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

[Anonymous]

Anonymous wrote:
on one hand i support the right of women to birth how and with whom they want. many people certainly thought i made a dangerous choice by birthing at home, so whenever i am inclined to think something is dangerous (such as breech birth at home, or birth with an unlicensed CPM, or unassisted birth, or elective cesarean, all of which i must admit do seem dangerous to me personally), i really try to remember that everyone has a different threshold of risk, and i try to support the choices that others make even if different than my own.

that said, i worry that maybe some midwives are being irresponsible by taking on clients who have a very high chance of adverse outcomes if giving birth at home. i believe home birth can be a reasonable option for low risk women, and i know the definition of 'low risk' is extremely controversial, but to me, there are some situations where i feel like the midwife just shouldn't agree to attend a woman. but where that "line" is in terms of what's safe and what's not is very hard to draw. some home birth midwives will attend women who want a VBAC and some won't. who am i to tell a woman or midwife what level of risk is acceptable or who is a 'good' candidate for home birth? it's very hard to find that line.

i do think women deserve accurate information about the risks of various settings. the problem is that research on home birth is not very clear. there is a lot of controversy over whether home birth does or does not have a higher risk of perinatal death. when i planned my home birth, i really wasn't aware of this controversy. everything i had read suggested that home birth was as safe as hospital birth, and this is what i wanted to believe -- but most of these studies were from other countries, where the system works differently. so i'm not sure i really did have all the information on the risks of being at home, or even that such information actually exists.

i think sometimes there's a tendency on the part of home birth supporters and midwifery supporters to defend midwives and home birth at all costs, and to not see clearly when there might be circumstances where home birth is not a wise choice, or when a midwife makes a poor decision. without knowing the details of this situation, i can't really know what happened in this case. i certainly wouldn't blindly support a midwife without knowing the details of a situation, nor would i condemn her. i feel like sometimes in situations like this, the whole birth community rallies around the midwife, and there isn't much self reflection or questioning or even thoughts about the baby who has died. it kind of is off putting to me.

birth does go well almost all of the time, but when it doesn't, the person who's there really needs to be able to recognize that there's a problem and address it. the whole "babies die in hospitals too" argument doesn't really resonate with me -- because i think that often what babies die from at home is very different than what babies die from in the hospital. so while it is certainly true that babies die in both settings, i think home birth supporters do need to be humble and accepting of criticism when there are bad outcomes at home, and to work hard to make home birth safer, rather than just pretending it's perfect and that babies that die are just random flukes. i think we owe it to those babies and mothers to try and prevent those situations from happening.

I had a home birth a few years ago and I agree with this poster, especially the bolded parts. I had a wonderful, easy, uncomplicated birth, but I do feel that, looking back on it, I may not have had all pertinent information about the risks involved, and were I to choose home birth again in the future I would be a lot more cautious. That said, even back then there is no way in hell I would have attempted any breech delivery at home, much less a footling. What on earth were they thinking? Reading the mom's post, I have a feeling I might know who the person is who advised her to attempt a vaginal delivery and that person typifies the radicalism I have seen regarding home birth and being against the medical establishment at all costs, including, apparently, a baby's death. Just goes to show that both extremes are equally wrong. There is a happy medium between overuse/abuse of medical interventions and just "trusting birth" no matter what. I think *most* women who choose home birth, and most midwives who provide home birth services, are in favor of that happy medium, but there are radical elements that give home birth a bad name. Because of this foolishness, the VA legislature is probably going to come down on CPMs like a duck on a june bug in terms of restricting their scope of practice.

OTOH, I can't let the parents off the hook here. They had to have been told by multiple people that footling breech is not safe for vaginal delivery. If they chose to believe the wrong person/people, that's at least partially on them. Which is not to say that the situation is not utterly tragic for everyone involved. So sad this happened.

[Anonymous]

This is very upsetting to hear about. I'm a supporter of women making EDUCATED birthing choices. Sounds like in this case there was a knowledge gap that ended up causing tragedy. So sad, especially because this was a FTM. I think there will be plenty of blame to go around here: the midwife, the parents, and even potentially any OBs and Birth Centers that were consulted (if any of these parties failed in their duty to explain the risks to these parents). I don't think this is an example of a reason NOT to homebirth, but it certainly is going to provide some aweful insight into the broken system we have for women's health in this county. The fact that parents like this appear to be completely on their own when evaluating risks they don't have the knowledge and experience to weigh properly is appalling. That's supposed to be the job of ANY care provider...midwife or Dr. Unfortunately, we have a system were both midwives and Dr.'s are not working TOGETHER to improve outcomes for families. Scary and sad.

[Anonymous]

PP here, just to be clear: when i said this shouldn't be a reason to shun homebirthing, I didn't mean to imply that vaginal breech delivery is something that should be attempted at home...it kind of reads that way, but that's not what I mean. I just meant that this is more of an example of how important it is for families to have access to reliable information from competent caregivers.

[Anonymous]

A quick google search of Karen Carr reveals a thread in mothering magazine on KC stating that she is well-known for doing breech homebirths, and even footling breech homebirths.

http://www.mothering.com/community/forum/thread/1071717/midwife-information

[Anonymous]

I tried accessing the court records but it does not seem to accept my PACER login - Alexandria's court has its own, separate system. Any Virginia attorneys reading this who could do us a favor, call up the relevant documents and summarize? I would very much like to know the details.

And by the way, thank you to everyone who has commented so far on this thread. It reveals a whole spectrum of views and attitudes surrounding birth and risk and medical care.

Just for what it's worth:
A lot of direct-entry midwives (this includes Certified Professional Midwives like Karen Carr, as well as other types of midwives who do not become nurses before entering midwifery) have a very matter-of-fact view about life and death. They accept that we all are born and we all die, and sometimes maternal and/or newborn death is unavoidable.

Many of us who choose to birth at home feel this way also. The way that many OBGYNs and other doctors are trained, to fend of death at all costs with extreme measures, is repellent to some people.

It sounds as if this couple was not of this mindset, but rather was somewhat uneducated about the risk they were taking with a vaginal delivery of a footling breech.

Both they and Karen Carr made a mistake - she was not the right care provider for them. She did not understand that they did not understand the risks.

[Anonymous]

Both they and Karen Carr made a mistake - she was not the right care provider for them. She did not understand that they did not understand the risks.

That's certainly what it sounds like. FTM who has read too much and is of the mindset that medical intervention isn't necessary and that doctors are too quick to medicalize birth goes looking for a midwife who will deliver her high-risk pregnancy. Midwife doesn't properly educate the mother as to the risk and mother's belief that the birth industry is proven wrong and nature proven right. Tragic result for all parties.

[Anonymous]

Many of us who choose to birth at home feel this way also. The way that many OBGYNs and other doctors are trained, to fend of death at all costs with extreme measures, is repellent to some people.

Genuinely curious - you feel that death is preferable to a C-section? I know that the question sounds flamey, but I found this statement to be odd.

[Anonymous]

I'm another home birth mom who's very upset by this whole situation. I choose to VBAC at home because I got screwed by the hospital system, but once again it comes down to TRUE informed consent, communication, and education. My HB midwife was very clear on what is and isn't acceptable, had me read information about every test I took (20wk ultrasound, GTC, GBS) so I would understand exactly what they tested for, and I felt incredibly empowered thanks to her. I know someone who she delivered breech at home - but it was a surprise frank breech. I'm pretty sure she would have transferred care for a footling breech.

To the PP - those of us who've suffered from PTSD after a bad c-section experience would stop just short of that, I think. You won't find me back in the OR unless it's a life-or-death situation. I understand not everyone feels that way, but that's why protecting the choices available to women is so important.

It will be interesting to see what the reactions are when this makes the news. I also hope that it doesn't cause a knee-jerk anti-homebirth campaign, but that it does lead to better standardization for licensing. FWIW, I made sure my midwife was licensed in VA first.

[Anonymous]

I agree with the above long posts about how homebirth is suited for the very educated on the subject who accept risk and are good at risk-benefit analysis. I think everyone involved can shoulder some responsibility...Drs who turned her away, midwives, and the mom herself. I for one believe that if my baby died at home, it would have died at the hospital too and it was meant to be. I couldn't live with the "what-if some doctor did something to me or my baby to cause this?" nagging me. If I carefully choose and develop a relationship with a midwife, then the responsibility for my baby's harm still falls on me because I made all these choices. You have no idea which OB or nurse is going to be with you at birth.
That said, my risk-benefit analysis for a footling breech at home would be to go to a hospital that performs "natural cesareans," and accept my maiming-or-death-from-c-section risk which is actually almost equal to the maiming-and-death-from-breech risk. C-section for breech has never been shown to improve outcomes, just like c-section for any baby has not been shown to improve outcomes and in fact our maternal and fetal mortality rates are rising. It's a really tough decision if, like me, you know the statistics and work with women who were harmed or devastated by their c-sec, warranted or not. There is no guarantee of life.

[Anonymous]

12:20, Did the doctors turn her away? Or did they just explain that they would not be comfortable with an attempted vaginal delivery, and if she were in their care, they would insist on a c-section?
Because these are very different things.

[Anonymous]

Anonymous wrote:12:20, Did the doctors turn her away? Or did they just explain that they would not be comfortable with an attempted vaginal delivery, and if she were in their care, they would insist on a c-section?
Because these are very different things.

I mean turned her away for a vaginal birth, without making clear to her the risks involved in her kind of breech presentation. If that is what happened. If that Birth Care review is this mother's review, she appears to have gone hunting far and wide for someone to attend this birth and nobody would except Karen. While I'm at it, I'll go ahead and blame today's medical climate. If OBs were trained in breech and would attend breech in hospital, people wouldn't be forced to do homebirth and maybe this baby would have lived. Same with VBAC. They say these are risky births, so they force women to resort to what the OBs consider to be risky and dangerous homebirths to avoid most-times-unnecessary c-sections, or other abuses, instead of providing what they consider to be the safest place to birth these babies. Makes no sense at all.

[Anonymous]

Anonymous wrote:I agree with the above long posts about how homebirth is suited for the very educated on the subject who accept risk and are good at risk-benefit analysis. I think everyone involved can shoulder some responsibility...Drs who turned her away, midwives, and the mom herself. I for one believe that if my baby died at home, it would have died at the hospital too and it was meant to be. I couldn't live with the "what-if some doctor did something to me or my baby to cause this?" nagging me. If I carefully choose and develop a relationship with a midwife, then the responsibility for my baby's harm still falls on me because I made all these choices. You have no idea which OB or nurse is going to be with you at birth.
That said, my risk-benefit analysis for a footling breech at home would be to go to a hospital that performs "natural cesareans," and accept my maiming-or-death-from-c-section risk which is actually almost equal to the maiming-and-death-from-breech risk. C-section for breech has never been shown to improve outcomes, just like c-section for any baby has not been shown to improve outcomes and in fact our maternal and fetal mortality rates are rising. It's a really tough decision if, like me, you know the statistics and work with women who were harmed or devastated by their c-sec, warranted or not. There is no guarantee of life.

Although I do not know the exact details of this particular situation yet, I think the bolded comment above is astonishingly wrong. As 20:09 stated above, the things that cause deaths in hospitals and things that cause deaths at home are *sometimes* the same things, but often are very different things. E.g., using pitocin or cytotec to excess and causing a catastrophic uterine rupture that results in a baby's death is something that is ONLY going to happen in a hospital. But having a baby die from head entrapment during a vaginal breech birth is only going to happen where vaginal breech births do, which is to say, largely at home. I am very cautious and conservative in my beliefs about the use of c-sections and I absolutely believe that they increase risks for mothers and babies and are vastly overused ... but for a footling breech, there really would be no decision to make for me. That, along with placenta previa, transverse lie, and a few other things, are absolute indications for a c-section. Wanting a lower rate of c-sections and acknowledging that they are major surgery with risks and potentially dangerous side effects does not have to mean going all the way back to when a woman who would die or whose baby would die without one was SOL. Yes, the medical establishment has gone way too far in one direction, but I just cannot get on board with the idea that I should prefer taking a substantial risk of my baby dying to having a c-section -- and I consider myself fairly militant about natural childbirth (for myself, not for anyone else). I guess the question is what a "substantial" risk is to each individual. There are no universal answers to that. Everyone has to do what they feel comfortable with and I do believe women should have (informed) choices even if they are not the ones I would make ... but I fear that when something like this happens, the effect will be to foreclose choices for everyone.

[Anonymous]

Where have folks read that this breech birth was in the footling position? Or is that an assumption?

[Anonymous]

Well, duh, I wouldn't be having a homebirth with transverse, previa, prolapse, etc. If I had a normal pregnancy and birth, (this includes twins and breech) and baby died or was harmed during birth, then, what could anyone have done? Babies can be hurt during c-section breech birth, too, including strangulation and head entrapment in the incision!!! Did you know that?


Although I do not know the exact details of this particular situation yet, I think the bolded comment above is astonishingly wrong. As 20:09 stated above, the things that cause deaths in hospitals and things that cause deaths at home are *sometimes* the same things, but often are very different things. E.g., using pitocin or cytotec to excess and causing a catastrophic uterine rupture that results in a baby's death is something that is ONLY going to happen in a hospital. But having a baby die from head entrapment during a vaginal breech birth is only going to happen where vaginal breech births do, which is to say, largely at home. I am very cautious and conservative in my beliefs about the use of c-sections and I absolutely believe that they increase risks for mothers and babies and are vastly overused ... but for a footling breech, there really would be no decision to make for me. That, along with placenta previa, transverse lie, and a few other things, are absolute indications for a c-section. Wanting a lower rate of c-sections and acknowledging that they are major surgery with risks and potentially dangerous side effects does not have to mean going all the way back to when a woman who would die or whose baby would die without one was SOL. Yes, the medical establishment has gone way too far in one direction, but I just cannot get on board with the idea that I should prefer taking a substantial risk of my baby dying to having a c-section -- and I consider myself fairly militant about natural childbirth (for myself, not for anyone else). I guess the question is what a "substantial" risk is to each individual. There are no universal answers to that. Everyone has to do what they feel comfortable with and I do believe women should have (informed) choices even if they are not the ones I would make ... but I fear that when something like this happens, the effect will be to foreclose choices for everyone.

[Anonymous]

I can only speak to my experience with two Birthcare births (one at the birth center, one at home). The midwives were explicit as to what factors would risk me out of their care, and why. They were clear about what situations would cause them to refer me to a hospital and an OB, and why. I understood from what they said that in the event of any of those complications, the well-being of my babies (and myself) was going to trump my preference for an out-of-hospital birth.