Midwife charged in DC? Karen Carr, CPM...

[Anonymous]

Anonymous wrote:I'm the poster you've been fighting with but not this poster above, who I agree with.

I've posted on several other occasions on this thread. I've explained my position several times. So have other people who have similar positions. You don't want to hear that there are people who don't think that Karen Carr should be thrown in jail, which is fine. You're entitled to your opinion, and I'm entitled to say that I think your opinion is anti-woman.

On the certification issue, there have been several people who have chimed in about what it takes to get certified. Yes, not many CPMs have lost their certifications. Without knowing how many complaints have been brought, it's hard to know whether 5/X is a high number or a low number. Your other complaint seems to be the lack of scientific education that CPMs receive, which I think is valid. I support there being other avenues to becoming a midwife than nursing school, which includes many types of medical care not relevant to practicing midwifery, followed by a master's degree in midwifery. I support there being high standards, actual clinical education and an apprenticeship/mentoring program for new midwives. What I do not support is your blanket dismissal of the work of thousands of women, most of whom no one posting on this forum will ever meet or work with.

I think the point is that a CPM can still practice without a certification and no one will know the difference. The point is that a CPM can lose 10 babies to preventable causes, but as long as the mothers are happy and think that the CPM can do no wrong, no complaints are brought and no investigations are made.

What "blanket dismissal of the work of thousands of women" have I made?

[Anonymous]

But why should a woman have the "right" to an assistant at homebirth if she's having twins? Breech? Has gestational diabetes? I would argue that hospitals need provide more options for women, so that women can choose the option that's slightly more risky for the baby (vaginal breech, etc), but reduces her chances of CS. However, that's a social/legal question, and I'm not sure how easy those changes will be in the US.
Countries that have reasonably safe homebirths all seem to have highly trained (as in at least university-level) midwives who are all operating under the same system of risking patients out. Patients can't just say that they want a homebirth, even though it's a twin VBAC- if the risk assessment shows that homebirth is out, it's out. That attitude is so different from some of the super-pro-homebirth crowd here that, again, I'm not sure that it would ever work in the US.
I agree with the comments about CPM training. I think they should have to see hundreds of hospital births, as well as many homebirths, before they can practice alone.

I'm the PP you responded to and I actually do not believe that a woman has a legal right to have a state licensed professional attending her birth. The woman does have a constitutional right to not have the state dictate where she gives birth and she has a legal right to invite whoever she pleases into her home. Legislation should focus on outcomes as well as maintaining constitutional principals. I would argue by that disallowing CPMs and not allowing licensed CNMs to attend homebirths that states are creating the opposite desired outcome.

If all low risk women have no access to a licensed professional for a homebirth and their only choice is a hospital or unassisted more will turn to midwives operating underground. This creates a demand and legitimacy (not entirely undeserved) for underground midwives. If CPMs were licensed more low risk women would turn to them . The low risk women would have the benefit is being able to see reporting on outcomes, see that training requirements were met, tests passed, and complaint history. Women and non certified or licensed midwives would still exist but in lower numbers and the risk would be greatly reduced for the larger number of women using a certified, licensed CPM.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm the poster you've been fighting with but not this poster above, who I agree with.

I've posted on several other occasions on this thread. I've explained my position several times. So have other people who have similar positions. You don't want to hear that there are people who don't think that Karen Carr should be thrown in jail, which is fine. You're entitled to your opinion, and I'm entitled to say that I think your opinion is anti-woman.

On the certification issue, there have been several people who have chimed in about what it takes to get certified. Yes, not many CPMs have lost their certifications. Without knowing how many complaints have been brought, it's hard to know whether 5/X is a high number or a low number. Your other complaint seems to be the lack of scientific education that CPMs receive, which I think is valid. I support there being other avenues to becoming a midwife than nursing school, which includes many types of medical care not relevant to practicing midwifery, followed by a master's degree in midwifery. I support there being high standards, actual clinical education and an apprenticeship/mentoring program for new midwives. What I do not support is your blanket dismissal of the work of thousands of women, most of whom no one posting on this forum will ever meet or work with.

I think the point is that a CPM can still practice without a certification and no one will know the difference. The point is that a CPM can lose 10 babies to preventable causes, but as long as the mothers are happy and think that the CPM can do no wrong, no complaints are brought and no investigations are made.

What "blanket dismissal of the work of thousands of women" have I made?

Your original post that I was responding to, my emphasis added:

"How about if they just stop presenting themselves as "certified" if that certification is basically meaningless. People who want a Direct Entry Midwife can just choose one knowing that there is no science involved. No presentation of professional certification or education. Just pure biblical painful childbirth the way god intended it. No fake credentials needed."

Also, you are confusing "certification" with licensure. They are two separate things. Certification is handled by NARM. Licensure is handled by each state. They are related, but they are not the same thing, and the standards for each are different.

[Anonymous]

Karen Carr ... dead baby ... CPMs are frauds ... epidurals cause sleepy babies ... breast feeding strategy ... who is the real feminist ... this just keeps getting more and more off track.

I think there was a point to following this thread on page 30. On page 77, not so sure. I'm glad that this forum has hopefully educated some people who arrived and learned some real truths about the the fact that not all midwives are created equal. Does that make me an anti-feminist or an elitist chauvinist or a leftist Marxist hypochondriac with a penchant for African violets? Talk amongst yourselves.

[Anonymous]

Anonymous wrote:
Your original post that I was responding to, my emphasis added:

"How about if they just stop presenting themselves as "certified" if that certification is basically meaningless. People who want a Direct Entry Midwife can just choose one knowing that there is no science involved. No presentation of professional certification or education. Just pure biblical painful childbirth the way god intended it. No fake credentials needed."

Also, you are confusing "certification" with licensure. They are two separate things. Certification is handled by NARM. Licensure is handled by each state. They are related, but they are not the same thing, and the standards for each are different.

That wasn't me- I guess there are a couple of us here on the same "side." I'm the one arguing that high-risk homebirth is not in any way feminist, and is in fact anti-woman since it gives the veneer of professional acceptance to a situation that no professional should condone.

I do agree with the above to the extent that the CPM certification is pretty meaningless. There will be some CPMs that have gone above and beyond the basic education requirements and have formed decent working relationships with OBs. There will be other CPMs that "trust birth" and are so sure of their own competence that they will take on any level of risk. If your particular CPM is charismatic, as many seem to be, she will have no problem providing you with several pleased consumers who had good outcomes, while her overall rates of perinatal morbidity/mortality might actually be atrocious.

If "CPM" really means "has met only the most basic requirements imaginable," how is it just to expect the pregnant woman to sort out which CPM is clinically competent and which has been lucky in her first 75 births? The statistics are with you when you have a baby- most moms and babies come out just fine. I just wouldn't want to be the first hypoxia/dystocia/hemorrhage/cord prolapse that the CPM has seen.

[Anonymous]

Here's a firsthand account of a woman's home birth with a CPM who was practicing illegally in Kentucky and the CPM encountered her first birth in which the baby had breathing difficulties. So yes, this happens, and yes, I would not want it to be me either. I'm all for on-the-job experience, but I don't think this is in anyone's best interest:

http://erincraig.wordpress.com/2009/06/09/birth-story-part-1/

[Anonymous]

Anonymous wrote:

Anonymous wrote:
Your original post that I was responding to, my emphasis added:

"How about if they just stop presenting themselves as "certified" if that certification is basically meaningless. People who want a Direct Entry Midwife can just choose one knowing that there is no science involved. No presentation of professional certification or education. Just pure biblical painful childbirth the way god intended it. No fake credentials needed."

Also, you are confusing "certification" with licensure. They are two separate things. Certification is handled by NARM. Licensure is handled by each state. They are related, but they are not the same thing, and the standards for each are different.

That wasn't me- I guess there are a couple of us here on the same "side." I'm the one arguing that high-risk homebirth is not in any way feminist, and is in fact anti-woman since it gives the veneer of professional acceptance to a situation that no professional should condone.

I do agree with the above to the extent that the CPM certification is pretty meaningless. There will be some CPMs that have gone above and beyond the basic education requirements and have formed decent working relationships with OBs. There will be other CPMs that "trust birth" and are so sure of their own competence that they will take on any level of risk. If your particular CPM is charismatic, as many seem to be, she will have no problem providing you with several pleased consumers who had good outcomes, while her overall rates of perinatal morbidity/mortality might actually be atrocious.

If "CPM" really means "has met only the most basic requirements imaginable," how is it just to expect the pregnant woman to sort out which CPM is clinically competent and which has been lucky in her first 75 births? The statistics are with you when you have a baby- most moms and babies come out just fine. I just wouldn't want to be the first hypoxia/dystocia/hemorrhage/cord prolapse that the CPM has seen.

SIGH. OKAY. I was pissy with the poster who was being pissy with me. If that was not you, I apologize for my attitude but stand by my opinions.

I agree with you that high risk home birth is dangerous. I personally think it's crazy and I wouldn't do it. But I don't think that pushing it further underground is a good solution either. Clearly it's not a solution that is working, since this baby still died. As for how it's just to expect a pregnant woman to figure out the competence of her midwife, I think we all on some level have to determine what level of training we're comfortable with.

I don't mean to dismiss what happened in this situation as an issue of people's comfort levels alone, but on some level, it is that. The pregnant woman in this case made a choice. Is she blameless in the situation? Why is she not getting charged with involuntary manslaughter too?

[Anonymous]

Anonymous wrote:

Anonymous wrote:
Your original post that I was responding to, my emphasis added:

"How about if they just stop presenting themselves as "certified" if that certification is basically meaningless. People who want a Direct Entry Midwife can just choose one knowing that there is no science involved. No presentation of professional certification or education. Just pure biblical painful childbirth the way god intended it. No fake credentials needed."

Also, you are confusing "certification" with licensure. They are two separate things. Certification is handled by NARM. Licensure is handled by each state. They are related, but they are not the same thing, and the standards for each are different.

That wasn't me- I guess there are a couple of us here on the same "side." I'm the one arguing that high-risk homebirth is not in any way feminist, and is in fact anti-woman since it gives the veneer of professional acceptance to a situation that no professional should condone.

I do agree with the above to the extent that the CPM certification is pretty meaningless. There will be some CPMs that have gone above and beyond the basic education requirements and have formed decent working relationships with OBs. There will be other CPMs that "trust birth" and are so sure of their own competence that they will take on any level of risk. If your particular CPM is charismatic, as many seem to be, she will have no problem providing you with several pleased consumers who had good outcomes, while her overall rates of perinatal morbidity/mortality might actually be atrocious.

If "CPM" really means "has met only the most basic requirements imaginable," how is it just to expect the pregnant woman to sort out which CPM is clinically competent and which has been lucky in her first 75 births? The statistics are with you when you have a baby- most moms and babies come out just fine. I just wouldn't want to be the first hypoxia/dystocia/hemorrhage/cord prolapse that the CPM has seen.

I think the same statement could be made about doctors. I don't know about you but I have seen some insanely incompetent HMO docs who have obviously met some type of minimum requirements. I used to work in my family's law firm and I have seen doctors do some horrific things to people, some of which lead to their deaths. It is always up to the individual to determine how competent and qualified a practitioner that they hire to attend to their health care might be. We make these decisions for ourselves all the time. The fact that an individual has been to medical school does not necessarily protect you from incompetence. It's safe to say that MDs kill and seriously injure a lot more people than midwives do.

[Anonymous]

So doctors = bad killers

and CPM = birth goddess journey guides with angelic "Certification"

[Anonymous]

Anonymous wrote:So doctors = bad killers

and CPM = birth goddess journey guides with angelic "Certification"

Straw man.

[Anonymous]

Anonymous wrote:So doctors = bad killers

and CPM = birth goddess journey guides with angelic "Certification"

No. Incompetent people exist in every field and it's up to the individual to choose a competent provider. Personally, I wouldn't go to a CPM but I think women are smart enough to choose for themselves.

[Anonymous]

Anonymous wrote:

Anonymous wrote:So doctors = bad killers

and CPM = birth goddess journey guides with angelic "Certification"

Straw man.

Yeah really, what are you? A reporter?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So doctors = bad killers

and CPM = birth goddess journey guides with angelic "Certification"

Straw man.

Yeah really, what are you? A reporter?

If you don't know what the straw man fallacy is, look it up. Google is your friend.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So doctors = bad killers

and CPM = birth goddess journey guides with angelic "Certification"

Straw man.

Yeah really, what are you? A reporter?

If you don't know what the straw man fallacy is, look it up. Google is your friend.

Of course I know what it is. I was responding to the PP who twisted my words around- not to the person who said "Straw Man"

[Anonymous]

Anonymous wrote:

Anonymous wrote:
If "CPM" really means "has met only the most basic requirements imaginable," how is it just to expect the pregnant woman to sort out which CPM is clinically competent and which has been lucky in her first 75 births? The statistics are with you when you have a baby- most moms and babies come out just fine. I just wouldn't want to be the first hypoxia/dystocia/hemorrhage/cord prolapse that the CPM has seen.

I think the same statement could be made about doctors. I don't know about you but I have seen some insanely incompetent HMO docs who have obviously met some type of minimum requirements. I used to work in my family's law firm and I have seen doctors do some horrific things to people, some of which lead to their deaths. It is always up to the individual to determine how competent and qualified a practitioner that they hire to attend to their health care might be. We make these decisions for ourselves all the time. The fact that an individual has been to medical school does not necessarily protect you from incompetence. It's safe to say that MDs kill and seriously injure a lot more people than midwives do.

If you think that medical school + residency = only bare minimun standards, then I guess I can't really say anything.

Yes, I think that everyone will agree that there are doctors and nurses who are incompetent and who commit malpractice. The difference is, they have received the training and should know better, and there is a process to have your complaints reviewed at the hospital and state levels. The difference is, a doctor or nurse who has committed malpractice and been fired will not find it nearly as easy as a CPM to continue to practice.

Of course you can say that MDs injure a lot more people than midwives- MDs SEE a lot more people, and a lot sicker people, than midwives. The question is the rate at which doctors, nurses, CNMs, and CPMs preside over preventable serious morbidities and mortalities during birth. And if only MANA would release its numbers, we could have a much more productive conversation about who is killing clients at the higher rate.