The Quest for the Ultimate Addiction Cure

By Alex Roslin
Could the root of an African shrub hold the key to getting millions of addicts off heroin, coke, and crack – oh, yeah, and cure alcoholism in its spare time? Can a single dose of an extract from the mysterious shrub's root bark be worth years on a therapist's couch?
Some of the answers may soon be found in a three-bedroom house on the Sunshine Coast. Tucked away there on a hill, with a stunning view of the ocean and surrounded by tall trees, is the Iboga Therapy House.
Forty years after globetrotting backpackers introduced a substance called ibogaine into the U.S. drug culture, the extract from western Africa's Tabernanthe iboga shrub has become an underground rage among drug-addled Hollywood celebs willing to plunk down between $3,500 and $10,000 for ibogaine treatment at any one of about a dozen unregulated clinics worldwide, including the one in B.C.
Because ibogaine is illegal in the U.S. – one of just three countries to ban the substance, along with Belgium and Switzerland – clients have to travel to clinics in countries such as Canada, Mexico, Costa Rica, and Slovenia for an "ibogaine experience".
Advocates liken the miracle drug – which can unleash a reality-shattering trip so powerful it has been described as "dying and going to hell 1,000 times" – to the Holy Grail of addiction cures, comparable in importance to the discovery of penicillin. Although ibogaine's alleged ability to quickly cure opiate addiction without withdrawal symptoms was discovered relatively recently, the substance has long been used in Gabon by hunters to stay alert and, in larger doses, in week-long sacred ceremonies in the Bwiti religion.
Yet despite the extraordinary claims about ibogaine's powers, a B.C. study launched last February is the first time the drug's therapeutic benefits for opiate addiction are being measured systematically in a public investigation. (Other clinics haven't released data.)
Preliminary results from the Sunshine Coast clinic have justified much of the hype. "I've witnessed people's lives being turned around," said Leah Martin, one of the study leaders. Of 20 pre-study clients who took ibogaine at the facility in 2004, 13 were found to be abstaining when evaluated later, after an average interval of six months. The abstainers included six out of seven cocaine or crack addicts, three of eight opiate addicts and four of five people with other addictions, including to meth and multiple substances.
With an overall abstinence rate of 65 percent, ibogaine does way better than the 10-percent average of conventional drug-treatment programs, Martin said. What's more, the clients at the B.C. facility are usually the hardest cases.
"People who contact the Iboga Therapy House have already done every type of program in their city and are scouring the Internet [for help]. They've been in detox multiple times and are highly resistant to other therapy. They say, 'This is my last hope,'" she said.
Ibogaine works in two ways. It eliminates cravings for heroin and other drugs in many people, but it also often works at a deeper level, getting them to revisit life experiences–good and bad–and helping many find ways to heal and ensure cravings don't come back. Scientists say it's like hitting a reset button for your brain. Traces of the drug remain in the body for up to six months, continuing to ward off addictive urges in unknown ways. "It truly is its own category [of drug]," Martin said. "Right after, it's common for people to say, 'Whoa, what was that?' But a month later, people might wake up and remember something and be able to move forward."
Ibogaine appears to work on "every neurotransmitter system we know about", Kenneth Alper, a psychiatry professor at New York University School of Medicine, told the Journal of the American Medical Association in a 2002 story on ibogaine. Alper, who is also a co-investigator in the B.C. study, has called the use of ibogaine "one of the biggest paradigm shifts regarding treatment for addiction in the span of my career".
In a testimonial on the Iboga Therapy House's Web site, one client says of the trip: "I pretty much died to my old self. I yelled, I kicked, I screamed (inside myself) but this new knowledge is too powerful to ignore." Says another: "I believe Iboga brings you into and through the land of the dead, to the land of the Gods."
The Georgia Straight connected with Martin early one morning near the end of her 8 p.m.-to-8 a.m. shift as a program worker at a Downtown Eastside residential detox centre run by the Portland Hotel Community Services Society. She spoke about her own ibogaine trip: "I felt as a facilitator I should know what it was like, to be able to relate."
An ibogaine experience usually lasts 24 to 36 hours, most of which is, typically, spent on your back because of impaired muscle coordination and perception. The first four hours usually involve plenty of vomiting, coupled with hallucinations and strange physical sensations. This isn't a drug for clubland.
Next is eight hours of what Martin called the "cognitive phase: the beginning stages of insights. You're remembering things or events. It tells a very interesting story of yourself and your life."
The intense visions are dreamlike, Martin said, but "if you find yourself in a vision you don't like, you can just open your eyes. There is a lot of randomness along with insights. It truly was a reflection of my mind and the things I obsess about. I laughed at myself a lot, realizing how ridiculous people can be."
This is the phase that can give people with addictions deep new insights into their troubles. "If you had trauma, people can relive that. After they're traumatized, sometimes they shut themselves off from the pain, and that's why they adopt certain habits. But to be able to see it in a healing way [with ibogaine] can be beneficial."
Then comes another 12 to 24 hours of "residual stimulation" as the person keeps dreaming but slowly comes down, often falling asleep.
Advocates say the drug isn't addictive itself partly because the trip is so hellacious. "It is not a recreational drug," said Rick Doblin, president of the California-based Multidisciplinary Association of Psychedelic Studies, which is helping to fund the Iboga Therapy House study. Doblin is also the principal investigator.
The ibogaine work is just one of MAPS's stable of groundbreaking research projects. The group is also funding the first-ever studies of therapy involving ecstasy, LSD, and magic mushrooms to deal with mental-health issues like posttraumatic stress, end-of-life anxiety, and obsessive-compulsive disorder. The U.S. studies all have an official okay from the U.S. Food and Drug Administration and even of the drug warriors at the Drug Enforcement Agency, and are attracting interest from the U.S. military for treating PTSD among Iraq vets.
Early results show ecstasy is not only safe for therapeutic purposes, but it can also help people who don't respond to conventional therapy or treatment with the pharmaceutical drugs normally given for posttraumatic stress: Zoloft and Paxil. Doblin described the ecstasy results as "dramatic"–far better than those from the standard treatments.
The work has still met ferocious resistance from the DEA, however. MAPS is battling the agency in court to get permission for scientists to grow marijuana in order to study its use for pain relief, control of nausea, and other medical purposes. Last February, a judge ruled in MAPS's favour, but the DEA has filed a series of objections, citing security concerns and likening Doblin to Colombian drug lord Pablo Escobar.
Speaking over the phone from his home in Boston, Doblin said he owes much of his doggedness and success to his own ibogaine trip in 1985, a year before he founded MAPS. "I feel it's been a major contributor to what I've been able to accomplish," he said, describing the experience as "lasting, powerful and very positive, although at the time it was horrendous".
Back then, already active in drug-policy reform, he said he suffered from a neurosis common to many activists–"a certain arrogance, that we know the better world". An underground therapist suggested ibogaine could help him grow personally and become a more effective activist.
Doblin took it one morning at the oceanfront house of a therapist, who stayed at his side. He lay in bed with his eyes closed all day, vomiting constantly, coughing and feeling like he was choking. The barf brought out complex emotions: "a line between self-criticism, self-perception, and self-hatred". He started to blame his intense nausea on his inability to just chill out and unwind. "I thought this was all my doing–that I couldn't relax. If only I was better, I could be a better tripper," he said. Then came realization: here was a metaphor for his struggles with his arrogance. "I was crucified on the cross of my own self-perfectionism," he said, laughing.
Twelve hours later, the stars came out, his guts relaxed, the upchucking stopped and everything got good. "I had one of the most blissful nights of my life. It felt like transcendence through exhaustion," he said. "I'm forever grateful for that experience. I think about it often."
The experience helped Doblin work out the arrogance thing; it also enabled him to develop the confidence to strike out and found MAPS. Yet he doesn't believe it's the easy wonder drug some suggest, and he supported the B.C. study partly because of the underground myths about ibogaine. "We've been deluded for a long time with the miracle-cure approach," he said.
One problem is many ibogaine clinics that offer the expensive treatment are happy to let potential clients believe it will solve all their problems, Doblin said. The clinics have little incentive to follow-up with clients or study the treatment's effectiveness, which, he said, is widely overestimated.
First off, he said ibogaine isn't for everyone. It requires one to be "open to the self-reflection that ibogaine permits. It takes a certain courage to go through an ibogaine experience." Even for these folks, he said, the trip has to be supported by aftercare and, possibly, a second dose.
There may also be safety concerns. About a dozen deaths have occurred during the 3,600 recorded ibogaine treatments that have taken place outside Africa since 1990. Advocates say pharmaceutical drugs also cause adverse reactions. Also, coroner reports in most of the cases placed the blame not on ibogaine, but on conditions like heart or liver disease and, in one case, a man choking on his vomit while eating a sandwich after the session had ended.
Just the same, the Iboga Therapy House screens potential clients for several medical conditions like ulcers, liver problems, blood clots, and heart trouble. Patients start with a small test dose and are observed for an hour for adverse reactions before the rest of the gram-sized full dose is given.
Gone, however, are the halcyon days when the clinic used to offer free ibogaine. In 2005, its founder, Vancouver pot entrepreneur Marc Emery, ran out of cash to fund the facility, so it had to close. Last February, the clinic reopened with money from MAPS. It now hopes to become self-sustaining by charging $4,700 for a five- to seven-day treatment session for dependence on heroin, methadone, and other opiates, cocaine, crack, or alcohol. (Shorter, cheaper sessions are also offered for spiritual or strictly therapeutic trips.)
Aside from the ibogaine, which the clinic buys for $700 a dose from a distributor in Spain, the sessions include therapy, massage, acupuncture, mild yoga, and elements of the traditional Bwiti ceremony to set the mood for the ibogaine session. Only one client or couple stays at the house at any time, and staff are on hand around the clock to monitor them.
Doblin said the B.C. ibogaine clinic is inexpensive when compared to hospital programs. Besides that, the cost doesn't seem high compared to addiction's drain on people and society. Almost 10 percent of the B.C. government's budget is spent on substance abuse and problem gambling, according to a 2005 drug-policy report by the City of Vancouver. That report recommended alternative treatments for drug dependency, including the therapeutic use of psychedelic drugs like peyote and ayahuasca.
Although ibogaine wasn't mentioned specifically, Zarina Mulla, a city drug-policy planner and report coauthor, spoke enthusiastically about it in a phone interview from her office.
"It helps users analyze some of the issues behind the drug abuse. Perhaps this is the most important thing because you can relapse and go back to the drug," she commented.
Mulla said alternative approaches are vital at a time when the Harper government has announced a new Canadian drug policy modelled on the U.S. police-and-prisons approach, which she called "a failure…There's such a large amount of money for enforcement [in the Harper policy] and none for harm reduction and only a little for prevention and treatment."
Leah Martin, for her part, said she's not holding out hope for any federal funds for the ibogaine clinic. It did apply once, but was rejected. "They were looking for teens that do [drug-education] tables at raves. We were a bit too obscure for them. People generally don't know about [ibogaine]."
And in the current climate, that's not all bad. "We're lucky ibogaine is unscheduled [not banned] in Canada. We play our cards so we kind of stay off the radar."

For more info:

Is E Good for the Brain?

Some shrinks—and military officials—believe ecstasy may be penicillin for the soul

By Alex Roslin
FALL 2007

Is E penicillin for the soul? Maybe not if you’re George Bush or the DEA. But growing numbers of shrinks and families of folks with psychological problems say ecstasy is pretty much a Holy Grail of mental-health drugs.

No one’s been able to research the magical “love drug” since the U.S. banned it in 1988. But times they is a-changin’. MDMA, the scientific name for E, is being studied for the first time to help people who are depressed, majorly stressed or suffering from post-traumatic stress like soldiers and cops.

And get this: the studies have the U.S. government’s stamp of approval.

Early results are nothing short of miraculous; they threaten to blow people’s ideas about the drug’s safety and usefulness wide open and stick a finger in the eye of the war on drugs.

The patients’ stories are heavy. An Israeli man who survived a terrorist bombing that killed 10 people was suffering from post-traumatic stress. Therapy and various psychiatric drugs weren’t helping. He took some MDMA at a party and finally managed to calm his anxieties for the first time.

Shane, 25, took E with his girlfriend Sue after he was diagnosed with terminal kidney cancer that had spread through his body. The cancer caused the couple so much stress they almost broke up. They dimmed the lights and sat on the couch chilling to quiet music waiting for the E to take hold. “We both noticed an extreme calm and relaxation wash over us,” Shane said later. They held each other and cried, realizing for the first time they had been pushing each other away because they were so scared.

“It was a closeness I hadn’t felt in a long time with him,” Sue said. “We grew physically closer and felt a need to touch. It was in no way sexual—it was almost like a desire to be inside of each other.”

The session changed their lives. “By having ‘broken the law’ and done MDMA together, we have the chance to bring a lifetime of love and understanding into our short time together,” Sue wrote later in a testimonial.

If Rick Doblin has his way, people like Sue and Shane won’t have to break the law to get help from E. Preliminary results from the studies show MDMA can help even hardcore patients who were thought to be untreatable, says Doblin, the president of the Multidisciplinary Association of Psychedelic Studies (MAPS), which is sponsoring the five MDMA studies.

“We had dramatic results in almost everybody—multiple times greater than with the standard treatments,” he said. “When they’re done, (the patients) wouldn’t qualify to be in the study any longer. They can return to normal functionality.”

One study nearing completion involved 15 people with moderate to severe post-traumatic stress due to sexual assault and other violent crimes. It included only people who didn’t respond to conventional therapy or the two drugs normally given to such patients—Paxil and Zoloft.

“So far, we’re seeing a greater effect than what was found with the Paxil and Zoloft trials. It’s looking very promising,” said Dr. Michael Mithoefer, a South Carolina psychiatrist doing the study at his clinic.

What’s the MDMA secret? Mithoefer said it seems to help people overcome their mistrust and fears and get in touch with their own “healing intelligence” to process their trauma. “They tend to feel, ‘Okay, I can do this. I can actually talk in detail about the trauma and I won’t be overwhelmed by the fear,’” he said. “People have the fear that if I go there I’ll start crying and never stop or go crazy.” That’s a big problem, he said, because patients need to revisit the trauma as part of healing.

The patients take a 125-milligram dose of MDMA on two or three occasions as part of a series of therapy sessions. They wear eyeshades and listen to soft music and are encouraged to go into their emotions. Mithoefer doesn’t say much until the patient is ready to talk.

“It’s fundamentally different from other kinds of medications,” Doblin said. “It’s not about forgetting the trauma or just taking painkillers and trying to ignore it, but finding a deeper level of acknowledgement.”

Before you go out and pop some E to get your head straight, remember these studies are being done in a controlled setting in the presence of a specially trained therapist who helps patients deal with the heavy emotions that MDMA can release. And it can get pretty intense.

“Some subjects said, ‘I don’t know why you call this ecstasy.’ It may be a difficult and challenging experience,” said Mithoefer.

Dr. George Greer, a New Mexico psychiatrist, prescribed MDMA to 80 patients in the 1980s when it was legal and said it had amazing effects. “Virtually all of them thought it was helpful,” he said. “When I gave it to a couple, every time the communication improved and it improved the relationship.”

Greer called the 1988 ban on ecstasy “a huge blow.” He sued the DEA to be allowed to keep giving it to patients, but the DEA overruled a court judgement in his favour.

He is now medical director at the Heffter Research Institute, which is sponsoring research into therapeutic uses of psilocybin—the active ingredient in magic mushrooms—for helping people with obsessive-compulsive disorder and end-of-life stress from terminal illnesses.

“The theory is it resets the serotonin receptors so they’re more balanced and you don’t have obsessive-compulsive symptoms,” said Greer.

One of the patients in the study was Pamela Sakuda, who was suffering a lot of anxiety after she was diagnosed with cancer and given six to 14 months to live. A single psilocybin session allowed Sakuda to let go of much of her stress and “understand how precious the present was,” said her husband, Norbert Litzinger.

Three hours into the trip, Litzinger was asked to come to the hospital room where his wife having her session. “She was just glowing,” he said. “Her first words were, ‘I love you.’ I said, ‘I love you, too. How are you feeling?’ She said, ‘Just wonderful.’

“She realized we had stopped making plans because she expected to die, so what’s the purpose of making plans? That was gone. She said, ‘Let’s make plans.’”

Notzinger said his wife turned the last two years of her life into a blur of activity filled with traveling, clubbing into the wee hours of the morning, weight-lifting and power-walking 40 kilometres a day; she also became an activist petitioning for the therapeutic uses of psychedelic drugs and marijuana, for which she also got a permit because of her cancer.

Along with the MDMA studies, MAPS is also sponsoring research into psilocybin, LSD and ibogaine, a super-intense hallucinogen that makes an acid trip feel like a wine cooler buzz. Ibogaine is thought to help reduce heroin addiction and alcoholism.

Doblin says he’s getting calls from the U.S. military about the research and hopes to recruit Iraq war vets and cops to the MDMA studies. Military officials think MDMA could help some of the 216,000 vets suffering from post-traumatic stress, mostly dating back to Vietnam, he said. Treating them costs $4.3 billion U.S. a year, and soon a new crop of vets from Iraq and Afghanistan is expected to enter the system. It’s estimated 30 percent of combat soldiers suffer from PTSD.

“How many of those people could be taken off the disabled lists?” asks Doblin.

But all this research is meeting a lot of resistance from the all-powerful U.S. drug-war lobby. Even though MAPS got an ok from the Food and Drug Administration to start its MDMA research in 2001, it took another three years to get approval from the squareheads at the Drug Enforcement Agency. “The DEA was really tough,” Doblin said. “They just delayed and delayed and delayed.”

The approval process included studying the safety of MDMA. Contrary to all the horror stories about how E will rot your brain, MAPS was able to show it’s safe for human testing and that any risks are “minimal,” said Dobin. “There is absolutely no evidence MDMA is hurting (the patients). It seems like it’s quite safe.”

Mind you, there’s also a difference between taking E in a clinical setting, where the purity and dose are controlled, and a club, where you don’t always know what you’re getting and people can abuse the drug, said Mithoefer.

“Our main purpose was to see if it’s safe for use with patients, and we are seeing it is,” he said. “The large majority of drugs we use in medicine can be dangerous if used inappropriately.”

Once the final data is in sometime in 2008, the next step will be to get government approval for full-scale testing on 250 to 300 patients. If successful, Doblin hopes science will trump drug-war politics and MDMA will be approved for use in therapy. One of the obstacles, he said, is the fact that pharmaceutical companies can’t get a patent on MDMA, which means there’s not a lot of money to be made off it.

“We’re trying to get the politics out of the way,” Doblin explains. “Our goal is for MDMA to be taken for granted and for people to ask, ‘Why was this ever illegal?’”

For more info:
Multidisciplinary Association of Psychedelic Studies
Family accounts from MAPS' Rites of Passage project
MDMA-Assisted Therapy Method

Centres of Controversy: Hospitals Vs. Midwives

There are only two birthing centres in Montreal, which must turn away many eager parents. Midwives say resistance from the medical community is hindering their practice from growing in Quebec.

Special to The Gazette
The Montreal Gazette
Saturday, September 29, 2007

There’s a fine line between relaxed and sleepy, and Renelde Napoli strikes it perfectly. She is in her seventh month of pregnancy and a little tired out, but still in good spirits as she juggles caring for first-born Olivia, 4, and preparing to exhibit her jewellery at an upcoming art show.
She hopes to have her baby at the CLSC Lac St. Louis Birthing Centre in Pointe Claire with the help of midwives. While many expecting parents opt for hospitals because they feel safer there, Napoli feels the opposite.
“The birthing centre feels like a more comfortable and safer environment. It feels more like home—not threatening, with machines everywhere.”
Napoli has experienced both settings. She had planned to give birth to Olivia in the Pointe Claire birthing centre, but her first baby arrived just days too early—36 weeks into her pregnancy.
The cutoff for births there at the time was 36 weeks, five days. (It has since been reduced to 34 weeks.) So Olivia was born at the LaSalle General Hospital with the assistance of Napoli’s midwife.
Napoli said the hospital’s staff were “really nice,” but that she far prefers the extra care and natural philosophy of a midwife. So when it came time for baby No. 2, she immediately signed up again at Pointe Claire despite the fact she doesn’t have a car and needs to borrow or rent wheels to make the 30-minute trip from her Plateau home.
“The birthing centre seems so much more natural,” Napoli said. “I love that they take time to talk to you. Each appointment is an hour, and if it’s longer, it’s no big deal.”
Napoli is part of a growing movement of Quebec parents seeking an alternative to the hospital birthing experience.
Waiting lists at Montreal’s two birthing centres (the second is in Côte des Neiges) are long, with only 30 per cent of expecting parents able to get a spot. Parents who don’t sign up within a few weeks of becoming pregnant probably won’t get a spot.
A 2005 poll for Quebec’s Health Ministry found 15 per cent of Quebec women would like to give birth at a birthing centre, while another nine per cent would like to do so at home with the help of a midwife.
Yet only about 1.5 per cent of the province’s 80,000 annual births are currently assisted by midwives. The reason: Quebec has only 90 midwives working at eight birthing centres, well short of the 500 practitioners and 40 birthing centres that midwives say are needed to meet the demand.
Advocates say birthing centres are more natural for the 80- to 90 per cent of pregnancies that are low-risk and don’t require medical intervention, and that they can ease the burden on Quebec’s overworked obstetricians, who typically have a caseload of 200 to 300 births per year, compared with 80 for each team of two midwives.
Yet plans to expand the number of birthing centres in the province have stalled. A new birthing centre scheduled to open next year in the Laurentians got off the ground only after 14 years of campaigning by community groups and funding from the city of Blainville to construct the building.
In Montreal, midwives and community groups have campaigned for 10 years to create a birthing centre in the Plateau. With the Health Ministry refusing to finance a third birthing centre on the island, the local health board that includes the Plateau said it is hiring four midwives this fall to work out of the Ste. Justine Hospital.
Activists are negotiating with a private foundation to finance the construction of a building in the Plateau that they hope the Health Ministry would rent for use as a birthing centre.
Such a centre nearby would have come in handy for Moiya Callahan, a Mile End resident expecting her third baby in April. Like Napoli, she must rent a vehicle to attend prenatal appointments with her midwife at the Pointe Claire birthing centre, where she had her first two kids. Because of the distance, she is considering a home birth the third time around.
When Callahan learned she was pregnant with her first son, she went to a hospital for her first prenatal checkup, but said quickly got turned off. “I saw the doctor for about three minutes. It was not a very nurturing environment.”
She learned about midwives on the Internet and was won over by their philosophy of natural childbirth and self-empowerment. “You can spend an hour with them at appointments. Then, you really have that trust. Having that trust in them makes you trust yourself more.”

So why the delay in creating new birthing centres? A big part of the reason, midwives say, is resistance from the medical community in a country that was one of the last in the industrial world in which authorities started to legalize midwifery.
Quebec let some midwives practice in a pilot project starting in 1995, but midwifery was legalized only in 1999, while midwife-assisted home births were allowed just in 2005. Midwifery remains illegal in Newfoundland and Labrador, New Brunswick, Prince Edward Island and Yukon and the Northwest Territories.
Indeed, if gynecologist Corinne Leclerc has her way, parents like Napoli and Callahan won’t be able to give birth outside hospitals. Leclerc heads a committee on midwifery issues at the Quebec Association of Obstetricians and Gynecologists.
“We are firmly against birthing centres and homebirths because of the security of the newborn and mother. We would like to work with (midwives), but in hospitals,” she said.
As an example of what can go wrong, Leclerc cited the case of a stillborn baby in a Montreal home birth attended by two midwives in Nov. 2006.
Quebec coroner Paul Dionne issued a report in August saying the death was preventable. He recommended the Quebec Order of Midwives, the professional body that regulates midwifery, change a number of its practices.
Midwives called the death tragic, but several said the coroner’s report was biased against midwives and has fostered misconceptions about the safety of their work.
“I thought the coroner was biased, not having done his homework,” said Gisela Becker, vice-president of the Canadian Association of Midwives.
“Many places in Canada and the world have demonstrated that home births are safe. When a death happens in a hospital, you hardly ever hear about the details.”
Sinclair Harris did a wide-ranging examination of Quebec birthing centre data as part of a study she presented at an international midwifery conference in 2004. Harris is a clinical instructor of midwife students who has worked for 14 years as a midwife in Quebec and Britain and 20 years as an obstetrical nurse in the high-risk-delivery room at the Royal Victoria Hospital.
Harris compared data on all 8,400 midwife-assisted births in Quebec between 1995 and 2002 and publicly available figures on 76,000 hospital births.
The number of perinatal deaths (those in which the fetus dies in the latter months of pregnancy, is stillborn or dies in the first weeks of birth) was 57-per-cent higher in hospital births, according to the data.
Harris cautioned the lower rate of interventions in birthing centres is partly because they accept only mothers with low-risk pregnancies. But, she said, the figures show midwifery is safe.
Harris criticized Dionne’s report, saying it suggests a lack of knowledge about midwifery protocol. “His recommendations are reasonable, but most are already in place,” she said.
For example, Dionne recommended that midwives get regular skills retraining and create guidelines to measure a labour’s progress and what to do in emergencies. Harris said retraining is already done and the guidelines already exist.
Another recommendation in the report falls into “grey zone,” she said—that midwives should transfer the mother to a hospital if they spot the presence of baby stool, known as meconium, in the amniotic fluid. In the case of the stillborn baby, Dionne said the fetus died as a result of swallowing meconium. The attending midwives later told police investigating the incident they had noticed some light meconium when they ruptured the mother’s water during labour on the night of Nov. 21, 2006.
Harris said the presence of meconium doesn’t necessarily mean the fetus is in danger and is not in itself a reason for a hospital transfer if the fetus is showing no other signs of distress.
Leclerc, the gynecologist, agreed meconium isn’t by itself normally considered a reason for a hospital transfer.
“Probably if the baby wasn’t suffering, the doctor would have said (to the midwives) it’s okay to continue what they’re doing,” she said.
Indeed, the Quebec Midwives Act requires only that midwives do a phone consultation with a doctor if “thick or unusual” meconium is noticed.
In the case of the stillborn baby, his heartbeat remained healthy for more than four hours after the discovery of meconium, slowing only during the final stages of pushing. The coroner’s report said the baby probably died about 15 minutes before it was born at 8:21 a.m.
Harris also criticized Dionne for failing to include a key fact in the two-page summary of his report published on the coroner’s website. The complete 10-page report, which the coroner’s office provided by email, notes an indirect cause of the fetus’ death was that it had a severely underdeveloped brain, which had a gestational age of only 23 to 25 weeks.
“The baby would have been completely incompetent neurologically and would probably have died within a few weeks (of birth),” Dionne told The Gazette this week.
But he said that doesn’t change his opinion that the midwives made mistakes. For example, he said, they should have called 911 immediately when pushing seemed to have stalled.
He also stood by his recommendation that a mother should be immediately transferred to a hospital if any meconium is detected. When told Leclerc’s differing opinion, he said: “I don’t give a damn. There should be an automatic transfer, period.”
As for the midwives’ criticism that he was biased and that his recommendations are already part of midwifery protocol, he said: “It’s not my business to answer them. Yes, I did some recommendations (for practices) I knew they were already doing. But it’s on paper, and their members didn’t do it. They were lax.”
The mother of the stillborn baby refused to comment: “We’re trying to turn the page.”
The Quebec health ministry, for its part, doesn’t plan to change rules governing midwives, and is leaving any reforms up to the Quebec Order of Midwives, which is studying Dionne’s report.
Back in the Plateau, Napoli said the death was “absolutely awful,” but that she believes midwifery has been unfairly maligned in the outcry over the case. “What about all the babies who die in the hospital? Doctors make mistakes, too.”

Midwifery Facts

Midwife-assisted births that involve a Caesarean: 6.2%
Hospital births that involve a Caeserean: 18.5%
Midwife-assisted births that involve an episiotomy (a cut to widen vagina to help baby emerge): 1.9%
Hospital births that involve an episiotomy: 30%
Perinatal deaths per 1,000 among midwife-assisted births: 4.7
Perinatal deaths per 1,000 among hospital births: 7.4
Fetal deaths per 1,000 among midwife-assisted births: 4.2
Fetal deaths per 1,000 among hospital births: 4.3
Cost of a midwife-assisted birth in 1997: $2,062
Cost of a hospital birth: $3,016
Percent of midwifery clients requiring hospitalization during pregnancy: 3.3
Percent among hospital clients: 10.3
Percent of midwifery clients who breastfeed at birth: 98
Quebec average for breastfeeding at birth: 72 percent
Sources: Public Health Agency of Canada, Evaluation Study of Quebec Birthing Centre Pilot Projects, Institut de la statistique du Québec, Quebec College of Physicians, Quebec Order of Midwives, Quebec Association of Midwives

For More Information