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

[Anonymous]

Anonymous wrote:

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.

ME TOO.

We are getting ready to start TTC baby #2 and so I am thinking about all these issues all over again - finding a new practitioner, assessing that person's qualifications, etc. It was interesting the first time around, but like the rest of pregnancy and birth, I think can do better the second time.

[Anonymous]

You are letting your rage get the better of you, or perhaps you don't really know much about birth. 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.

I'm not the poster you are responding to, but YOU are letting your lack of surgical knowledge (you are obviously NOT an OB) getting the better of you!
The OR 3 doors down WILL be able to do the best to save the baby, and you can do a Duehrssen incision into the cervix and get the baby out. You can also try a maneuver to push the baby back in, and go surgically into the uterus. Bottom line: there are a few different options, none of them doable by a midwife at home.

And let's be clear: a speedy 911 call is always appropriate! The paramedics can assist with the resuscitation and have meds and medical control backup, not to mention oxygen (I assume she had that, but after what we've heard so far, who knows?) - it's the right thing to do, and there is no downside to it!!!
... Unless of course, you have an ego the size of Alaska - or you are hiding something, because you are committing a crime?!

[Anonymous]

I think it is easier for those with babies who were born healthy to consider a breech homebirth a good choice for mothers. Those like me whose children would have died had they not been born in a hospital (and I was not considered high risk) just cannot help ourselves but to wonder. Seeing my child struggle to live has changed a lot for me. I don't know how I could have lived with myself if my child had died due to a decision I made solely for myself.

[Anonymous]

Anonymous wrote:

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.

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!

Moreover, the arrogance of Ms. Carr for thinking with certainty that she could actually handle a breech vaginal delivery complication disgusts me. This woman took a gamble that the birth would be complication free. She gambled with a life. Every vaginal breech home birth is a gamble....if the head fits you win a healthy baby and if the head doesn't fit, sorry you get a dead one.

[Anonymous]

Anonymous wrote:

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!




Vaginal breech is not an option in DC/MD/VA. Tchabo is the only one, and he is retiring. This is the issue. This is utterly disgusting and it is a shame. Let's get mad at the OB/GYNs who won't/can't learn the skills to manage vaginal breech. This mother had no choice when it came to vaginal/c-section in the hospital.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!

Vaginal breech is not an option in DC/MD/VA. Tchabo is the only one, and he is retiring. This is the issue. This is utterly disgusting and it is a shame. Let's get mad at the OB/GYNs who won't/can't learn the skills to manage vaginal breech. This mother had no choice when it came to vaginal/c-section in the hospital.

I'm sorry but a rational person would come to terms with the fact that the vaginal delivery they wanted isn't possible then. How is it a better decision to do it at home?

[Anonymous]

Anonymous wrote:I don't know the first thing about Karen Carr and I am unqualified to argue any of the particulars in this case. But I worry that this sad story will harm the perception of home births and midwives in general, CNMs included. I went to visit my very sick FIL in the hospital last week, a retired OB/Gyn, who was feeling nostalgic about his life. He talked and talked about the hundreds of babies he helped deliver in Germany during his residency and here is what he had to say, to paraphrase:
"It was the midwives who taught me the most. These women were so knowledgeable. Most doctors don't know how to deliver babies. Their training teaches them to do too much. Too much manipulating and cutting and pulling. Most of the time birth is a process that will happen without any help from the doctor but doctors are trained to try to try to force things. The midwives knew how to watch and wait. They taught me everything. It was a beautiful thing to watch. This was a long time ago but I see it getting worse all the time with all the c-sections."
Just want to point out, after his residency, the remainder of his career was practiced in the US.

Then maybe you'll be interested to know that the road to becoming a midwife in Germany is over 3 years long structured formal theoretical and practical education AFTER you have already been a nurse or equivalent, including, as far as I know, more than 1600 hours of theoretical and over 3000 hours of practical training, that is including working in newborn nurseries, delivery rooms, ORs, peds floors... and is finished by passing a FEDERAL exam that includes written, practical and oral parts. Only then may you carry the credential of a midwife and practice.

Quite different from the high school drop out apprenticeship after which you get a certificate from your peers without any oversight or regluations if you ask me....

[Anonymous]

Anonymous wrote:

Anonymous wrote:

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!

Vaginal breech is not an option in DC/MD/VA. Tchabo is the only one, and he is retiring. This is the issue. This is utterly disgusting and it is a shame. Let's get mad at the OB/GYNs who won't/can't learn the skills to manage vaginal breech. This mother had no choice when it came to vaginal/c-section in the hospital.

I'm actually going to get mad at you for not going to medical school and specializing in obstetrics and learning to manage vaginal breech. I think it's pretty entitled of you to be mad at someone or an establishment even for not learning or teaching skills that have become obsolete for the very reason that it's been proven safer to deliver by c-section. The medical community practices evidence based medicine and the evidence is in favor of cesarean in this case. It's silly to have young doctors waste their time learning an obsolete skill.

Furthermore, there is only so much managing that can be done with vaginal breech. If the head doesn't fit it doesn't fit....period. You can't maneuver a skull bone like you can a shoulder. You don't have the option of breaking the skull like you would a shoulder if all else fails. If the head doesn't fit you either deliver by c-section or the baby dies.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!

Vaginal breech is not an option in DC/MD/VA. Tchabo is the only one, and he is retiring. This is the issue. This is utterly disgusting and it is a shame. Let's get mad at the OB/GYNs who won't/can't learn the skills to manage vaginal breech. This mother had no choice when it came to vaginal/c-section in the hospital.

I'm sorry but a rational person would come to terms with the fact that the vaginal delivery they wanted isn't possible then. How is it a better decision to do it at home?



Stupid quoting!

I'm actually going to get mad at you for not going to medical school and specializing in obstetrics and learning to manage vaginal breech. I think it's pretty entitled of you to be mad at someone or an establishment even for not learning or teaching skills that have become obsolete for the very reason that it's been proven safer to deliver by c-section. The medical community practices evidence based medicine and the evidence is in favor of cesarean in this case. It's silly to have young doctors waste their time learning an obsolete skill.

Furthermore, there is only so much managing that can be done with vaginal breech. If the head doesn't fit it doesn't fit....period. You can't maneuver a skull bone like you can a shoulder. You don't have the option of breaking the skull like you would a shoulder if all else fails. If the head doesn't fit you either deliver by c-section or the baby dies.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!

Vaginal breech is not an option in DC/MD/VA. Tchabo is the only one, and he is retiring. This is the issue. This is utterly disgusting and it is a shame. Let's get mad at the OB/GYNs who won't/can't learn the skills to manage vaginal breech. This mother had no choice when it came to vaginal/c-section in the hospital.

I'm sorry but a rational person would come to terms with the fact that the vaginal delivery they wanted isn't possible then. How is it a better decision to do it at home?

Stupid quoting!

I'm actually going to get mad at you for not going to medical school and specializing in obstetrics and learning to manage vaginal breech. I think it's pretty entitled of you to be mad at someone or an establishment even for not learning or teaching skills that have become obsolete for the very reason that it's been proven safer to deliver by c-section. The medical community practices evidence based medicine and the evidence is in favor of cesarean in this case. It's silly to have young doctors waste their time learning an obsolete skill.

Furthermore, there is only so much managing that can be done with vaginal breech. If the head doesn't fit it doesn't fit....period. You can't maneuver a skull bone like you can a shoulder. You don't have the option of breaking the skull like you would a shoulder if all else fails. If the head doesn't fit you either deliver by c-section or the baby dies.

LOLOLOLOLOLOLOL! What? If there's one thing about evidence-based medicine, is that it is being completely ignored in obstetrics. Let's start with the lithotomy position for pushing, immediate cord clamping, use of cytotec, cord traction, and induction of first-time mothers on low bishop's scores. The evidence is overwhelming against these practices. LOL!
Also the study showing that vaginal breech is only slightly more risky than vertex has been cited here a bunch of times, as well as the canadian equivalent of ACOG speaking out against automatic c-section for breech.
http://www.sogc.org/media/advisories-20090617a_e.asp

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!

Vaginal breech is not an option in DC/MD/VA. Tchabo is the only one, and he is retiring. This is the issue. This is utterly disgusting and it is a shame. Let's get mad at the OB/GYNs who won't/can't learn the skills to manage vaginal breech. This mother had no choice when it came to vaginal/c-section in the hospital.

I'm sorry but a rational person would come to terms with the fact that the vaginal delivery they wanted isn't possible then. How is it a better decision to do it at home?

Stupid quoting!

I'm actually going to get mad at you for not going to medical school and specializing in obstetrics and learning to manage vaginal breech. I think it's pretty entitled of you to be mad at someone or an establishment even for not learning or teaching skills that have become obsolete for the very reason that it's been proven safer to deliver by c-section. The medical community practices evidence based medicine and the evidence is in favor of cesarean in this case. It's silly to have young doctors waste their time learning an obsolete skill.

Furthermore, there is only so much managing that can be done with vaginal breech. If the head doesn't fit it doesn't fit....period. You can't maneuver a skull bone like you can a shoulder. You don't have the option of breaking the skull like you would a shoulder if all else fails. If the head doesn't fit you either deliver by c-section or the baby dies.

LOLOLOLOLOLOLOL! What? If there's one thing about evidence-based medicine, is that it is being completely ignored in obstetrics. Let's start with the lithotomy position for pushing, immediate cord clamping, use of cytotec, cord traction, and induction of first-time mothers on low bishop's scores. The evidence is overwhelming against these practices. LOL!
Also the study showing that vaginal breech is only slightly more risky than vertex has been cited here a bunch of times, as well as the canadian equivalent of ACOG speaking out against automatic c-section for breech.
http://www.sogc.org/media/advisories-20090617a_e.asp

[Anonymous]

Anonymous wrote:

Anonymous wrote:

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!

Vaginal breech is not an option in DC/MD/VA. Tchabo is the only one, and he is retiring. This is the issue. This is utterly disgusting and it is a shame. Let's get mad at the OB/GYNs who won't/can't learn the skills to manage vaginal breech. This mother had no choice when it came to vaginal/c-section in the hospital.

That's BS for this case. It may be terrible that so few OBs are willing to attempt vaginal birth in the hospitals, but no midwife except Carr wanted to do it either. She had more complex issues than just being breeched. Saying it's just a matter of breeched or not is oversimplifying the issue.

[Anonymous]

Also relevant:

http://www.sogc.org/media/pdf/advisories/KotaskaCommentBreechJune09_e.pdf

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I have no problem with a mother attempting a vaginal breech delivery so long as it's in a freaking hospital where her baby's life can be saved if his head gets stuck or the cord compresses. That is the issue here. The mother wasn't negligent for attempting a vaginal breech delivery. She was negligent for doing so in her house!

Vaginal breech is not an option in DC/MD/VA. Tchabo is the only one, and he is retiring. This is the issue. This is utterly disgusting and it is a shame. Let's get mad at the OB/GYNs who won't/can't learn the skills to manage vaginal breech. This mother had no choice when it came to vaginal/c-section in the hospital.

That's BS for this case. It may be terrible that so few OBs are willing to attempt vaginal birth in the hospitals, but no midwife except Carr wanted to do it either. She had more complex issues than just being breeched. Saying it's just a matter of breeched or not is oversimplifying the issue.

What were the issues exactly?

[Anonymous]

I will never say that the medical community doesn’t have its faults and that women’s issues, including childbirth, aren’t often mishandled or evolved in the wrong direction. However, I think it’s even more arrogant for the USA midwife community to reject everything about it without having mastered it first. If an experienced OB starts rejecting the standard approaches in favor of midwifery ones, they know what they’re rejecting. When lesser trained and educated midwifery rejects things that (I’m sorry) they simply may not understand fully for lack of scientific training, it’s irresponsible. OBs are not brainwashed sheep. There are good and bad ones just like midwives. And to say midwives are better accepted elsewhere is only partially true – they’re also better trained medically there too. So I’m sorry – reading this thread for 2 weeks has only convinced me more and more that midwifery in the USA is far too unaware (and practically PROUD) of its limitations to practice responsibly when shit hits the fan.