An Arizona family, their community, and local midwives are questioning the ability of state regulators to properly supervise and promptly discipline some midwives after a birth tragedy in rural Graham County.
Six months ago, Jordan Terry and her baby Mack both died in childbirth. The subsequent investigation by the Arizona Department of Health Services was the third time in three years that certified professional midwife Sarah Kankiewicz was found in violation of state health and safety regulations. Last week, Kankiewicz surrendered her license after public outcry including pressure by other Arizona midwives.
Jordan and Mack
Parker Terry described his wife, Jordan, as an “open book.”
Last year, she got pregnant with her third baby. Instead of giving birth at the Safford hospital where she worked as a nurse, Jordan wanted to be at home with a midwife. Her due date was in December.
“Birthing pool in the living room underneath the Christmas tree with the stockings around and bringing Mack into the world with the spirit of Christmas right there,” Parker explained.
Jordan loved caring for babies in the hospital and had a goal of becoming a midwife herself.
“She was such a great mother; she was just wonderful,” said Jordan’s mom, Joie Haralson.
Haralson explained in rural Graham County, where they live, there were not many maternity care providers available.
“Not many midwives come here,” Haralson said.
Jordan hired Sarah Kankiewicz.
“Sarah had done a lot of successful deliveries of Jordan's friends,” Haralson said.
At the time, Kankiewicz was an Arizona-licensed, certified professional midwife.
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Kankiewicz “[reassured] me after millions of questions that she had an emergency plan laid out, it put me at ease,” Haralson said.
The midwife advertised on social media that she specialized in vaginal birth after cesarean [VBAC] as well as breech babies at home.
Both have risks of serious complications.
“If there's an old scar there [on the uterus], that can be a point of weakness where it ruptures,” said Dr. David Bryce, an emergency room doctor at Mount Graham Regional Medical Center. “There's a lot of bleeding because the uterus has a lot of blood vessels, and, so, you can bleed pretty quickly and pretty severely.”
Dr. Bryce, who worked with Jordan, said as soon as a uterine rupture happens “the clock is ticking.”
According to the American College of Obstetricians and Gynecologists, VBACs should take place in the hospital, but Arizona state regulations allow licensed midwives to supervise VBACs at home.
While Jordan was in labor on December 17, Parker said he noticed she was “losing color in her face.”
Parker looked to the midwife for guidance.
“We hired her to watch for the red flags, and when I called it out, all [Kankiewicz] said is she is doing okay,” Parker said.
Parker said his wife lost consciousness and stopped breathing in the living room.
She was rushed to the hospital where Jordan's work friends said it was a worst-case scenario.
“A young mother losing pulses dying in front of you,” Dr. Bryce said. “When you add on someone you know, it just amplifies it that much more.”
Jordan died from uterine rupture. Her baby, Mack, was stillborn.
“Hindsight is 20/20, and it just kills me,” Parker said. He said accountability for him is “ownership for the person but consequence for your actions.”
Midwife’s History
After losing Jordan and Mack, the family learned the Arizona Department of Health Services had issued two prior Statements of Deficiencies against Kankiewicz for failing to follow state safety and health regulations. In her four years as a midwife, Kankiewicz also paid five civil penalties for failing to turn in her required midwife reports on time. Those reports include detailed information on each patient, birth outcomes, and complications.
“I do wonder who looks at those reports,” Haralson said. “I wonder why it took so long for this to come about, maybe this would have been prevented.”
Licensed midwife Wendi Cleckner also questions whether ADHS has anyone with midwifery credentials involved in oversight.
“You have a state department that's full of people that don't actually do the profession,” Cleckner said. “They know how to go through and read things and check boxes, but to actually know what we do and how that affects people is lacking.”
After the death of Jordan and Mack, Cleckner and several other Arizona midwifes said they wrote a letter to Kankiewicz.
The letter said due to "serious concerns about compliance with our scope of practice” the other midwives urged Kankiewicz to "discontinue practicing midwifery in any capacity."
“We don't feel like the state was doing things fast enough, effectively,” Cleckner said.
ABC15 dug deeper last month and found ADHS’s licensing website for the public was both inaccurate and not up to date.
It listed a sixth civil penalty from 2022 for Kankiewicz, but ADHS later confirmed that fine was never issued. In mid-May, the agency also had not posted a Notice of Intent to Suspend Kankiewicz's license, which was dated in January, and the Notice of Intent to Revoke from early April.
The Notice of Intent to Revoke referred to violations of Arizona Code during Jordan’s labor, saying the "licensee did not immediately alert emergency medical services once the client began to visibly decline," did “not check vitals for client and fetus," did “not monitor whether dilation occurred," and "provided services to a client who had a previous cesarean section with complications."
“That's why I came public is to raise awareness to this situation, but also this midwife, Sarah, but also to the state because there's holes,” Parker said.
Two Licensing Agencies
The state system for licensing midwives can makes things harder for patients to understand their provider’s qualifications, allowed scope of practice, and disciplinary background.
Nurse midwives, who have masters-level college degrees, are licensed under the Arizona State Board of Nursing. They can use more medications and medical interventions than lay midwives licensed through ADHS. Most ADHS-licensed midwives are known as “certified professional midwives.” They must have a high school diploma, pass a written knowledge test, and complete an apprentice-type program and portfolio review by a third-party certification group, the North American Registry of Midwives. Kankiewicz was licensed by ADHS.
“I absolutely don't think it's laxity in the rules,” said Cleckner, who is also licensed by ADHS, “I think it's all about oversight.”
You can look up disciplinary history for ADHS-licensed midwives on AZCareCheck.com. Nurse Midwives have their licensing history on the Arizona State Board of Nursing website.
ADHS officials repeatedly refused to meet for an interview or comment on Kankiewicz’s history. The agency promised several times to give ABC15 a written summary of their process and requirements but have yet to provide it.
Sarah Kankiewicz declined to speak to ABC15, citing advice from her attorney.
On June 13, nearly six months after Jordan and Mack’s deaths, Kankiewicz agreed to surrender her midwifery license for at least 15 years as part of a settlement agreement with ADHS. According to the agreement, she "cannot provide midwifery services" in Arizona, can't post to social media or advertising to suggest she practices midwifery, and can't guide or mentor midwifery students.
“This isn't just business and profit,” Parker said. “This is my world. It's been destroyed.”
Parker said he "feels better" knowing this midwife can no longer practice, but nothing can undo his tremendous loss.
You can reach Melissa by email at melissa.blasius@abc15.com or call 602-803-2506. Follow her on X (formerly Twitter) @MelissaBlasius or Facebook.