biased investigations led by
departmental councils, the intentions trials are patent. The arbitrary of the disciplinary
chambers has already been revealed by the ECHR. This way of operating infringes
both article 16 and 6§1 of the European Convention of Human Rights.
This “divide and rule” process is doing a disservice to the profession and
consequently to the women's freedom to dispose of their own body. On the other hand,
it is supporting to whoever wants to control women and contributes to the exercise of
obstetric violence through the health institutions and their staff. This violence
encourages midwives to exert the same pressure on pregnant women.

In 2007, we read in article 13, chapter III of the Law on the Right of Women to
a Life Free of Violence47, how Venezuela defines obstetric violence:

[…] the appropriation of the body and reproductive processes of women by

health personnel, which is expressed as dehumanized treatment, an abuse of
medication, and to convert the natural processes into pathological ones, bringing
with it loss of autonomy and the ability to decide freely about their bodies and
sexuality, negatively impacting the quality of life of women.

For all those reasons, the necessity to dissolve the disciplinary chambers
becomes obvious. In the Netherlands, June 2014, a decision gave her licence back to
Laura van Deth, midwife struck off for practising out of her competence. The Court
stated that the integrated care habits not based on scientific evidence cannot be used
to reject supposedly deviant care. The decision reminds the practitioners' right and
obligation to carry on with the care of the patient even when the latter is out of the
protocol.
French midwives have to let go of the modern inheritance defined by technology
and patriarchy and take on the new paradigm of the post-modern era. Post-modern
midwives bring together ancient knowledge and scientific data, associate local and
global vision and share their knowledge with their colleagues who they consider like
sisters. Verena Schmidt practiced homebirth for 20 years in Italy, created a home
birth centre, a magazine for midwives and a homebirth midwifery school48. She is now
working on a birth centre in Florence. Here what she says about midwifery
teachings49:

The university midwifery training failed; the teachings in midwifery schools are
below the levels of today’s knowledge. We need a new midwifery practice to look
up to. We are losing great amount of time protecting women from the non-
physiological practices of the medical system. Women are under the control of
the medical system because it does not accept the existence of death. It is a
very abstract, mechanical system, cutting the women from thei
r feelings. A lot a rituals were made up in order to achieve that. Matriarchy was
replaced by patriarchy and the archetype of the dismembered woman appeared.
Terror is here, we cannot let our wisdom show for fear of being punished. We
need to support one another to put the pieces back together, belong to a group
and listen to our individual instinct. We need to work like sisters, sharing a new
vision, a new direction.

To meet this new paradigm, we must bring to an end the depreciative and
47
Ley sobre el Derecho de las Mujeres a una Vida Libre de Violencia, Gacete Official de la Républica Boliviariana de
Venezuela, March 19, 2007, n°38.647, p. 353.350. (translation by Pérez, 2010, p210)
48
www.marsupioscuola.it
49
Conference Midwifery Today on. November 3rd, 2013.
powerless representations we accepted and interiorized as the norm for women. We
also must break the taboo of perinatal death: this very taboo incites the control of
women's bodies by the patriarchal society. The patriarchal system considers that
pregnant women lose their capacity to make the right decision for themselves but also
and above all for their babies. This is how the patriarchal system found its purpose in
protecting women from themselves and deciding what is good for them for them.
The pregnant women must be at the very centre of all public health policies
because they own the right and competence to enforce their choices. Insure that
pregnant folks are at the core of every decision making will end chivalry and jealousy
between midwives will disappear as well as power take over by some heads of health
services. One objective have to bring us all together, preserve the health of the
pregnant population through the guarantee of human rights. Protecting the mother
protects the child.
Re-establishing those midwives unfairly banned is the first step towards the
restored dignity of a practice, that the most experienced consider not only a
profession but an art. These dividing confrontations are using up our energy while
there are so many battles to fight for the recognition of our competences.
The great human qualities necessary to midwifery practice must remind all of
the respect we owe to those taking on this great responsibility, regardless of the
places they choose to work in.

Mother of five
Midwife

Founder of the Observatory of Obstetric Violence: every Monday from 2 to 4pm at the
birthcentre of Pau.
Administrator of the Facebook page: La Revolution des Roses – France
#StopObstetricViolence
President of the National Union of Midwives for homebirth, Les Femmes Sages
Student in 2nd of Psychology in Toulouse University
Consultant and trainer in health, birth and education

I wrote this study on the request of the lawyer Hermine Hayes-Klein, founder of
Human Rights in Childbirth whom I met in 2013 during a conference in Blankenberg,
Belgium.
This study gives a picture of the breaches of human rights in homebirth in France. It
describes how independent midwives are being illegally sued by the Midwifery Council
and highlights obstacles to their practice created by the French state. These midwives
are advocates of women’s right to birth where and with whom they want (ECHR, Case
of Ternovsky v. Hungary, December 2010).

Translation from French: Lauranne Viven