Price County family blames midwife for death of their child

FIFIELD, Wis. (WSAW) – Josie Schmidt is preparing for the birth of her third child as she marks the first anniversary of her second child’s death, Marien Jo. During this pregnancy, she is receiving care through a hospital. It is a choice she is making due to Marien’s delivery.

“The experience of, like, going into labor in my home, like, I don’t feel safe here anymore,” she said.

Josie had gone through a midwife with her first two births.

“I had such an amazing first experience with Presley,” Josie explained. “It was like, the most just calm, relaxing, and like, fulfilling experience I’ve ever had.”

That first experience was why she wanted to do it again when she learned she was pregnant in the summer of 2022. This was her first pregnancy with her husband, Alex Schmidt, who was unfamiliar with midwifery.

“I have a picture the day after having Presley of me taking a bath with her and it was like such a calm, like, beautiful experience. And like, that was what I was painting to him, which we did not have.”

She was due on Alex’s birthday, Feb. 27, 2023.

Josie went through a midwife in the Ashland area for her first pregnancy. That midwife was no longer practicing when she became pregnant with Marien, so Josie asked for referrals. She was told she was in two midwives’ service areas. One in central Wisconsin was unavailable around her due date. The other was from Upper Michigan, Sandra Pera.

“We were referred to her by three women, five births total, and one of them was including my mom from 10 years ago.”

Josie’s mother also assisted a friend during birth who was receiving midwifery care from Pera. Friends and family who hired Pera spoke positively about their experiences. Pera sent 7 Investigates comments from other patients and assistants over her three decades as a midwife who also had positive deliveries and care.

Josie looked up her certification and license, which appeared to be in good standing. She also found a TV6 news story from 2015 featuring Pera’s services and the benefits of midwifery. The Schmidts set up an initial consultation.

“I didn’t ask all the questions I remember asking the initial midwife,” Josie said. “She talked about my mom a lot at the initial visit and asked how she was doing and asked how my sister was, and there wasn’t really much conversation about like, the care that we were being provided. But I just went with it, because I was like, ‘Well, I’ve done this before; she’s done it longer; and she knows my mom.’”

“She also boasted about birthing close to 1000 babies, and only having one loss, which was a stillborn, and those were her words,” Alex added.

Now, it is two losses. Marien died during labor on Feb. 28, 2023. During her autopsy, a forensic pathologist determined she died of complications due to protracted labor and that she had a brain injury due to a lack of oxygen.

“We never saw her eyes. We never heard her voice,” Josie cried. “So it was, like, really confusing.”

A variety of investigations and legal events have occurred since Marien’s death. Here is where all of the various cases stand as of this publishing:

• The Wisconsin Guild of Midwives reviewed two complaints about Pera’s care from two different deliveries; one being the Schmidt’s case and another from 2021. On Nov. 3, 2023, the guild sent the Wisconsin Department of Safety and Professional Services a letter recommending it immediately suspend Pera’s license until further investigation was completed.
• The Wisconsin Department of Safety and Professional Services investigated the same two cases the guild investigated and was already working on a settlement with Pera when the guild’s recommendation was submitted. DSPS and Pera came to an agreement on Nov. 27, 2023, to have Pera voluntarily surrender her license in Wisconsin. Pera cannot ask DSPS to reinstate her license for two years. If she tries to get a license through DSPS again, she has to pay about $7,500 before the state will even consider it.
• Michigan Licensing and Regulatory Affairs confirmed to 7 Investigates it has an open investigation into Pera’s license in Michigan. Like Wisconsin, she can continue practicing while the investigation is ongoing.
• Pera has not previously received any other disciplinary action from the Wisconsin Guild of Midwives, DSPS, or Michigan Licensing.
• The Price County Sheriff’s Office with the help of Wisconsin’s Division of Criminal Investigation has been investigating the Schmidts’ case. It referred the 230-page case file to the district attorney, which court records state did not include two interviews with former patients, as they had not been transcribed at that time. In July, Pera refused to interview with investigators after the Schmidts’ counsel reached out in an attempt to sue her civilly. Investigators have made other attempts, but she still has not interviewed with law enforcement.
• The Schmidts met with Price County District Attorney Matthew McElroy at the end of November and told them he was declining to prosecute. He told 7 Investigates in an email his “office has reviewed the available evidence and based on that review we have decided not to file charges in this matter.” 7 Investigates asked for more details as to why or if he would be forwarding it to the Oneida County DA’s office, as that is where the death was declared. He has not responded. In a county meeting on March 7, 2024, he said he did not believe he could prove the crimes beyond a reasonable doubt.
• The Schmidts filed a John Doe petition with a Price County judge in January. On March 8, 2024, the judge ordered DA McElroy to either file charges in the case or provide an explanation as to why he would decline to prosecute and send the case file to the judge. He has 90 days from the judge’s order to make either decision.
• According to court records, the Schmidts consulted with lawyers to file a civil malpractice lawsuit against Pera, however, the Schmidts say because she does not carry malpractice liability insurance, attorneys have not taken up the case.
• Pera’s attorneys sent the Schmidts a cease-and-desist letter on Nov. 3, 2023, after the Schmidts created a Facebook group sharing their experience and the various investigations and events that have followed.
• 7 Investigates contacted Pera and her attorneys offering an opportunity to interview and comment. They declined saying in an email they cannot comment on specific patients or patient-related matters “due to HIPAA, Wisconsin’s law regarding patient confidentiality, and other concerns.” 7 Investigates twice told them we have patients’ consent to discuss their cases and asked how they would like to receive that consent. They have not responded. They concluded their comments with this:

Pera, herself, then proceeded to forward emails with patients’ and assistants’ written experiences to 7 Investigates speaking positively about her care. In all, about a dozen people shared their experiences with 7 Investigates, including a Michigan senator, who said Pera provided kind, calm, compassionate care.

Voluntarily surrendering her Wis. license

The stipulation agreement between the Wisconsin Department of Safety and Professional Services and Sandra Pera, which is included in the order, begins with this: “This Stipulation is entered into as a result of two pending investigations by the Division of Legal Services and Compliance. Respondent consents to the resolution of these investigations by Stipulation.”

The Wisconsin order also states that Pera denies falling below the standard of midwifery care or engaging in unprofessional conduct, but to avoid disciplinary proceedings, she agreed to give up the right to defend herself.

Pera’s attorney, Sean Gaynor stated in response to 7 Investigates, “It is important to clarify that Ms. Pera voluntarily surrendered her license to practice midwifery in Wisconsin and that no formal action has been taken against her or her license in the State of Michigan.”

DSPS declined 7 Investigates’ request to interview but answered questions via email. Communications Director John Beard said DSPS pursued the option to have Pera voluntarily surrender her license after receiving two separate case complaints against Pera.

Beard explained, “Had she not agreed to surrender her license, the department would have been required to present the case before an administrative law judge, where the burden of proof would have been on the department to prove the alleged violations by a preponderance of the evidence. The department would also have been required to argue appropriate discipline. The administrative law judge would issue a decision after all evidence was presented/arguments were heard.”

“During a disciplinary proceeding, due process is afforded to the license holder as prescribed by law, much like at trial,” he continued. “The stipulation she signed outlines the rights she was giving up by settling/surrendering the license. The disciplinary options available to the department in state law regarding licensed midwives are reprimand, limit (place conditions on a license), suspend, or revoke a license. Limitations can be used in conjunction with a reprimand and suspension.”

Beard said the initial complaint against Pera in 2021 remained open since it was filed and was going through the complaint handling process. That complaint was filed by the pediatrician who assisted with the birth. She noted in the complaint she encouraged the family to file a complaint as well. DSPS said its investigator spoke with the family, but Beard explained because the complaint did not come from the family, it made it more challenging.

Between July 15, 2021, when the pediatrician reported, and when the Schmidts filed their complaint on March 9, 2023, no disciplinary action was taken. Pera’s licensing page showed she was active and eligible to practice midwifery with no issues.

“There were no prior complaints about Sandra Pera since the time she was licensed in 2008, so obviously, no discipline. If there had been any prior complaints that led to any sort of discipline/action, they would have been attached to her license and published on the website.”

He explained complaints and investigations are confidential unless adjudicated or actions have been taken that stemmed from complaints.

“They are confidential for a couple (of) reasons. It could impact the investigation (just like when police don’t talk about investigations) and it could significantly impact a license holder’s life and business when no violation of professional standards may have occurred.”

DSPS said it reported the orders related to Pera’s license to the National Practitioner Data Bank. NPDB would not confirm with DSPS if the North American Registry of Midwives, where midwives in Wisconsin and other states receive certification, also was notified about the order. NPDB would not confirm it with 7 Investigates either, stating federal laws protect the integrity and confidentiality of the reporting process and bar the release of any information on the registration, reporting, or query practices of any particular organization eligible to query the NPDB.

NARM also lists midwives on its website who have had their certifications revoked or suspended; Pera is not listed. When 7 Investigates inquired about whether NARM was conducting its own investigation into Pera. Its executive director, Ida Darragh, referred to the previously mentioned lists adding, “The only information NARM makes available to the public is whether the certification status is Active, Inactive, Retired, Expired, or Revoked. Continuing education is required for both recertification by NARM and relicensure by the states.” She added the legal actions that had taken place relating to Pera thus far indicated “the appropriate licensing agencies are investigating the issues.”

Tips for vetting a midwife

Since 2006, Wisconsin has had legal rules listing the requirements midwives must abide by to be licensed. There are several items patients are required to be told, both verbally and in writing, in the initial consultation. For example, the midwife is supposed to tell patients how many times they have had to transfer patients to a hospital for care. The guild said this transfer happens about 10% of the time, including both for conditions identified early in prenatal care, like gestational diabetes, as well as emergency transfers during labor.

“If somebody says they’ve only had, you know, a 1% transfer rate over 15 years, that would be very hard for me to believe,” Jane Crawford Peterson, the guild’s director of community relations said.

She added emergency plans unique to each patient are also required in that initial consultation. She said an answer of “we’ll go to the ER” would be a red flag for her.

Crawford Peterson also recommends that people get examples of informed consent forms from a few midwives, even if they are not in your area, so patients can get a sense of what they should know before signing up for care. If you are looking to have a home birth, she recommends asking the midwife whether they are connected with a physician who has privileges at your nearest hospital. She noted, that being connected to a birth center does not necessarily mean the midwife has connections to a hospital, as birth centers can be run by other midwives.

She recommended asking about who may be assisting with the birth and how they are qualified. She said having the midwife travel several hours away from your home is also “not conscientious because too much can happen between the time they call you and the time you will arrive.”

The guild’s website also provides resources for families to learn about what to expect from a midwife.

Filing complaints

In Wisconsin, there are several places where people can file complaints if they are not satisfied with the care they are receiving. DSPS can file a complaint online here.

The guild has a separate process people can file a report to its incident review committee. Any violations of state licensing laws must be reported to DSPS. The IRC could also recommend education for incidents that do not violate licensing rules.

NARM outlines how to file a complaint on its website, including that a complaint must be received within 24 months of the date of the last care provided by the midwife, and a signed records release and confidentiality agreement from the patient must be included within two weeks that the complaint was made or the complaint will be closed.

clarification: In Pera's statement to DSPS, she characterized Josie's mother's assistance during her friend’s birth as her assisting as a doula. However, Josie's mother told 7 Investigates that she is not certified, nor has she been employed as a doula, but was asked by a friend to join her for the birth for support.