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The Nielson’s attorney, Eric Rossman in Boise, said he pursued the case pro bono because he couldn’t “in good conscience dismiss the case as long as they continue to practice in this facility.”

Objective measures of Idaho’s midwife-doctor relationships _ and their impacts on babies _ are difficult to come by, because the state doesn’t keep comprehensive records of the outcomes of midwife-assisted births requiring hospital transports.

A private effort, the Idaho Perinatal Project run by St. Luke’s, documented 138 instances between 2005 and 2011 where mothers who planned a home birth were transported to a hospital.

Though its records are also incomplete _ reporting is voluntary; there are no reports for 2012 _ they do point to the trauma that accompanies a planned out-of-hospital birth where something goes wrong. There were at least nine cases where infants died at or before arriving at the hospital and several instances of birth asphyxia, fractures, post-partum hemorrhage and unexpected twins.

For many doctors who don’t see the cases of successful home births, these tense interactions add to already deep misgivings about midwifery.

“There were also 34 cases which had no infant outcome listed,” said Dr. Scott Snyder, medical director of St. Luke’s Newborn Intensive Care Units. “The data is not an overestimation of what we’re seeing. It’s an underestimation.”

Snyder does believe standards set by Idaho’s midwife licensing that took effect in 2010 have fostered communication between most midwives and doctors, despite problems investigators found at The Baby Place. Midwives now visit St. Luke’s, attending some staff meetings. Doctors’ appreciation for midwives’ services has grown, he said.

Snyder is also hopeful when the Idaho Legislature reviews the state’s midwife rules in 2014, when the existing licensing law expires, they’ll make it mandatory for midwives and doctors to track outcomes of transfers.