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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I do actually agree with this one statement and I am not the PP who called you crazy by the way. I think you are frustrating but not crazy. I am the PP you are responding to here. I do not think all doctors suck or that all medical training is subpar. But sometimes that is the case. I hope we all know that. My point was (and I think you might be deliberately misreading all of my comments) that women are capable of researching their practitioners and making their own choices. That's it. I have never specifically defended the CPM credential. I have even said that I would not hire one myself and at my age and with my specific risks, if I were to give birth again, I would do it in a hospital with an OB/GYN.

I'm sorry I'm being frustrating- it really isn't my intention. I guess the point I'm trying to get at is that it's not really fair to say that it's a woman's responsibility to research her practitioner and make a choice based off of that when you're talking about CPMs.

If you have several OBs and/or CNMs that have been recommended to you by friends and family, you know that they've all received similar training and hopefully are all competent to do what they're supposed to do. Your decision is mostly about personal compatibility, not the skills that that CNM/OB does or doesn't have. For example, you're probably more worried about the CNM's rate of using certain interventions (epidurals, CS, induction) and their personal attitudes about VBAC or NCB. Unless you've heard a horror story somewhere, your assessment really isn't about the CNM/OB's credentials; it's about how a typical birth by one of their typical patients lines up with how you envision your birth going.

If CPMs are selling themselves as better/safer than hospital birth, and your CPM provides you with the names of a few happy clients, what does that really tell you? According to her credential alone, she's attended many, many fewer births than a CNM or OB. Is it then your fault when your CPM doesn't do appropriate neonatal resuscitation when your baby doesn't start breathing immediately, since yours is the first hypoxic baby she's encountered? Or what if she's attended over 1000 births, but when you ask about how many babies have died she says that there have been a few, but all were due to birth defects. Is that true? How do you know? What research can a woman really do to ascertain that her particular CPM is appropriately trained and prepared, since the CPM credential all by itself really isn't that reassuring?

Well you do have some valid points here and these are some of the reasons that when I was in my early twenties, pregnant with my first child, and almost dead set on a homebirth, I looked into what it means to be a lay midwife and decided I wasn't comfortable with the qualifications (and in many cases the lack thereof). I knew someone well who called herself a lay midwife and she was pretty much just a hippy who had lived on a commune where she apprenticed with a midwife. We didn't have the internet and I couldn't find a nurse midwife who would attend my birth at home so I went to a birth center. It was a compromise for me- I really wanted that homebirth. So you see, here I was young and pregnant and terrified of hospital birth for many reasons and yet I was smart enough even without the internet to figure out that a lay midwife was not for me. I give other women the same credit. They can figure out what a lay midwife is. It's a person who doesn't have formal medical training but who may or may not have enough practical experience to attend birth at home. And it's up to the consumer to ask a lay midwife the difficult questions and decide on her own comfort level. I just can't be convinced that it's a good idea to give up this very basic freedom. And I definitely can't be convinced that we should allow the government to decide when we are too "high risk" to be allowed to deliver without being forced into surgery.

I agree that consumers really do have to ask the tough questions of their healthcare providers and then go with the one who fits the best. I really see the CPM credential as deliberately trying to confuse consumers, though. Several women on this thread have expressed surprise at the difference in training between CPMs and CNMs, and I would bet that the women on this board are as a whole more knowledgable about the policies and procedures of birth than the general population.

I'm not sure where all of the talk of the government forcing women into surgery is coming from. If some hospitals aren't offering breech vaginal birth or twin vaginal birth (with certain presentations) or VBAC, women can certainly speak to or correspond with the head of obstetrics or a board member about the reasons for those exclusions, and perhaps work toward making more options available. The government doesn't generally dictate hospital policy, though, as far as I can tell.

If you're referring to the case against Karen Carr, she was practicing without a license when a baby died. I would hope that if I died while somebody was engaging in a high risk activity without a license, that the unlicensed person would be investigated and indicted if their actions had contributed to my death.

Or do you mean the fact that CPMs aren't legal in all states? I would think that if they could show some hard data about how their outcomes are as good or better than hospital outcomes, that there would be no problem with gaining acceptance. And if that data shows that outcomes are worse, well, that would be a starting point for figuring out how to improve them. But I have to admit that if CPMs aren't showing good outcome data to state legislatures, and are then perplexed as to why they aren't gaining acceptance, that I don't have much sympathy.

[Anonymous]

Karen Carr is absolutely amazing, she delivered my 1st child and G-d willing she will be delivering my second this July.

[Anonymous]

Anonymous wrote:Karen Carr is absolutely amazing, she delivered my 1st child and G-d willing she will be delivering my second this July.

[Anonymous]

Anonymous wrote:Karen Carr is absolutely amazing, she delivered my 1st child and G-d willing she will be delivering my second this July.

When I took a helicopter tour of Costa Rica, I felt comfort in the fact that a fatal helicopter crash has just occurred the previous week. I figured that since a disaster just happened, that lessened my chances of being involved in a fatal helicopter crash.

But perhaps the proper analogy in comparison to the above poster's statement would be that someone is preparing to fly in a helicopter with the same pilot who walked away from a crash last week that killed everyone on board.

I'm pretty certain that Karen Carr should be barred from practicing lay midwifery while her felony charges are in court. I hope the above parent has a backup plan unless she's planning to deliver her baby in the cozy confines of Carr's jail cell.

[Anonymous]

I find this thread amazing. However, I think many of the people weighing in haven't been in a breech birth situation. Just because you say you're going to do things a certain way, once you know the risks involved, your opinion may change.

FWIW, my OB has delivered breech babies vaginally but does not deliver breech babies vaginally. I'm sure many OBs have done the same in emergency situations but do not make a practice of it mainly for liability issues.

[Anonymous]

Anonymous wrote:I find this thread amazing. ...

FWIW, my OB has delivered breech babies vaginally but does not deliver breech babies vaginally. I'm sure many OBs have done the same in emergency situations but do not make a practice of it mainly for liability issues.

I too find this thread fascinating. I would add that "liability issues" is a prettier way to say that "there may be brain damage or death of the child or serious injury or death to mother, and the doctor or someone else who has insurance may be found at fault as a result of inaction, malpractice, or oversight."

A CPM who tries to handle a complex and volatile situation by herself in a living room, like Carr is accused of doing, may not be motivated by liability issues because she does not have insurance. I'm sure that Carr would not "want" to harm a child or a mother, but her actions and the risks that she readily accepted in this case would argue against the levity of her judgment. I think a trial before her peers is a more suitable place for her than a July home birth setting.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Karen Carr is absolutely amazing, she delivered my 1st child and G-d willing she will be delivering my second this July.

I have to second this reaction!

[Anonymous]

Ironically, I don’t think Karen Carr’s any more or less competent than other qualified midwives in dealing with the issue that caused the death of this poor child. Her incompetence lies in her refusal accept the case’s risk by taking it on, and then failing to transfer fast enough (or even having transportation on stand-by).

It makes the point that even the most competent and experienced midwife sometimes won’t be objective enough to appease a mother about hospital/c-section fears (or even accompany her in this!) but lead her to believe that the home-birthing risks are still lesser than the hospital ones when it’s clearly not true.

Because of this kind of case, I can certainly see why many who respect the desire for homebirth still believe that a hospital setting remains safer than the home one. It can handle the emergencies that lead to tragedy. Part of Carr’s job in this case was to help the mother accept her reality and accompany her through it. She didn’t.

[Anonymous]

From In Service to Women...

"Today Karen Carr, CPM worked out a plea deal. She will have no jail time after already serving 6 days upon her arrest a few weeks ago. However, she has many fines to pay including the prosecution's costs. Please continue to help us with donations. We will give a total cost update soon. Thank you for your support.
The charge for involuntary manslaughter was dropped. However, child endangerment was one of the charges she reluctantly pled to. This gave her the best chance to avoid jail time. She pled guilty to two felonies. It will change her life but she will not be in jail. She will not practice in VA again".

[Anonymous]

motions hearing today just ended
results
- plead child endangerment, plead performing invasive procedure.

sentence time served, community service (50 hours), don't provide midwifery service in VA, don't apply for license in VA, fines less then $10,000.

case closed

done!!!!!!!!!!!!

[Anonymous]

Anonymous wrote:Ironically, I don’t think Karen Carr’s any more or less competent than other qualified midwives in dealing with the issue that caused the death of this poor child. Her incompetence lies in her refusal accept the case’s risk by taking it on, and then failing to transfer fast enough (or even having transportation on stand-by).

It makes the point that even the most competent and experienced midwife sometimes won’t be objective enough to appease a mother about hospital/c-section fears (or even accompany her in this!) but lead her to believe that the home-birthing risks are still lesser than the hospital ones when it’s clearly not true.

Because of this kind of case, I can certainly see why many who respect the desire for homebirth still believe that a hospital setting remains safer than the home one. It can handle the emergencies that lead to tragedy. Part of Carr’s job in this case was to help the mother accept her reality and accompany her through it. She didn’t.

I'm one of the posters who has been arguing back and forth about the qualifications of CPMs, and I completely agree with this post. This is one of the things that I have been trying (unsuccessfully) to articulate since like page 6 of this thread.

[Anonymous]

I am with you PP - this is exactly the heart of the issue.

and to this poster:

But outside those scenarios lets not kid ourselves - when you got an epidural you risked your baby's health for your own comfort.

Epidurals are safe for the mother and for the baby. Why shouldn't a mother be able to seek out comfort for her pain? I was definitely able to feel my contractions and the position of the baby when I had an epidural. The sensations were still there absent the pain.

[Anonymous]

Anonymous wrote:Ironically, I don’t think Karen Carr’s any more or less competent than other qualified midwives in dealing with the issue that caused the death of this poor child. Her incompetence lies in her refusal accept the case’s risk by taking it on, and then failing to transfer fast enough (or even having transportation on stand-by).

It makes the point that even the most competent and experienced midwife sometimes won’t be objective enough to appease a mother about hospital/c-section fears (or even accompany her in this!) but lead her to believe that the home-birthing risks are still lesser than the hospital ones when it’s clearly not true.

Because of this kind of case, I can certainly see why many who respect the desire for homebirth still believe that a hospital setting remains safer than the home one. It can handle the emergencies that lead to tragedy. Part of Carr’s job in this case was to help the mother accept her reality and accompany her through it. She didn’t.

Why do you think you have enough information to judge how competent Karen is compared to any other midwife? It is strange that you seem to think you know when you in fact have no idea whatsoever.

Also, there was nothing that a speedy transfer would have accomplished in this case. When a baby is stuck, there is no EMT on the planet who is going to have more skill than the midwife to get it out, and, by the time you make it to a hospital it would be too late anyway.

Karen was my midwife for my last baby and I would hire her again without any hesitation. Even for a breech baby -- heck, *especially* for a breech baby. I know from personal experience that Karen is the last person in the homebirth community to try to make anyone believe anything about birth. She lays out risks and benefits, says she cannot guarantee outcome (no birth provider can) and most importantly she does what should ALWAYS be done -- she lets the parents make up their own minds.

[Anonymous]

I too find this thread fascinating. I would add that "liability issues" is a prettier way to say that "there may be brain damage or death of the child or serious injury or death to mother, and the doctor or someone else who has insurance may be found at fault as a result of inaction, malpractice, or oversight."

Not exactly. There is an important distinction between liability risk and outcome risks. Limiting liability risk does not always limit outcome risks for the patient. The c-section rate increase from liability drivers come from the "time" argument. For example, a trial of labor for VBAC, breech, or any pregnancy can be fine but if there is a bad outcome, the plaintiff can always argue that the provider did not choose to move in a c-section in time. This becomes a finding of fact for a jury who may be more swayed by the emotional loss of a baby. The plaintiff can pull out expert witnesses who will say they would have done it sooner. If there is any logistical delay of even 10 or 15 minutes in getting into the OR, the hospital can also be open to liability. The doctor may have made an appropriate time call but if he did not realize that the OR team was not available at that moment he and the hospital still bear liability for the outcome.

The reverse does not hold true for bad outcomes from a c-section. Complication risks involved in surgery are more accepted within the defined standard of care. If the mother or baby has a bad outcome, even death, from a c-section it is much more difficult for the plantiff to win. The plaintiff can not win just because the death occurred, even if the death occurred because of the c-section or an infection resulting from the surgery. The plaintiff would need to show gross neglience on the part of the doctor which is hard to do or show that hospital staff recklessly violated procedures which again is difficult to do. You might think that a situation where the doctor did not make a large enough incision and the baby died or the doctor cut something else would trigger gross neglience. It often does not unless there is a consistent pattern of prior incidents which the hospital was aware of and improvement was not made. You almost would need to provde that the doctor was intoxicated or something else extreme to win the case. Since a c-section falls with defined standard care for many situations, you can not prevail by arguing that you should not have had a c-section even if the bad outcome would not have occurred with a vaginal birth.

From a liability standpoint, doctors would be better off giving everyone a c-section even though they would experience more bad patient outcomes not less. Hospitals would be much better off giving everyone a c-section. It is expensive and logistically difficult to have an OR and OR team standing reading to have the baby out in several minutes. They would avoid this expense and liability risk of a logistical problem. The hospital also makes significantly more money from operations than it does from a mother giving birth naturally. I'm actually very impressed with the ob/gyns who do fight this trend on behald of their dedication to bette patient outcomes. We focus often focus on the ones who are part of the problem rather than the ones trying to not give in.

[Anonymous]

Anonymous wrote:I am with you PP - this is exactly the heart of the issue.

and to this poster:

But outside those scenarios lets not kid ourselves - when you got an epidural you risked your baby's health for your own comfort.

Epidurals are safe for the mother and for the baby. Why shouldn't a mother be able to seek out comfort for her pain? I was definitely able to feel my contractions and the position of the baby when I had an epidural. The sensations were still there absent the pain.

Thanks for willfully misunderstanding what I wrote. Sure epidurals are generally safe, just like riding in cars, elective c-sections and vaginal breech births are generally safe. But epidurals are not zero risk to the baby or to the mother (duh). Its fine to make the choice that pain relief is worth some small risk to mom and baby, but do not pretend that you are not making that choice. The fact is, in a normally progressing labor, a hospital birth without an epidural is safer in absolute terms than a hospital birth with an epidural. That is becase there is zero risk to the baby or the mom from NOT having an epidural in a normal vaginal delivery. Again occasionally they are medically indicated, but that is in a tiny percentage of cases. So any mom who claims that she would not tolerate any risk to the baby, but then gets an epidural, is just a giant hypocrite.