Anonymous wrote:NP. When I saw the story on the WaPo website (https://www.washingtonpost.com/investigations/interactive/2023/home-birth-midwife-karen-carr/) right now, I remembered this thread and wondered if the midwife in today's story was the same as the one I'd read about on DCUM so many years ago, when I was pregnant with my midwife-delievered VBAC baby. I'm shocked that yet another baby has died, but in a way I'm relieved to know that there's only one notoriously dangerous midwife in our area. Maybe now something will be done.
My heart goes out to this family.
If you think that there is only one dangerous midwife in our area, you are sorely mistaken. There are CNMs in this area who are just as narcissistic and egomaniacal as Karen Carr. If you want to search you can find some cases in the DC Superior Court records - and those are just the instances of poor outcomes where the women filed suit, not the ones where women had bad outcomes and advocated against the negligence or mistreatment they experienced in other ways.
I’m not anti midwife. There are also some who are truly fantastic. But I could list off, by name, several CNMs in the DMV that I had care from personally who suffer from the same hubris as Carr did.
There was a great comment on the article by a retired OB or L and D nurse that said something to the effect of, there are women in this profession who really enjoy having power over other women, and it is so true. It’s not true of every provider, but it’s definitely true of some.
I have suffered terrible abuse at the hands of male and female OBs and female midwives.
Male OB/RE: botched saline sono and caused a horrific high risk pregnancy (very thin C section scar that was threatening to spontaneously rupture before the due date) against my wishes, horded records in an attempt to cover it up. The abnormality is so large is plainly visible on the memory FET ultrasound the nurse gave me not realizing what happened right in front of her
Male OB: asked if I needed to take my pants off for an ultrasound (which the above condition needed), he said "No, I'm keeping mine on" and told me to "trust me" about extremely dangerous VBAC, lied to me and said my uterus was normal, fired him and went to-->
Three female midwives: engaged in a group conspiracy to "run out the clock" on the above pregnancy, pretending the issue was being addressed when it was not
Male OB who did 2nd C section: Told him in plain English I thought I had an infection, gave me a deer in the headlight look then didn't do anything to help me. Refused to see me in person after because he's "high risk". Sent me to below OB-->
Female OB: "It doesn't matter" when I told her my baby almost died, tried to bully me out of having my uterus fixed. I walked on on this b--ch
Finally met a competent surgeon, turns out my uterine edges were 100% separated, spanned by thin adhesion only, and my uterus was infected with poop bacteria for over a year, and yes I did have symptoms and complained about them, everybody blew me off
As for this midwife, I am shocked she's being charged with a crime when partial birth abortions are legal. It's wrong to bully a woman for getting an abortion but it's fine to bully her for her birth choice? Total BS. This will just cause women to give birth at home unassisted. Why is there no consequences for the horrific behavior of these providers? Why is this culture of treating women like absolute s--t institutionalized in obstetrics? Those are the real questions that need to be asked.
Are we just BANNING all vaginal breech births? So mom has ONLY the choice between surgery or a late term abortion? What happened to that baby could have easily happened in a hospital attempted vaginal breech delivery. The baby was only stuck for 20 minutes and chances are even in a hospital a C section would not have been done in only 20 minutes
I have done alot of research on this topic and I am convinced that C sections cause more babies to not be born due to maternal choice and silent infertility than they save from fetal loss during birth, probably a 10:1 ratio. Just look at countries with the worst healthcare systems, they are teaming with babies.
99% of women who are asked to choose between TOLAC and repeat C are not being given the most critical piece of information to make that decision, namely their residual myometrium/lower uterine segment thickness, which highly inversely correlates with uterine rupture risk. There is a conspiracy to keep this information away from women because routinely scanning would expose the OBs with incompetent surgical technique and open them up to lawsuits. OBs would rather babies just die or bully women into repeat Cs, which carry a risk to their lives. "Just cut everybody" cannot and should not be the solution to every obstetric problem in the world.
You are blabbering on about *a lot* but I can say with 120% certainty this is not true. There is not a proven direct correlation and while uterine health examinations exist, no peer-reviewed studies have shown a direct relationship uterine rupture. This is why some doctors (rightfully) refuse VBAC.
I do however agree with you that doctors need to be much more forthcoming about the risks than they are, and honest that there is no single test that will put a former cesarean woman’s mind at complete ease.
Signed, I do this research as part of my job.
DP. Doctors refusing to do VBAC doesn’t seem to be something that’s based in science or research at all. I requested double layer sutures at my c -section and waited the two years my OB said would allow maximum healing before getting pregnant again. The first practice affiliated with Inova Fairfax that I found for my second birth paid lip service to me VBACing but by my second trimester it was clear I was going to get a repeat c-section, so I switched. The midwife at the second practice showed me my records on which the doctor had written, in all caps, by hand, do not allow VBAC. I ended up at GW with the OBs (though one of the midwives there was the second set of eyes for my resident, who was on the newer end) and had a safe VBAC.
I’m pretty staunchly opposed to home births, and I used to be all in on the cult. But honestly when you get a chance to personally see some of the voodoo and biases in obstetrics? Look at your post and then someone posts actual research - and you claim to do research for this field for a living? I’m glad I’m done having kids.
Wow. I’m not so sure I’d be that cavalier about such a clear recommendation against VBAC from a doctor. What was it based on? Just because you ended up with a successful vaginal birth does not mean the risk was low. You need to understand risk statistics before you start claiming that obstetrics is “voodoo.”
DP. For years, doctors were against VBACs for not-good reasons. Unless they could explain why clearly, I wouldn't put much weight in it.
Anonymous wrote:I had a planned c-section that went exactly as planned and resulted in a healthy baby and healthy mom. I recommend it highly.
Cannot imagine what is going through the heads of people opting for utterly untrained birth assistants, but it must be bad.
Pure arrogance. They believe they are somehow able to control medical outcomes with good vibes and a positive outlook. If that were the case 1 in 3 women wouldn't have died in childbirth up until the advent of modern medicine.
Ugh, wapo. This story is incredibly sad, but it also was insanely slanted.
To arrive at the 2x as any deaths at home births vs hospital, ACOG, whose figure it is (of course it is) counts hospital transfered home births (in other words midwife or family recognizes emergency and goes to hospital) as “hospital” births regardless of the plan. And they don’t segment the homebirth data for those with prenatal care or not, high risk or not. Other studies have shown that low risk women who plan and intiate a homebirth actually have pretty equivalent outcomes. I had two hospital births. One with a doctor who medicalized the whole thing and stressed me out and made me push in lithotomu position (4th degree tear and 16 years later still have pain from the granuloma) and my second was a midwife (at a hospital). Second was easier and better and no tearing despite a bigger baby. I have lost count of friends who were restricted to bed, no movement, laid on their backs, told not to eat, told not to drink, and ultimately had the proverbial cascade of interventions. C sections are not NBD. They’re a massive surgery that often lead to more surgeries. I wasn’t personally comfortable with home birth but the simplistic dismissals or calling people who see risk on both sides of the equation and make an informed choice based on unskewed data as narcissist stupid or murderers is just too much. I wanted nothing more than a safe baby, but for me the hospital certainly has procedures that made my birth less safe and good for the baby. There’s so much failure to follow eveidence based medicine in obstetrics. Surgeons are trained to cut, and many do.
Anonymous wrote:Ugh, wapo. This story is incredibly sad, but it also was insanely slanted.
To arrive at the 2x as any deaths at home births vs hospital, ACOG, whose figure it is (of course it is) counts hospital transfered home births (in other words midwife or family recognizes emergency and goes to hospital) as “hospital” births regardless of the plan. And they don’t segment the homebirth data for those with prenatal care or not, high risk or not. Other studies have shown that low risk women who plan and intiate a homebirth actually have pretty equivalent outcomes. I had two hospital births. One with a doctor who medicalized the whole thing and stressed me out and made me push in lithotomu position (4th degree tear and 16 years later still have pain from the granuloma) and my second was a midwife (at a hospital). Second was easier and better and no tearing despite a bigger baby. I have lost count of friends who were restricted to bed, no movement, laid on their backs, told not to eat, told not to drink, and ultimately had the proverbial cascade of interventions. C sections are not NBD. They’re a massive surgery that often lead to more surgeries. I wasn’t personally comfortable with home birth but the simplistic dismissals or calling people who see risk on both sides of the equation and make an informed choice based on unskewed data as narcissist stupid or murderers is just too much. I wanted nothing more than a safe baby, but for me the hospital certainly has procedures that made my birth less safe and good for the baby. There’s so much failure to follow eveidence based medicine in obstetrics. Surgeons are trained to cut, and many do.
Other studies? You mean studies done by MANA? Lol. No, the death rate evidence is pretty solid, the other data you’re referring to is outside the Us in small European counties where only actual real CNMs or their equivalent are doing home births and that is in very homogenous populations with universal health care and strict criteria for homebirth candidates and transfer protocols where hospitals are geographically quite close. Comparing that to the heterogenous US population which is highly diverse, lacks universal health care, has many rural areas and health care deserts, and has a 3 tier midwifery system that includes one credential that basically is akin to “have a HS diploma and help out in a few homebirths” (which is what Jill Dillard did fWIW) who perform homebirths with super high risk patients and you are comparing, in essence, apples to elephants.
Anonymous wrote:Ugh, wapo. This story is incredibly sad, but it also was insanely slanted.
To arrive at the 2x as any deaths at home births vs hospital, ACOG, whose figure it is (of course it is) counts hospital transfered home births (in other words midwife or family recognizes emergency and goes to hospital) as “hospital” births regardless of the plan. And they don’t segment the homebirth data for those with prenatal care or not, high risk or not. Other studies have shown that low risk women who plan and intiate a homebirth actually have pretty equivalent outcomes. I had two hospital births. One with a doctor who medicalized the whole thing and stressed me out and made me push in lithotomu position (4th degree tear and 16 years later still have pain from the granuloma) and my second was a midwife (at a hospital). Second was easier and better and no tearing despite a bigger baby. I have lost count of friends who were restricted to bed, no movement, laid on their backs, told not to eat, told not to drink, and ultimately had the proverbial cascade of interventions. C sections are not NBD. They’re a massive surgery that often lead to more surgeries. I wasn’t personally comfortable with home birth but the simplistic dismissals or calling people who see risk on both sides of the equation and make an informed choice based on unskewed data as narcissist stupid or murderers is just too much. I wanted nothing more than a safe baby, but for me the hospital certainly has procedures that made my birth less safe and good for the baby. There’s so much failure to follow eveidence based medicine in obstetrics. Surgeons are trained to cut, and many do.
I would be super interested in someone providing links and a deeper explanation of the studies as well. From my understanding, the Wax study that cited 2-3x mortality for home births was largely debunked because of various reasons, such as including congenital defects and unplanned home births. I thought MANA never actually released anything substantial, which has earned them criticism but their reporting has been entirely voluntary and they mostly just trying to get data from midwives—not just success rates. What I found interesting is in the WaPo footnote is that they say they based their numbers of higher mortality for home birth on CDC numbers, which weren’t linked. But they did say they excluded congenital defects and only included planned home births with midwives so it’s definitely worth looking more into.
FWIW, I’m firmly of the opinion that modern home births, when done properly, should have lower mortality and morbidity rates than the hospital. But only when the mother is low-risk and in the rare event something does happen for that low-risk mother/pregnancy, that the midwife have an existing relationship with the nearby hospital that the mother is also aware of so that transfers (including mother’s health information) can be done as smoothly as possible with communication between both sides. I know Karen Carr was revered as a goddess because she would take on high-risk clients no one else would take. Her success rate given the odds was high. I have very mixed feelings about it all and agree that WaPo’s coverage was biased (but Carr didn’t want to comment, so) but hope that this tragedy can help spur greater transparency, communication and research into the field.
Couldn’t agree more. This is PP who originally discussed wapo’s skewed data. I’m also mixed. Some women should give birth in hospitals. It seems Karen took those women on. It’s hard for me to fathom being on either side of the choice since I went to a hospital for my healthy pregnancies. (I was 40 for my second, so I was not low risk). But the data has big flaws because as pp says they compared unplanned, unassisted births in the home birth set and included successful hospital transfers in the hospital data. Overall it’s a complex issue and the reporting here was exceedingly biased.
I realize Karen Carr doesn’t carry malpractice insurance, but could the family file a wrongful death (or whatever the correct term is) civil suit? I think that’s what it might take drive her out of practice.
I would be willing to contribute to a legal fund for this.
Anonymous wrote:I realize Karen Carr doesn’t carry malpractice insurance, but could the family file a wrongful death (or whatever the correct term is) civil suit? I think that’s what it might take drive her out of practice.
I would be willing to contribute to a legal fund for this.
It would probably be a waste of money for the family and cause unnecessary strife. It’s really difficult to prosecute midwives for something like this unless you have proof that they were grossly negligent and even then it’s hard. Not all midwives are the same and it’s important to do your research. I was shocked that the couple did no research on Carr. Articles about her lawsuits and other controversies pop up right away on Google’s first page but they admitted they didn’t look anywhere past googling for her website.
Anonymous wrote:I had a planned c-section that went exactly as planned and resulted in a healthy baby and healthy mom. I recommend it highly.
Cannot imagine what is going through the heads of people opting for utterly untrained birth assistants, but it must be bad.
They know exactly what they are doing. And they pick Karen Carr specifically for her experience with high risk births that no one else will touch. The WaPo article was pretty disingenuous.
They don’t know what they’re doing. That’s kind of the issue.
I personally had low risk pregnancies, did research, and ultimately went with certified nurse midwives for two home births that went just fine. I wanted home birth not for crunchy granola reasons but to minimize unnecessary medical interventions; As far as I could tell at the time, if you were low risk and your midwife was a CNM, the home birth/hospital outcomes data seemed pretty similar, with fewer c-sections in the home birth cohort. My CNMs believed in judicious use of medical technology. No way would they attend breech or twin births outside of a hospital.
Reading that WP article, it appeared that the midwife (1) was not a medically trained nurse (2) took on high risk cases like twins and breech babies for home birth (3) at the very least failed to adequately document what was seen/done during a birth that was supposed to be low risk.
Breech and twin home birth seems really unwise to me. That said, I think it definitely should be legal for a woman to birth where she chooses, because of her right of body autonomy.
But should it be legal for a **licensed professional** to assist at home with what will be a high risk birth? I think that’s the tricky question.
If women are to truly have choice regarding their body and control thereof, would prohibiting a licensed midwife to attend high risk home births either (1) effectively negate choice or (2) result in more bad outcomes when women resort to unattended births? Say it is a mother who will refuse to go to a hospital for religious reasons, no matter what, is it not better for them to have someone trained assist than for them to try to “free birth” or have someone with no training?
The couple with the breech baby in that article were **turned away** by a CNM practice. They sought out another midwife who would do it and found Carr. If she had not agreed to help them, what would they have done? Go to a hospital maybe? Find someone with less experience? I don’t know.
I do think luv ensure should mean something. For example, I don’t think a licensed heating/AC professional or electrician should be allowed to help you set up some kind of electrical situation in your home that has a good likelihood of burning your whole house down. The whole point of licensing is to protect people by setting boundaries around what is acceptable professional behavior.
I don’t know the answer to these questions but to me it is complicated and the WP article didn’t really get at some of nuance here. I do think it hit the nail on the head with regard to the transparency issues. Although, in fairness, how easy is it to know the track record of physician ob/gyn?
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