How a birth center delivery devastated a Florida family
By Emily Le Coz, Josh Salman and Lucille Sherman
Everything was coming together for Melinda Pino and her husband, Shawn McKee. The couple just settled into a new home with wide hallways and doors – perfect for the wheelchair their daughter would need.
Caring for a toddler with severe brain damage was tolling, but the little girl who wasn’t supposed to make it out of the hospital started to seem more alert. They began researching special needs schools, stem cell therapy and machines to help her walk. For the first time since Madeleine’s birth, the young parents could see a future.
They felt so confident about her progress that they turned off her precautionary breathing equipment one February night. She died in her sleep. Three days before her third birthday.
“She saw an opportunity and that was it,” McKee said. “Three years that felt like a lifetime.”
Maddie suffered from cerebral palsy , the result of oxygen loss during a delivery with a licensed midwife at a Florida birth center.
Maddie spent much of her life in and out of the hospital, racking up more than $1 million in medical fees. She ate through tubes that fed food directly into her intestines. She endured a dozen seizures every day and required round-the-clock care. A common cold would develop into pneumonia, then a collapsed lung and another eventual death scare.
Licensed midwife Deborah Jacobs Marin noticed signs of distress during the February 2010 delivery. But she let the first-time mother push for four more hours without calling for help, even after losing the baby’s heartbeat, according to a lawsuit filed by the family .
Marin denied the allegations in a court document but agreed to a settlement for an undisclosed sum . She did not return three calls for comment.
Despite those legal woes and a previous, unrelated reprimand from the Florida Department of Health, Marin still works at the same South Florida birth center.
After Maddie’s death, the family moved to Arizona, where they’re raising three healthy children.
But pictures on the beige walls are all Isabella, Adeleine, and Christopher have to remember their oldest sister.
“I still don’t compute in my head how this happened,” Pino said. “Thank God we had my daughter for three years.”
Maddie’s birth came on one of those rare mornings Miami drops below 50 degrees. A week overdue, Pino took a hot shower to help ease the contractions.
During her 45-minute ride to the Hollywood Birth Center in Broward County, Pino was passing hospitals and remembered wanting to just stop. By 8 a.m., she was 8 centimeters dilated. At the birth center, she got right into the warm tub to labor.
But Pino’s progression slowed.
She forgot breakfast, and by now, she was hungry. But she couldn’t swallow. She couldn’t even catch her breath. The pain was unbearable.
Three hours later, Marin – the midwife leading the delivery – broke her water. Pino could not stop pushing. The baby was turtling, her head popping in and out.
“She said, ‘You can’t have this baby here – we need to go to a hospital,’” Pino said. “I didn’t want to move, it was too painful.”
But the midwife didn’t call 911.
“She gave us 15 more minutes – that turned into a few hours,” Pino said. “You hire these people to guide you. I’ve never done this before. I don’t know what point the situation becomes an emergency. That’s not the job of the mother.”
She went down on all fours – and the baby started to come out.
Maddie’s hand was stuck near her face. The newborn was covered in thick, pea soup meconium, which stained her fingernails yellow. She didn’t cry. She was purple and not breathing. The only thing keeping the infant alive was a beating heart.
When paramedics arrived, they loaded Maddie into an ambulance, her father by her side.
An annual report filed with Florida’s Agency for Health Care Administration confirms the birth center transferred a newborn in poor condition on Feb. 26, 2010, for breathing problems and ingested meconium.
Back at the birth center, Pino started nodding off and said the midwife slapped her to wake up.
She remembered getting up to use the bathroom, a trail of blood leading back to the bed. The sheets were soaked and stained.
“It looked like a murder scene,” she said.
Joe DiMaggio Children’s Hospital was five minutes away. Maddie’s eyes were twitching back and forth; her breathing sporadic. But medical staff estimated she would be home by the end of the weekend.
The next day brought devastating news. The baby had seizure activity from apparent brain damage. The official diagnosis was hypoxic-ischemic encephalopathy, according to provided medical documents . During the prolonged delivery, the fetus lost her supply of blood and oxygen, killing vital brain cells.
Maddie would never live a normal life.
Physicians prescribed Phenobarbital, a powerful and sedative seizure medication. The mother and her daughter shared skin-to-skin kangaroo time, and took newborn pictures. Then they stuffed Maddie’s face with more tubes.
“The recommendation from doctors was just to let her die,” Pino said. “They told me to let her be an angel.”
Maddie spent the first six weeks of her life in the neonatal intensive care unit. There was a lot of testing, trial and error. They would constantly switch medicines and tinker with doses. Several times, physicians urged the family to sign a do-not-resuscitate order.
“That was not an option for us,” Melinda said. “We couldn’t just let her go.”
The doctors at Joe DiMaggio Hospital told the family there was nothing else they could do, but the parents wanted a second opinion, so they worked with insurance to have Maddie transferred by ambulance to Miami Children’s. Physicians at the new hospital gave them more time.
The couple lived in in their daughter’s hospital room. No social life – their daughter’s nurses, doctors and specialists became their only friends. In the hospital’s pharmacy, they’d be confused for employees. They knew the good pastries were kept in the surgery center and which floors stashed the best coffee.
At Pino’s suggestion, doctors eventually took Maddie off the seizure meds.
All of a sudden, she gained reflexes. They started oral feeding therapy. And speech therapy. And pulmonary therapy. Anything to get her to latch or swallow.
They battled pneumonias, a collapsed lung and acid reflux. A good stretch would mean five days without a death scare.
“There were no options – at least, no good options,” McKee said. “The first year to 18 months was pretty much survival mode. It’s like being in a war zone, real life or death situations, and you’re just trying to make it to the next milestone. There was no end in sight.”
By July, Maddie stabilized. The first-time parents could finally bring home their daughter. But not without feeding pumps, an oxygen tank, suction machines and nurse care.
Within six months, she was back in the hospital with a cold. The family went straight from New Year’s Eve fireworks to the emergency room. This time, she was intubated for 11 days and put on life-support.
During Maddie’s hospitalization, McKee was laid off from his job at a dietary company.
“I remember thinking, ‘Good – that’s great,’” Pino said. “‘We’re going to need this time because we might not be taking a baby home with us.’”
The couple also used the opportunity to get married. During a shift change at the hospital, they dashed to her father’s house, where their stepmother wed them in the kitchen. That night, the family celebrated with an impromptu dinner at Red Lobster.
But there was no honeymoon. The newlyweds spent the rest of the night with their daughter in intensive care.
Maddie’s condition eventually improved. Physicians prescribed Methadone to wean her off some of the other medications, and the strong narcotics were working. At one point, Maddie grabbed her father by the ears and pulled him toward her face. It was the most interaction they’d ever seen.
In February, the family celebrated Maddie’s first birthday at home.
She was never hospitalized again.
“We started a new life at home – with a kid with severe medical needs,” Pino said. “We just isolated ourselves.”
The oxygen levels often dipped in their bedrooms, so on most nights, Maddie slept in the living room, her mother on an air mattress beside her.
The family moved out of their townhome and purchased a new house – with wide doors and hallways – planning for Maddie’s future in a wheelchair. The new place was right down the street from a hospital and 10 minutes to therapy.
They tried to assimilate into a normal life. They took Maddie to the park, picked out a Christmas tree together and spent a day at the beach.
When Maddie was 18 months old, Pino and McKee also got pregnant with their second child, Isabella. They went to Stephanie Fink, a certified nurse midwife, who is married to an obstetrician, and delivers in a hospital. She became close with the family.
“When you see red flags, that’s when you transfer a patient,” Fink said. “You don't wait for the emergency. You've got to see the writing on the wall. It sounds like there was definitely red flags during (Maddie’s) delivery. She didn't get transferred early on, when she needed to be.”
“It was a very difficult situation, but I've never seen a family so connected and caring,” she said. “It was almost like she didn't have special needs, the way they loved her.”
When Isabela was born, they laid her on Pino’s chest, and the baby lifted her own head.
Ten seconds into life, she accomplished something Maddie barely could.
“You don’t have time to think about it or be sad,” Pino said. “You’re just so focused. We just went minute to minute, hour to hour, trying to string a few good days together. You don’t see the big picture.”
Pino started blender diets using fresh vegetables and eggs from free-range chickens kept in their backyard. That worked for some time, but when Maddie started aspirating, they had to go back to partially-digested formula.
Maddie would seem more alert, even attempting the push buttons on a toy.
The family looked into stem cell therapy and medical marijuana. Insurance approved coverage for a wheelchair and a walker.
“There’s so much stuff that goes into keeping someone alive,” Pino said.
Maddie was almost 3, and no longer needed her breathing equipment all the time.
She strung together several good days. And then one night, McKee woke up panicking. Maddie was dead.
“She had been doing so good that day,” Pino said. “There was so much momentum, and then you just hit a brick wall. It was nonnegotiable. Until then, I had been able to negotiate every moment of her existence.”
Melinda and Shawn already ordered Maddie’s birthday cake from the bakery.
They decided to keep it, celebrating their child’s third birthday at her own wake.
Friends started a crowdsourcing page and raised enough money to buy them a headstone.
The experience was the exact opposite of glowing stories they read about online – and recalled from Ricki Lake’s “Business of Being Born” documentary.
By all indications, the baby was perfectly healthy. She had all of the ultrasounds done, and there were no high risks. Melinda was 29 years old and fit, with no medical issues in her life.
“You don’t want your kid to get the side effect of an epidural,” she said. “Looking back, if only it was just that – the side effect of an epidural. If only.”
After Maddie’s death, the couple had vivid nightmares of their daughter’s resurrection.
Pino says she is not religious. But when caring for Maddie, she felt bigger then herself.
“I felt plugged in, and Maddie was the plug,” she said. “I know it was her because she’s gone now, and I don’t feel it anymore.”
Mother’s home-birth death turns ‘greatest day’ to ‘worst day’ in family’s life
Eric Dexheimer, Austin American-Statesman
In the spring of 2013, Amanda Garbacz was on top of the world. A standout student, she had recently graduated from the University of Arkansas with a civil engineering degree and become engaged to another engineer. Now she was about to become a new mother.
The previous fall, Amanda, then 23, learned she was pregnant. Her early prenatal checkups showed her to be in generally sound health, but raised several concerns. She had seen a cardiologist for a rapid heartbeat and arm numbness. In October, an obstetrician also had noted her asthma and labeled her pregnancy “high-risk.”