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

[Anonymous]

Anonymous wrote: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!!!!!!!!!!!!

Seriously? Is this true? So this is merely a slap on the hand. Because of the deal there will be no investigation, and no hearing of the parents to find out what happened or how?

[Anonymous]

Anonymous wrote:

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.

Thanks for making the argument that being in the hospital in the first place is safest. And for the record, I was OPINING about Karen Carr's compentence in my comment, and saying she probably was fine at what she does, just not at identifying when she shouldn't be doing. Hence, HOSPITAL.

[Anonymous]

Anonymous wrote:

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?

Agree totally with second quote !!! To the first person quoted: It IS easy to misread your comments the way you write them! Medical training is so highly regimented, structured, examined, and so long - it's not subpar, rest assured, not in this country. If that's not how you truly feel I'm relieved to hear that!

I understand the point that you're trying to make, but seriously? There is quite a lot of variety in the quality of training at different medical schools within this country. If they are all the same, why are some schools more sought after than others? Why are there rankings at all? And just like any other profession, there are good, dedicated doctors and there are doctors who are less good.

I understand that people have concerns about the training level of CPMs. I have concerns about it myself. But let's not sit here and pretend that all med schools, residencies and doctors are created equal. They are not and you need go no further than this forum to find people looking for "a good OB" in the area to see that.

So there are good/bad docs/midwives. Ok. Tiebreaker? If you have a bad doc in the hospital, there’s plenty more staff to request or help. With a midwife at home in crunch time, you’re on your own.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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!!!!!!!!!!!!

Seriously? Is this true? So this is merely a slap on the hand. Because of the deal there will be no investigation, and no hearing of the parents to find out what happened or how?

they said why she chose a home birth for her baby, even before she knew her baby was breech. the prosecution read a statement that said that the mother's mother had died in a hospital when she was young and that she didn't want to give birth in hospital because of it. now you know. breaks your heart right?

[Anonymous]

Anonymous wrote:I understand the point that you're trying to make, but seriously? There is quite a lot of variety in the quality of training at different medical schools within this country. If they are all the same, why are some schools more sought after than others? Why are there rankings at all? And just like any other profession, there are good, dedicated doctors and there are doctors who are less good.

I understand that people have concerns about the training level of CPMs. I have concerns about it myself. But let's not sit here and pretend that all med schools, residencies and doctors are created equal. They are not and you need go no further than this forum to find people looking for "a good OB" in the area to see that.

As I mentioned before, when people are looking for a "good" OB/CNM, it's usually not their competence that's being questioned- it's usually the bedside manner, the rate of using certain interventions, the "birth philosophy." People want a nice doctor who has a similar risk tolerance, because it's assumed that competence is a given.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Are you a pain specialist? Can you tell us about the current literature that links pain control quite strongly with faster recovery times? How about the literature that shows that inadequate acute pain control can lead to chronic pain as well as overall dissatisfaction with the experience? There is not "zero risk" to the mother who avoids adequate pain control out of fear of harming her baby.

What I'm getting here is that the mother is expected to take a greater risk with her future health with respect to pain control during labor, but expected to take a lesser risk with her future health by avoiding CS. Does that sum it up?

Umm no, labor pain has a purpose, unlike pain from surgery or an illness. Find me a single study, or any literature whatsoever, that says that mothers who get epidurals recover faster or have fewer long term problems. In fact the opposite is true, because labor pain results in the release of endorphins which promote bonding and a faster recovery. Epidurals also result in more tearing because they make controlled pushing much more difficult - pain when the baby is crowning sends the mother a signal to wait and let her body stretch. Get an epidural if you want but to pretend that it is for medical reasons is absurd. But feel free to point me to the study that says that women who get epidurals versus women who do not recover faster and live healthier lives. The level of denial this argument demonstrates is amazing to me - why the need to insist that an epidural is somehow morally superior, or medically necessary? Its for comfort - nothing wrong with that, but nothing admirable about it either.

[Anonymous]

Anonymous wrote:Umm no, labor pain has a purpose, unlike pain from surgery or an illness. Find me a single study, or any literature whatsoever, that says that mothers who get epidurals recover faster or have fewer long term problems. In fact the opposite is true, because labor pain results in the release of endorphins which promote bonding and a faster recovery. Epidurals also result in more tearing because they make controlled pushing much more difficult - pain when the baby is crowning sends the mother a signal to wait and let her body stretch. Get an epidural if you want but to pretend that it is for medical reasons is absurd. But feel free to point me to the study that says that women who get epidurals versus women who do not recover faster and live healthier lives. The level of denial this argument demonstrates is amazing to me - why the need to insist that an epidural is somehow morally superior, or medically necessary? Its for comfort - nothing wrong with that, but nothing admirable about it either.

Labor pain doesn't have a purpose. It's the body's response to the acute changes taking place in labor. Treating labor pain is just like treating any other kind of pain, caused by any other physiological process.

[Anonymous]

Most obgyns have seen very few uncomplicated
natural childbirths---isn't the epidural
rate something like 98%?

[Anonymous]

Umm no, labor pain has a purpose, unlike pain from surgery or an illness.

I hate this response, which I hear all the time. Pain from surgery or an illness does have a purpose. All pain has a purpose. It is the body's way of telling you that something is wrong, or to be careful regarding the activity you are doing that causes the pain. This is why the select number of children who have the disorder where they cannot feel pain have difficult lives and suffer horrible injuries.

[Anonymous]

Anonymous wrote:Most obgyns have seen very few uncomplicated
natural childbirths---isn't the epidural
rate something like 98%?

Estimates put it around 75-80%.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Umm no, labor pain has a purpose, unlike pain from surgery or an illness. Find me a single study, or any literature whatsoever, that says that mothers who get epidurals recover faster or have fewer long term problems. In fact the opposite is true, because labor pain results in the release of endorphins which promote bonding and a faster recovery. Epidurals also result in more tearing because they make controlled pushing much more difficult - pain when the baby is crowning sends the mother a signal to wait and let her body stretch. Get an epidural if you want but to pretend that it is for medical reasons is absurd. But feel free to point me to the study that says that women who get epidurals versus women who do not recover faster and live healthier lives. The level of denial this argument demonstrates is amazing to me - why the need to insist that an epidural is somehow morally superior, or medically necessary? Its for comfort - nothing wrong with that, but nothing admirable about it either.

Labor pain doesn't have a purpose. It's the body's response to the acute changes taking place in labor. Treating labor pain is just like treating any other kind of pain, caused by any other physiological process.

All pain, including labor pain, has a purpose. The question is: when is it more harmful than helpful treat it? A lot of people would argue aggressively treating labor pain isn't justified because there are actual benefits to being able to feel the pain, as the first poster suggested. Epidurals can be useful and worth in many circumstances, but not all, and they may actually mask pain that is trying to communicate something important to a mom and her caregivers.

I'm a chronic back pain sufferer. Instead of covering the pain up with meds, I've taken agressive action with physical therapy and chiropractic care to help prevent the pain instead of just covering it up. The path I've taken won't work for everyone...it depends on how manageable the pain is. I think the same philosophy should apply to birthing decisions too.

[Anonymous]

Anonymous wrote:I'm a chronic back pain sufferer. Instead of covering the pain up with meds, I've taken agressive action with physical therapy and chiropractic care to help prevent the pain instead of just covering it up. The path I've taken won't work for everyone...it depends on how manageable the pain is. I think the same philosophy should apply to birthing decisions too.

Chronic pain =/= acute pain, and undertreated acute pain can lead to chronic pain.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Umm no, labor pain has a purpose, unlike pain from surgery or an illness. Find me a single study, or any literature whatsoever, that says that mothers who get epidurals recover faster or have fewer long term problems. In fact the opposite is true, because labor pain results in the release of endorphins which promote bonding and a faster recovery. Epidurals also result in more tearing because they make controlled pushing much more difficult - pain when the baby is crowning sends the mother a signal to wait and let her body stretch. Get an epidural if you want but to pretend that it is for medical reasons is absurd. But feel free to point me to the study that says that women who get epidurals versus women who do not recover faster and live healthier lives. The level of denial this argument demonstrates is amazing to me - why the need to insist that an epidural is somehow morally superior, or medically necessary? Its for comfort - nothing wrong with that, but nothing admirable about it either.

Labor pain doesn't have a purpose. It's the body's response to the acute changes taking place in labor. Treating labor pain is just like treating any other kind of pain, caused by any other physiological process.

All pain, including labor pain, has a purpose. The question is: when is it more harmful than helpful treat it? A lot of people would argue aggressively treating labor pain isn't justified because there are actual benefits to being able to feel the pain, as the first poster suggested. Epidurals can be useful and worth in many circumstances, but not all, and they may actually mask pain that is trying to communicate something important to a mom and her caregivers.

I'm a chronic back pain sufferer. Instead of covering the pain up with meds, I've taken agressive action with physical therapy and chiropractic care to help prevent the pain instead of just covering it up. The path I've taken won't work for everyone...it depends on how manageable the pain is. I think the same philosophy should apply to birthing decisions too.

I spent a lot of time thinking about this issue when I was pregnant. There is a difference, in my mind, between pain and suffering. I had an unmedicated birth. It was painful and hard. I didn't feel like I suffered, though, and plan to have an unmedicated birth next time as well. If I had felt like I'd suffered the first time around, I would probably make different choices the second time.

[Anonymous]

I see this a lot, and it really confuses me. Do you know any OB/GYNs personally? Why do you think that they have less experience with unmedicated nonsurgical birth than a CNM? Have you looked at OB/GYN residency requirements? OBs have attended tons and tons of births, and since CS accounts for ~1/3 of all births (and a much lower percentage of first-time deliveries), of course they have extensive experience with unmedicated nonsurgical birth. All things being equal, OBs prefer uncomplicated vaginal deliveries. They're easier, the mothers tend to go home quicker, and the OB gets a comparable amount of money for less work. Of course, if the OB specializes in high risk pregnancies then she probably doesn't see as many "uncomplicated" deliveries, but I don't think you're referring to that population.

I'm not the PP but I do know ob/gyns. Many of your assumptions are off-base. The c-section rate of 1/3 does not mean that 2/3 of births are unmedicated. The epidural rate is very high, 95% or higher with hospital births. Mid wives only see epidurals if they deliver in a hospital setting so mid wives see far more natural births than ob/gyns. Residents may see barely any during their training despite seeing hundreds of patients. Many FTMs do not realize though that providing labor support is the nurses job not the ob/gyn's job. Your ob/gyn is not trained to provide support throughout labor not do they do this with you. They are trained to monitor looking for signs of pathology or fetal/maternal stress. They are trained to deliver or "catch the baby". They are trained to intervene with surgical or pharmacological treatments if the need arises. They are trained as surgeons. Finding an ob/gyn who is supportive of natural child birth means finding one who will sign off things like intermittent monitoring, drinking or eating during labor, being more flexible about the clock but it is still unlikely that this ob/gyn will be with you the whole time.

The nurses are expected to be the support person but the nurses may or may not be accepting of this role for various reasons. Older school nurses were not trained to support natural childbirth and old habits die hard in nursing. They may want you in bed while a different nurse who believes in natural child birth may do everything she can to keep you moving, offer different positions etc. Staffing affects this too as supporting a women through labor is time intensive. If the nurse has a large patient load, she is going to prefer that women get an epidural and do not need support. You may luck out and get a great nurse on a slow day or you can bring a doula to support you if you want to maximize your chance for having a natural birth. Nurses are not supposed to "catch the baby" so the pushing and delivery stage goes back to the ob/gyn.

Mid wives are responsible for prenatal care, supporting the mom throughout labor, and performing the delivery. The continuity of care and the time spent with the mother along with training on how to manage pain and labor throughout the process but the patients of midwives at an obvious advantage in achieveing natural childbirth.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm a chronic back pain sufferer. Instead of covering the pain up with meds, I've taken agressive action with physical therapy and chiropractic care to help prevent the pain instead of just covering it up. The path I've taken won't work for everyone...it depends on how manageable the pain is. I think the same philosophy should apply to birthing decisions too.

Chronic pain =/= acute pain, and undertreated acute pain can lead to chronic pain.

Actually, in my case, overtreating accute pain lead to masking of ensuing chronic pain. Had a nasty back injury, NEEDED pain meds for sanity, but ultimately what I really needed was anti-inflamatories and muscle relaxants to get at the source of the pain, as well as physical therapy. The narcotics were the first thing they gave me though...when they wore off, the pain was still there. LOTS of back pain sufferers (too many) choose the narcotic pain medication route and don't really do anything to actually heal their pain.

No need to parse this further. The analogy isn't perfect but the point is that all pain serves a purpose. It's a signal to you that you need to do something. In the case of labor, pain can communicate that you need to try something else...and that can mean pain meds, or it can mean a new position, or slowing down pushing, etc. Depends on the situation.

Finally, not treating labor pain does not lead to chronic pain. Where on earth did you get that? If anything there is substantial evidence that epidurals can lead to chronic pain resulting from pelvic floor injury. That's a true fact.