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

[Anonymous]

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.

You frankly have no right or reason to get mad at the OB/Gyns who DO learn these skills as much as possible and available during their training.

You may want to get mad at the legal system in our country, that has malpractice lawyers salivating at a chance for a multimillion dollar lawsuit.
(Would "Carr, MD" -all other circumstances the same- have gotten off with a $5000 fine, while happily continuing her practice - yeah right!!! NEVER.)

Maybe you'd like to take a look at US history of when the laws changed and promoted the current culture, in correlation to the amount and numbers of vaginal breech deliveries in hospitals. Also something developed over this time called the STANDARD OF CARE, of what 'most reasonable professionals would do if faced with the same situation', something doctors must adhere to, driven by research and also by the findings of past court rulings, and as an OB if you deviate from the standard of care, you are on your own, basically practicing outside the realm of what you are supposed to do (however, according to the result of this case; apparently CPMs are exempt from the standard of care with impunity)

So this is NOT a 'won't/can't' situation, not at all, rather a 'mustn't' situation! It's not in the power of any OB/Gyn to change this fact, this culture, or this environment, or our laws. The public, the citizens, our political leaders (hmmm, almost all lawyers...) could change this, but I have little hope they will.

[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.

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?

First-time birth. Advanced age. The type of breech. Read upthread. There were REASONS why even the midwives of the area didn't want the case. I'm very stunned by those who are so pro-midwife here seem to ignore the fact that their own community judged this as too risky for a home-birth assisted only by a midwife. Why trust the judgement of Carr over her entire community all of a sudden? Makes no sense.

[Anonymous]

Anonymous wrote:

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....

Yes, but my FIL was talking about lay midwives. He is 79 years old and this was during his residency. He has always been incredibly respectful of and grateful for the knowledge these women passed on to him.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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....

Yes, but my FIL was talking about lay midwives. He is 79 years old and this was during his residency. He has always been incredibly respectful of and grateful for the knowledge these women passed on to him.

I believe you what your FIL said (and I'm sad to hear he is sick), but there ARE NO "lay" midwives in Germany, please believe me, not for 70 something years.... There is not even a term for this in German. I believe this may have been a misunderstanding or a lost-in-translation thing...
I do hope your FIL will be better soon, he sounds like a kind man who is passionate about his profession!

[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?





this is the most inane comment yet.

Then freaking GOT TO MEDICAL school yourself!!!!!!!!!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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....

Yes, but my FIL was talking about lay midwives. He is 79 years old and this was during his residency. He has always been incredibly respectful of and grateful for the knowledge these women passed on to him.

I believe you what your FIL said (and I'm sad to hear he is sick), but there ARE NO "lay" midwives in Germany, please believe me, not for 70 something years.... There is not even a term for this in German. I believe this may have been a misunderstanding or a lost-in-translation thing...
I do hope your FIL will be better soon, he sounds like a kind man who is passionate about his profession!

It could have been a misunderstanding. I will ask him to clarify because I am interested in the subject. Either way, the point was that he feels that the training of OB/Gyns leads to a very different approach than that of midwives. His statement had nothing to do with this case but I thought it was relevant to the discussion. And thank you, he is a very good man and he seems to be feeling a bit better today

[Anonymous]

Anonymous wrote:

What were the issues exactly?

First-time birth. Advanced age. The type of breech. Read upthread. There were REASONS why even the midwives of the area didn't want the case. I'm very stunned by those who are so pro-midwife here seem to ignore the fact that their own community judged this as too risky for a home-birth assisted only by a midwife. Why trust the judgement of Carr over her entire community all of a sudden? Makes no sense.

This has confused me the whole thread. Ever since it was revealed that the mother was 43, everyone has thrown that in as a risk factor that made vaginal breech birth/home birth unsafe for this mother. I don't understand why her age has anything to do with the outcome in the birth, or why it would affect whether a midwife would want to take her on as a client in this or any situation. My understanding is that advanced maternal age is correlated with a higher incidence of true risk factors and slightly higher incidences of certain adverse outcomes: birth defects, stillbirths, PIH, gestational diabetes, preeclampsia, and so forth -- most of which are/can be screened for by both midwives and doctors. But standing alone, I don't see why her age was a risk factor, or how it had anything to do with head entrapment of a breech baby. The fact that she was a primip, yes, absolutely influenced the risk of head entrapment, but why her age? Personally, I just thought her age made the story more poignant, as she will likely not have another opportunity to become a biological mother, at least with her own eggs.

[Anonymous]

People are making huge assumptions about the "type of breech". I would like even one link to a reliable source where the type of breech presentation is stated. One poster even said something along the lines of "when the baby turned footling" where there is NO EVIDENCE that it ever occurred.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Personally, I just thought her age made the story more poignant, as she will likely not have another opportunity to become a biological mother, at least with her own eggs.

Exactly. That's why I can't imagine why this woman --- who probably struggled to get pregnant --- was so arrogant that she risked everything for a midwife/home birth. This is so incredibly sad for everyone involved, but I hope women read this and think twice about second guessing their doctors. Quite frankly, I am always shocked by the women who seem to think they know better than their doctor. And I am totally perplexed by pregnant women who take such risks. I have 3 kids, and I worried about my pregnancies and deliveries until I held my baby safely in my arms. Just because you read about someone on the Internet having a successful vaginal breech delivery (or fill in the blank with someone overcoming the odds) somewhere doesn't mean it's a risk worth taking --- particularly when you are talking about your health and the health of your child. I don't see how any woman can defend anything about what happened in this sad situation; you can't defend the actions of the mother who was fully aware of the risk she was taking, and you can't defend the actions of the midwife who was equally aware. Reckless arrogance resulting in tragic consequences.

[Anonymous]

All that should really matter is a healthy newborn!!!!!!!

[Anonymous]

Anonymous wrote:

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?!

AND......here we go again folks with the name calling, assumptions, and utter lack of comprehension of an alternate viewpoint - despite 90 pages of some very thoughtful and rational posts countering these exact points.

[Anonymous]

Not calling 911 'because it wouldn't have made a difference' is an alternate viewpoint?

... well, I guess you could call it that.

Quite alternate, like in alternate universe.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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?!

AND......here we go again folks with the name calling, assumptions, and utter lack of comprehension of an alternate viewpoint - despite 90 pages of some very thoughtful and rational posts countering these exact points.

I know. There's another thread that formed in the Off-Topic forum for the people who want to judge, blame, insult, and declare their own superiority. I wish they would just stay over there and leave this discussion alone.

[Anonymous]

Shouldn't we judge and blame? Shouldn't we try to get other pregnant women in this forum to think twice before recklessly ignoring their doctor and taking needless risks?

[Anonymous]

I have read this thread for 95 pages.

The only name calling I will do is that if you hire Karen Carr as your midwife you are a freaking IDIOT.

That is all.