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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

When a baby gets stuck during the birth, the only option is to work to free the baby and complete the delivery. A speedy 911 call is NOT going to change the outcome. An EMT is NOT going to be able to offer anything greater than what the skilled midwife/OB is already doing. Even having an operating room three doors down is NOT going to help. Once a baby is partially born, there are no other magic answers; you have to finish getting the baby out, and if more than 10 minutes pass, the baby is just not going to make it unless there is a miracle. Maybe you take some personal comfort from thinking that a hospital could have saved this baby, and I think that as mothers who are horrified at this case, it is easy to believe that the right medical team could have saved this baby. However, I honestly believe that the outcome would have been exactly the same regardless of where the birth occurred.
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I disagree (and I am the person who has had a homebirth vbac so I am not anti-homebirth- I have also had 2 C-sections, one of them I am thankful for or my baby wouldn't be here today)!!!! My OB told me she has had some very serious and difficult SD (shoulder dystocia) cases, one of which they saved the baby by basically cutting open the cervix (I know, awful, but better than a dead baby). She also said there were some other SD cases where the baby was totally stuck and she had to quickly push the baby back up into mom and rush them to the OR where they were saved. So I couldn't disagree with you more, being close to an OR CAN mean the difference between life or death!!!!

Did she tell you if they all came out healthy and whole?

She did say sometimes when this is done the babies can be left with nerve damage in their arms (talking about SD here- but I am sure the parents would rather have their baby alive even if they are left with a damaged arm). That is why she wanted me to go ahead with a C-section, my baby was at serious risk for SD. That was a risk I wasn't willing to take. My homebirth baby had been much smaller and had less risk factors than my last baby, and that is why I went ahead with that homebirth. I still support hb in LOW risk cases, but I will personally never have another one again. My next baby will be a planned C-section (although I know it is done, I personally don't feel comfortable doing a vbac after 2 C-sections, I did feel okay with doing a vbac after 1, but not 2). Shoot me.

Your body, your choice. Do what you want and leave other people alone with their choices.

Oh my god!!! This is exactly what I’m talking about! “Leave people alone with their choices”???? Because she has a diversified view that’s based on individualizing the birth plan to the history, context, and risk assessment of each pregnancy? Because she doesn’t 100% distrust hospitals and 100% vouch for homebirths no matter what?! This poster is educated, smart, AND experienced. But since her posts aren’t inflammatorily shooting down one side or the other, take her out of the discussion altogether? I can’t help but wonder how many such decent, educated, respectful, and objective posters bailed on this thread ages ago due to comments like yours. Unfortunately, researching expectant mothers will be stuck with having to decipher through the crap to hopefully find this little pearl of a poster. Way to go. Doing everyone great favors here.

[Anonymous]

Anonymous wrote:

When a baby gets stuck during the birth, the only option is to work to free the baby and complete the delivery. !

Actually if a baby in the breech position gets stuck on the way out the safest thing for the doctor to do is to gently push the baby back into the womb and perform an emergency c-section. Trying to work it free could result in a neck injury, nerve damage or death. A stuck breech baby means the head is stuck because the pelvis is too narrow but the rest of the baby has already been delivered. Not much option here because it's skull bone against pelvic bone. There just aren't techniques to work the baby free in this situation. Basically the head fits or it doesn't. If the baby is in the correct birthing position and the head doesn't fit through the pelvis the mom just doesn't progress through labor and will ultimately need a c-section but it's not the same life or death extreme situation.

Also, to clarify what another poster suggested....shoulder dystocia usually occurs when the baby gets stuck in the correct birthing position. So the head has already been delivered but the shoulders are too wide to pass. There are maneuvers to free the shoulders but if they don't work the OB does need to cut open the cervix. This happened to someone I knew. She ended up with 30 stitches and a recovery far worse than it would have been with a c-section. That's why many OB's watch fetal measurements closely near the end of pregnancy and if mom is past her due date will likely recommend induction to prevent the baby from getting too big for the birth canal.

[Anonymous]

Actually if a baby in the breech position gets stuck on the way out the safest thing for the doctor to do is to gently push the baby back into the womb and perform an emergency c-section. Trying to work it free could result in a neck injury, nerve damage or death. A stuck breech baby means the head is stuck because the pelvis is too narrow but the rest of the baby has already been delivered. Not much option here because it's skull bone against pelvic bone. There just aren't techniques to work the baby free in this situation. Basically the head fits or it doesn't. If the baby is in the correct birthing position and the head doesn't fit through the pelvis the mom just doesn't progress through labor and will ultimately need a c-section but it's not the same life or death extreme situation.

Also, to clarify what another poster suggested....shoulder dystocia usually occurs when the baby gets stuck in the correct birthing position. So the head has already been delivered but the shoulders are too wide to pass. There are maneuvers to free the shoulders but if they don't work the OB does need to cut open the cervix. This happened to someone I knew. She ended up with 30 stitches and a recovery far worse than it would have been with a c-section. That's why many OB's watch fetal measurements closely near the end of pregnancy and if mom is past her due date will likely recommend induction to prevent the baby from getting too big for the birth canal.

[Anonymous]

You know what I find interesting - some of the most "staunch hb" advocates I know are actually pro life and extremely religious. I find this the ultimate paradox. It's "wrong" to terminate an unwanted pregnancy, yet it's cool if the baby dies during childbirth because mom wanted a homebirth (although she'd been deemed high-risk by numerous other providers)? As the staunch hb advocate would say - it's cool because we know that moms and babies die sometimes. Bullshit! When it happens in the hospital, you all call it negligence and murder. In this case, the mother had all the right to choose homebirth and as many, many posters pointed out, no provider had the obligation to take on an unsafe scenario.

When we talk about the 40-50 breech deliveries Carr has performed, I'm curious to know how many were delivered by women over 40, primigravidas, with a full term (or >40 week gestation)? These are the "real" statistics we need to know before fully understanding the level of risk at hand here. Do these "breech" deliveries assume singletons only or vertex/breech twins? It is far easier to do a breech extraction when one baby has already been born (i.e. twins). It's much easier to deliver a breech when mom has had 4 other children. How many were complete or frank breeches, as opposed to footling? And when (as mom herself stated in her own review on CitySearch) did the baby turn into an unfavorable position (assumingly from frank or complete breech to footling?). Shouldn't the transfer have occured once the baby turned footling breech and not 33 minutes after resuscitation efforts failed?

Obviously this mom wanted her hb and come hell or high water she was going to have it. That is certainly her choice and now she must live with the consequences, but it is the provider who must ALWAYS act under the premise of - "first do no harm". Can we in our heart of hearts believe that KC acted in such a manner? Why did she not return the client's fee until yesterday's court proceeding? These kinds of questions linger in my mind. This is not about MIDWIVES and MIDWIFERY CARE on the whole. This is about one generally good provider who made a poor decision and a bad call at the expense of her client and now someone is dead.

[Anonymous]

Anonymous wrote:You know what I find interesting - some of the most "staunch hb" advocates I know are actually pro life and extremely religious. I find this the ultimate paradox. It's "wrong" to terminate an unwanted pregnancy, yet it's cool if the baby dies during childbirth because mom wanted a homebirth (although she'd been deemed high-risk by numerous other providers)? As the staunch hb advocate would say - it's cool because we know that moms and babies die sometimes. Bullshit! When it happens in the hospital, you all call it negligence and murder. In this case, the mother had all the right to choose homebirth and as many, many posters pointed out, no provider had the obligation to take on an unsafe scenario.

When we talk about the 40-50 breech deliveries Carr has performed, I'm curious to know how many were delivered by women over 40, primigravidas, with a full term (or >40 week gestation)? These are the "real" statistics we need to know before fully understanding the level of risk at hand here. Do these "breech" deliveries assume singletons only or vertex/breech twins? It is far easier to do a breech extraction when one baby has already been born (i.e. twins). It's much easier to deliver a breech when mom has had 4 other children. How many were complete or frank breeches, as opposed to footling? And when (as mom herself stated in her own review on CitySearch) did the baby turn into an unfavorable position (assumingly from frank or complete breech to footling?). Shouldn't the transfer have occured once the baby turned footling breech and not 33 minutes after resuscitation efforts failed?

Obviously this mom wanted her hb and come hell or high water she was going to have it. That is certainly her choice and now she must live with the consequences, but it is the provider who must ALWAYS act under the premise of - "first do no harm". Can we in our heart of hearts believe that KC acted in such a manner? Why did she not return the client's fee until yesterday's court proceeding? These kinds of questions linger in my mind. This is not about MIDWIVES and MIDWIFERY CARE on the whole. This is about one generally good provider who made a poor decision and a bad call at the expense of her client and now someone is dead.

What a bizarre thing to say. Do you honestly think it made a difference to those parents to get their money back? I think it would have been very strange and unwelcome if Karen Carr had called these people up and assured them they would get a full refund for services rendered. I can't imagine that it would have occurred to any of the people involved in the case until the court ordered it.

[Anonymous]

Anonymous wrote:

Actually if a baby in the breech position gets stuck on the way out the safest thing for the doctor to do is to gently push the baby back into the womb and perform an emergency c-section. Trying to work it free could result in a neck injury, nerve damage or death. A stuck breech baby means the head is stuck because the pelvis is too narrow but the rest of the baby has already been delivered. Not much option here because it's skull bone against pelvic bone. There just aren't techniques to work the baby free in this situation. Basically the head fits or it doesn't. If the baby is in the correct birthing position and the head doesn't fit through the pelvis the mom just doesn't progress through labor and will ultimately need a c-section but it's not the same life or death extreme situation.

quote]

The more I learn, the worse I feel toward home birthing. If this is true (see how I don’t just assume that it is), then indeed a vaginal birth in a hospital would have been safer than at home. I don’t know many mothers who can be told “your baby is stuck and is dying. If we don’t push it back in and perform a c-section, your baby will probably die” and still persist with a vaginal delivery despite knowing they indeed tried their best. Karen Carr could not push the baby back in b/c she could not them follow up with a c-section. So there you have it – there WAS a solution a hospital could have provided. Perhaps having called 911 the second things were looking bad would have allowed her to push the baby back in so it could get oxygen and the hospital could have prepped for the emergency c-section during the transfer and things MIGHT have been different (I won’t pretend to know – I do not). But to say that a hospital setting for a vaginal delivery wouldn’t have been any different is WRONG, and to say that the call to do a c-section in the first place wasn’t necessary is also WRONG. So many people here didn’t want to hear what they didn’t want to hear. Ultimately, Karen Carr should have known better and was PAID AND TRAINED TO. I sympathize with the parents and their loss, along with the traumas that apparently lead to their decisions. Parents aren’t the experts. Carr supposedly was. So were her peers, so were the OBs. What the hell made her think she was better than all of them in this high-risk situation (and YES, HIGH RISK!!!!)?! I'd like to be able to say "well, hindsight is 20/20", but there's a reason only Carr was willing to take this on: NO ONE ELSE WAS NUTS ENOUGH TO. Sometimes you just have to forget weighing natural birth against c-section, and start weighing the risks of an EMERGENCY c-section against a planned one.

[Anonymous]

"Obviously this mom wanted her hb and come hell or high water she was going to have it. That is certainly her choice and now she must live with the consequences, but it is the provider who must ALWAYS act under the premise of - "first do no harm". Can we in our heart of hearts believe that KC acted in such a manner? Why did she not return the client's fee until yesterday's court proceeding? These kinds of questions linger in my mind. This is not about MIDWIVES and MIDWIFERY CARE on the whole. This is about one generally good provider who made a poor decision and a bad call at the expense of her client and now someone is dead.



What a bizarre thing to say. Do you honestly think it made a difference to those parents to get their money back? I think it would have been very strange and unwelcome if Karen Carr had called these people up and assured them they would get a full refund for services rendered. I can't imagine that it would have occurred to any of the people involved in the case until the court ordered it. "

Most hb midwives ask clients to pay the fee upfront and the client can submit after the delivery for insurance reimbursement. This is not true in all cases, but in many. Or the insurance will only cover a part of the hb fee and the parents end up paying the rest out of pocket. So this isn't like a normal OB service - she had their money in hand and being the "beloved" midwife she is, don't you think she would have called this couple to talk things over after all was said and done? I would have. OBs wouldn't, but I envision my nice, kind hb midwife would.

[Anonymous]

This thread is hardly even a discussion anymore. Back and forth anonymously - no one knows who's responding to what anymore, people messing up the quote tags, etc.

It seems like there are several things going on here:

1. Discussion of the Karen Carr case - its specifics, the judgment of the parents, the judgment of the midwife, the actual court proceeding
2. Discussion of the issues underlying the Karen Carr case - CPM licensing and certification, breech vaginal delivery, home birth vs. hospital birth, midwives vs. OBs
3. People expressing their values and making judgments on other people's values - by which I mean, for example, that I personally had a midwife assisted birth center birth, plan for a home birth next time, will not be hiring a CPM and think that if a pregnancy is high risk, it becomes "a medical issue" and should be dealt with in a medical institution and not a living room.

All these personal attacks on other people's values are really childish and unnecessary.

[Anonymous]

Anonymous wrote:This thread is hardly even a discussion anymore. Back and forth anonymously - no one knows who's responding to what anymore, people messing up the quote tags, etc.

It seems like there are several things going on here:

1. Discussion of the Karen Carr case - its specifics, the judgment of the parents, the judgment of the midwife, the actual court proceeding
2. Discussion of the issues underlying the Karen Carr case - CPM licensing and certification, breech vaginal delivery, home birth vs. hospital birth, midwives vs. OBs
3. People expressing their values and making judgments on other people's values - by which I mean, for example, that I personally had a midwife assisted birth center birth, plan for a home birth next time, will not be hiring a CPM and think that if a pregnancy is high risk, it becomes "a medical issue" and should be dealt with in a medical institution and not a living room.

All these personal attacks on other people's values are really childish and unnecessary.

They’re only “personal” attacks if you deem them that way. I don’t take it personally that people assume I’ve fallen for the evils of hospitals/OBs/medical field’s propaganda for choosing to not home birth considering my risks even though it’s absolutely false – why should those who imply this take it personally that I disagree with them? As for the intertwined issues, well, they’re all intertwined so of course people will discuss them. There are many women absorbing all this, and I’d personally rather they see a messy multifaceted discussion than a one-sided one on either end.

[Anonymous]

Anonymous wrote:"Obviously this mom wanted her hb and come hell or high water she was going to have it. That is certainly her choice and now she must live with the consequences, but it is the provider who must ALWAYS act under the premise of - "first do no harm". Can we in our heart of hearts believe that KC acted in such a manner? Why did she not return the client's fee until yesterday's court proceeding? These kinds of questions linger in my mind. This is not about MIDWIVES and MIDWIFERY CARE on the whole. This is about one generally good provider who made a poor decision and a bad call at the expense of her client and now someone is dead.



What a bizarre thing to say. Do you honestly think it made a difference to those parents to get their money back? I think it would have been very strange and unwelcome if Karen Carr had called these people up and assured them they would get a full refund for services rendered. I can't imagine that it would have occurred to any of the people involved in the case until the court ordered it. "

Most hb midwives ask clients to pay the fee upfront and the client can submit after the delivery for insurance reimbursement. This is not true in all cases, but in many. Or the insurance will only cover a part of the hb fee and the parents end up paying the rest out of pocket. So this isn't like a normal OB service - she had their money in hand and being the "beloved" midwife she is, don't you think she would have called this couple to talk things over after all was said and done? I would have. OBs wouldn't, but I envision my nice, kind hb midwife would.

I didn't mean that she shouldn't have called them and talked to them about what happened. I meant that it would be weird to call and say "Hey, do you guys want your money back?"

[Anonymous]

Anonymous wrote:

Anonymous wrote:This thread is hardly even a discussion anymore. Back and forth anonymously - no one knows who's responding to what anymore, people messing up the quote tags, etc.

It seems like there are several things going on here:

1. Discussion of the Karen Carr case - its specifics, the judgment of the parents, the judgment of the midwife, the actual court proceeding
2. Discussion of the issues underlying the Karen Carr case - CPM licensing and certification, breech vaginal delivery, home birth vs. hospital birth, midwives vs. OBs
3. People expressing their values and making judgments on other people's values - by which I mean, for example, that I personally had a midwife assisted birth center birth, plan for a home birth next time, will not be hiring a CPM and think that if a pregnancy is high risk, it becomes "a medical issue" and should be dealt with in a medical institution and not a living room.

All these personal attacks on other people's values are really childish and unnecessary.

They’re only “personal” attacks if you deem them that way. I don’t take it personally that people assume I’ve fallen for the evils of hospitals/OBs/medical field’s propaganda for choosing to not home birth considering my risks even though it’s absolutely false – why should those who imply this take it personally that I disagree with them? As for the intertwined issues, well, they’re all intertwined so of course people will discuss them. There are many women absorbing all this, and I’d personally rather they see a messy multifaceted discussion than a one-sided one on either end.

I think it's possible to have a messy multifaceted discussion of issues without calling someone else's choices crazy or saying that the midwife should be publicly humiliated and rot in jail. I think it's possible to discuss people's fears of hospitals AND home births without calling the people on either side of the debate crazy or malicious or irresponsible or any of the other things that have been thrown around in this thread. I think it's also possible to have a debate without assuming that the other side has been taken in by propaganda.

I'm a reasonable person and I'm interested in this issue for a lot of reasons. You sound like you could say exactly the same thing, so clearly we're not the people I'm talking about, but they exist on both sides, as you can tell by the 90+ pages that this monster has grown into.

[Anonymous]

"Yes, yes YES!!!! So many people, doctors included, forget this. Whatever happened to the land of the free. Drives me crazy that people are free to intentionally kill their baby in utero yet Mamas are denied the right to choose the type of birth that is best for them and their baby."

We are free to terminate a pregnancy. Should we opt to carry a pregnancy to term we have obligations to provide reasonable care for our children. Denying your child life saving medical intervention is, for example, illegal. I think choosing a home birth under the circumstances that existed in this case is akin to denying life saving care to your child.

[Anonymous]

Anonymous wrote:
"Yes, yes YES!!!! So many people, doctors included, forget this. Whatever happened to the land of the free. Drives me crazy that people are free to intentionally kill their baby in utero yet Mamas are denied the right to choose the type of birth that is best for them and their baby."

We are free to terminate a pregnancy. Should we opt to carry a pregnancy to term we have obligations to provide reasonable care for our children. Denying your child life saving medical intervention is, for example, illegal. I think choosing a home birth under the circumstances that existed in this case is akin to denying life saving care to your child.

Well, if you could prove that choosing a cesarean for breech would leave the mother and baby perfectly healthy, then I would be close to agreeing with you. It gets messy though when you look at the research and find that 1) vaginal breech birth is only marginally more risky than vaginal vertex birth, and that 2) cesarean birth introduces an entirely new set of risks. This is why it is best to leave birthing decisions up to the parents, and why it is good to have providers who have skills in a variety of birthing situations.

Also, to follow up on the "can't we all just get along post", I want to say that even though I support breech homebirth, I also fully support a woman's right to choose a 100% elective cesarean. I'm simply not interested in the law, or medical professionals, dictating what "should" be done to her. Every woman has a unique belief system and history. It is the height of arrogance for anyone to think that they know better than her whether or not she should have surgery to birth her baby. Of course, now that we all know what happened, it is very easy to sit around and Monday-morning quarterback the case.

[Anonymous]

Anonymous wrote:Well, if you could prove that choosing a cesarean for breech would leave the mother and baby perfectly healthy, then I would be close to agreeing with you. It gets messy though when you look at the research and find that 1) vaginal breech birth is only marginally more risky than vaginal vertex birth, and that 2) cesarean birth introduces an entirely new set of risks. This is why it is best to leave birthing decisions up to the parents, and why it is good to have providers who have skills in a variety of birthing situations.

Also, to follow up on the "can't we all just get along post", I want to say that even though I support breech homebirth, I also fully support a woman's right to choose a 100% elective cesarean. I'm simply not interested in the law, or medical professionals, dictating what "should" be done to her. Every woman has a unique belief system and history. It is the height of arrogance for anyone to think that they know better than her whether or not she should have surgery to birth her baby. Of course, now that we all know what happened, it is very easy to sit around and Monday-morning quarterback the case.

You might be my new (or not new? who knows anymore?) person on this thread. I completely agree.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Well, if you could prove that choosing a cesarean for breech would leave the mother and baby perfectly healthy, then I would be close to agreeing with you. It gets messy though when you look at the research and find that 1) vaginal breech birth is only marginally more risky than vaginal vertex birth, and that 2) cesarean birth introduces an entirely new set of risks. This is why it is best to leave birthing decisions up to the parents, and why it is good to have providers who have skills in a variety of birthing situations.

Also, to follow up on the "can't we all just get along post", I want to say that even though I support breech homebirth, I also fully support a woman's right to choose a 100% elective cesarean. I'm simply not interested in the law, or medical professionals, dictating what "should" be done to her. Every woman has a unique belief system and history. It is the height of arrogance for anyone to think that they know better than her whether or not she should have surgery to birth her baby. Of course, now that we all know what happened, it is very easy to sit around and Monday-morning quarterback the case.

You might be my new (or not new? who knows anymore?) person on this thread. I completely agree.

Me too but as far as I am concerned, there are several highly intelligent, reasonable people participating in this thread and that's why it has held my interest from the beginning. I do get bored when we have to go through several pages of finger pointing but the reasonable comments keep pulling me back.