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

[Anonymous]

I also think this is a healthy debate and have learned quite a lot in these 98 pages. I do hope that those of you who are currently pregnant and possibly considering your birth options will not let this thread or any thread be the end of your research. I was very anti-home birth (I just thought the idea sounded CRAZY and must be for hippies) at the beginning of my pregnancy. But I knew I wanted to attempt a natural childbirth and found that the midwives I was working with for my hospital delivery were really not receptive or supportive of my preferences. As the PP stated, most of their patients wanted epidurals and they poo-pooed me as a FTM wanting to go "all natural."

I ended up interviewing 3 HB midwives and decided that HB was the safest and best option for me and my baby. I strongly encourage anyone who thinks they may be even slightly interested in a home birth to interview a few homebirth midwives before making your decision.

You can use this website to find a directory of HB midwives in this area:

http://www.birthoptionsalliance.org/

[Anonymous]

What I don’t understand is the adamant defense with the realm of this very case of how a “low-risk breech” home-birth is reasonable and normally as safe as in the hospital, when the case itself proves how quickly things get complicated and death can ensue. Isn’t that a case FOR hospital births, even when things seem ok? People are also adamant on Carr’s competence, so doesn’t this tragic case make the argument – in that scenario - that even with the best home-care things can go terribly wrong? If the only reason to avoid hospitals is the worry that their practices bring on additional risks through medication and procedures, what’s so difficult about having a natural birth IN the hospital? I did. It wasn’t met with any resistance except some smirking and “we’ll see how you feel in the midst of it”. Didn’t seem like much to take when the payoff was a natural birth in the safest context of immediate care if something went wrong with either of us. It wasn’t like being at home, but I healthily walked back INTO my home with a healthy baby. Of course bad things happen in hospitals too, but seems like everything home-birthers are saying about it here is totally avoidable there with communication, whereas communication won’t provide the staff, expertise, and equipment your baby might urgently need at home.

[Anonymous]

I think what the previous poster was referring to was not the midwives who have backup hospital OB's available to accept transfers as needed, but the unlicensed midwives who drive up to the hospital and yes, DUMP, their patients. Yes, it is a terrible term, but it is what it is.


Yes, this is true and this behavior makes it harder for licensed midwives who do work in hospitals and are trying to create positive change from within. (It also adversely effects those legal homebirth midwives who also need to transfer). You don't have groups of renegade doctors out there (some with questionable education levels and skill) dumping patients at the door of the ER when things go awry - why would you expect the medical community to condone this behavior?

I do believe CPMs should be legal, credentialed and face monitoring the same way other health professions do, but until they are legal in places like MD and DC, the ole drive by and dump will not cease from existing.

Any woman who hires an illegal provider must be aware that this will happen (she will be dumped) and that if she does need to go to a hospital and adequate prenatal records cannot be found, she and her infant are likely to face many more interventions (i.e. labs, diagnostic tests, sepsis workup for a neonate that could be GBS positive etc,) in the event the hospital does not have this info. If you do see an unlicensed provider do a check and find out what kind of records s/he keeps. I would want a full prenatal history recorded somewhere (and a copy in-hand) in the event I needed to transfer (especially since we know these midwives spend more time during PNC...they should also be documenting fully what is done/discussed during each visit).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
"I agree...both sides DO need to work together. However, let's be honest....the VAST majority of the blame lies within the "medical" side of the equation. OBs and medical lobbying groups have spent a LOT of time and money fighting against DEM/midwifery. Yes, there are "some OBs who see the value of DEMs/midwifery."

The only reason I think an OB should work with a DEM is in the best interests of assuring the care and well-being of the laboring woman the DEM is dumping on them.

There is a reason why many OBs don't necessarily see the "professional" value of DEMs, and that is because, quite frankly, their credentials don't rate it.

Dumping? Really?! It's attitudes like this that create fear in the heart of Mamas when facing a transfer. It is a GOOD thing when a MW recognizes when a situation is out of the scope of her practice. Honestly, facing the hostility so often focused on MWs at a hospital is not an easy thing for a MW to do. I was astounded at what my MW had to deal with when transferring my care due to PTL. Honestly, it just served as further confirmation to me that (some) OBs need a serious attitude adjustment.

FTR...I do not think that breech birth was outside the scope of KC's practice/ability considering her experience.

Am I the only one who find's the use here of the term "Mama", incredibly condescending?

I think what the previous poster was referring to was not the midwives who have backup hospital OB's available to accept transfers as needed, but the unlicensed midwives who drive up to the hospital and yes, DUMP, their patients. Yes, it is a terrible term, but it is what it is.

Huh? Condescending? Mama is a term of absolute respect. I assure you, as the author of that post, that is the full intention behind the use of that word.

While there have been cases of "dumping" (not every DEM is a good one such as is the case with OBs), the vast majority do not practice this way. Of all the ones I know of in NoVa...none of them dump a Mama at the hospital. Further...there is always an OB available to accept transfers as needed. The catch point, however, is the attitude a Mama and MW are faced with when arriving at the hospital.

[Anonymous]

"...what’s so difficult about having a natural birth IN the hospital?"

At least in my experience, there were lots of hospital policies that were out of line with "natural birth" (and not evidence-based) like barring food and drink during labor, continuous monitoring (makes it hard to move around as needed during natural birth) immediate cord clamping, taking all the babies away to a "nursery" to see if they could maintain their temperature (crazy old-school!!) immediately after birth etc. Of course, none of these things would make me stay at home if I thought my baby's life was at risk, but please acknowledge that a lot of what goes on in a hospital is not in line with "natural childbirth." Many of these types of policies are what inspire people to pursue out-of-hospital births. Not referring to the mom in this case because her reasons were different (according to posts a few pages back) - but true for many other moms.

[Anonymous]

Anonymous wrote:"...what’s so difficult about having a natural birth IN the hospital?"

At least in my experience, there were lots of hospital policies that were out of line with "natural birth" (and not evidence-based) like barring food and drink during labor, continuous monitoring (makes it hard to move around as needed during natural birth) immediate cord clamping, taking all the babies away to a "nursery" to see if they could maintain their temperature (crazy old-school!!) immediately after birth etc. Of course, none of these things would make me stay at home if I thought my baby's life was at risk, but please acknowledge that a lot of what goes on in a hospital is not in line with "natural childbirth." Many of these types of policies are what inspire people to pursue out-of-hospital births. Not referring to the mom in this case because her reasons were different (according to posts a few pages back) - but true for many other moms.

PP here: I will acknowledge it's met with SOME resistence but it's nothing that takes more work to get your way than the work put into readying for your home birth. Pressure and criticism there is no worse than what home-birthers seem proud to take on about their home-birthing stance in blogs or real life. If I do it in a hospital, at least I know that i'm in a place that will take care of my child AND me and exhaust every option before calling it over. At least in that setting, i have the OPTION to being flexible about what I originally wanted v. what I suddenly might need.

All that said, I must reiterate how defending vaginal breech home-births and Karen Carr in this case ironically DISCREDITS home-births' safety when it comes to fast-progressing and deadly unforeseen issues. This was safe? Someone still ended up dead. She was great? Someone still ended up dead. Nothing this home birth provided the mother couldn't have been done at the hospital first before resorting to more invasive medical techniques. And yes, hospitals would have pressured heavily for a c-section, even bullied. But until she signed, they could not have done it. And the argument can't then morph into "she didn't want hospitals no matter what" b/c then you're essentially saying Carr only told her what she wanted to hear, making her incompetent, and you're also saying that OBs were right about needing the c-section in the first place, killing the "safe vaginal breech at home" argument. There just doesn't seem to be a way to look at this that is favorable to home births. I'm sorry.

[Anonymous]

PP here as well. I'm not defending the mom's decision in this case or Karen Carr AT ALL nor saying that breach home births are safe. I personally would not have made the choice to attempt breech home birth. I am just stating the other factors that drive moms to pursue home birth. Many of these things I mentioned are not negotiable in the hospital - they are hospital policy and there's no fighting it. Natural birth means more than just forgoing epidural (absolutely up to the mom) to many people.

I also considered myself as being flexible with my birth and was ready to transfer to a hospital at any point that the situation necessitated a transfer.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"...what’s so difficult about having a natural birth IN the hospital?"

At least in my experience, there were lots of hospital policies that were out of line with "natural birth" (and not evidence-based) like barring food and drink during labor, continuous monitoring (makes it hard to move around as needed during natural birth) immediate cord clamping, taking all the babies away to a "nursery" to see if they could maintain their temperature (crazy old-school!!) immediately after birth etc. Of course, none of these things would make me stay at home if I thought my baby's life was at risk, but please acknowledge that a lot of what goes on in a hospital is not in line with "natural childbirth." Many of these types of policies are what inspire people to pursue out-of-hospital births. Not referring to the mom in this case because her reasons were different (according to posts a few pages back) - but true for many other moms.

PP here: I will acknowledge it's met with SOME resistence but it's nothing that takes more work to get your way than the work put into readying for your home birth. Pressure and criticism there is no worse than what home-birthers seem proud to take on about their home-birthing stance in blogs or real life. If I do it in a hospital, at least I know that i'm in a place that will take care of my child AND me and exhaust every option before calling it over. At least in that setting, i have the OPTION to being flexible about what I originally wanted v. what I suddenly might need.

All that said, I must reiterate how defending vaginal breech home-births and Karen Carr in this case ironically DISCREDITS home-births' safety when it comes to fast-progressing and deadly unforeseen issues. This was safe? Someone still ended up dead. She was great? Someone still ended up dead. Nothing this home birth provided the mother couldn't have been done at the hospital first before resorting to more invasive medical techniques. And yes, hospitals would have pressured heavily for a c-section, even bullied. But until she signed, they could not have done it. And the argument can't then morph into "she didn't want hospitals no matter what" b/c then you're essentially saying Carr only told her what she wanted to hear, making her incompetent, and you're also saying that OBs were right about needing the c-section in the first place, killing the "safe vaginal breech at home" argument. There just doesn't seem to be a way to look at this that is favorable to home births. I'm sorry.

"Some resistance"? You have obviously never been met with all that some OBs and hospitals can and will throw at a laboring Mama up to and including threats with CPS and the legal system.

Further..nobody has said that homebirth is completely safe and free from risk. Just as with hospital births, things can and do go wrong. It's all about assessment and assumption of risk. This will obviously different for different families.

Finally, taking one homebirth and applying it to the entire concept and overall safety of homebirth is wrong. Should this case be taken into consideration...yes! However, the overall, entire picture paints a much more appropriate view and more complete picture.

[Anonymous]

Anonymous wrote:

It is a GOOD thing when a MW recognizes when a situation is out of the scope of her practice.

I have read every post in this thread, and I still don't understand why any mother would want to deliver a baby with someone for whom there are situations "out of the scope of her practice." Why not be safe and plan for any possibility from the get-go? ESPECIALLY if you are this woman with such a high risk of complications.

If you deliver a breech baby in the hospital with an OB, then essentially vaginal birth would be "out of the scope" of the OB's practice since no doctor or CNM with the exception of Tchabo will deliver breech babies vaginally in this area. And please don't argue that if a doctor won't do it, then it shouldn't be done. Studies have proven that vaginal breech birth is usually safe. And I am NOT saying that homebirth with a breech is a great idea. I am only saying that your point doesn't really hold water since some midwives have skills that many OB's no longer have.

[Anonymous]

Anonymous wrote:PP here as well. I'm not defending the mom's decision in this case or Karen Carr AT ALL nor saying that breach home births are safe. I personally would not have made the choice to attempt breech home birth. I am just stating the other factors that drive moms to pursue home birth. Many of these things I mentioned are not negotiable in the hospital - they are hospital policy and there's no fighting it. Natural birth means more than just forgoing epidural (absolutely up to the mom) to many people.

I also considered myself as being flexible with my birth and was ready to transfer to a hospital at any point that the situation necessitated a transfer.

I took the previous poster's intentions to mean that the arguments he or she quoted from intent home-birth advocates here to not make much sense - with or without the Karen Carr case involved. Risks are everywhere but the hospital-specific ones can be avoided with no more or less fight that it takes to have a home birth. Home birth risks can turn deadly with little recourse once they do. Pretty sure you CAN avoid the iv and such in a hospital with advance preperation. You can't force hospital policy to change in order for them to DO something they don't do, but they can't deny ignoring it in order for them NOT to do something you don't want. Is it easier in a way to get a midwife to agree and work with you? Sure. But it's not easier to shop and have the good fortune of finding a competent midwife in the mess that is their system and it's certainly out of your hands completely when it it comes to mother nature cursing you with a deadly complication. I hope pregnant moms reading this understand: TALK WITH YOUR OB AND THE HOSPITAL WAY AHEAD OF TIME AND LET THEM KNOW WHAT YOU WANT. EXPLAIN THAT YOU'RE DOING THIS TO MINIMIZE HOSPITAL PROCEDURE RISK IN COMBINATION WITH ELIMINATING HOME-BIRTH RISKS AS WELL. If your OB can't discuss this, find a new one. Like I said way, way earlier in this thread - you might be at a higher risk of a wreck in a car than in a plane, but it's also about your chances of SURVIVING the wreck.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

It is a GOOD thing when a MW recognizes when a situation is out of the scope of her practice.

I have read every post in this thread, and I still don't understand why any mother would want to deliver a baby with someone for whom there are situations "out of the scope of her practice." Why not be safe and plan for any possibility from the get-go? ESPECIALLY if you are this woman with such a high risk of complications.

If you deliver a breech baby in the hospital with an OB, then essentially vaginal birth would be "out of the scope" of the OB's practice since no doctor or CNM with the exception of Tchabo will deliver breech babies vaginally in this area. And please don't argue that if a doctor won't do it, then it shouldn't be done. Studies have proven that vaginal breech birth is usually safe. And I am NOT saying that homebirth with a breech is a great idea. I am only saying that your point doesn't really hold water since some midwives have skills that many OB's no longer have.

PP again: Take your midwife to the hospital with you. She can fight for you when you're too busy spitting nails from the pain and process and provide you with the same laboring methods you'd have at home - even if she's not catching the kiddo spewing out of you. I understand that the cord issues can be harder to fight - but again, advance communication will help, and the midwife and partner speaking on your behalf or along with you can settle this.

[Anonymous]

PP here: I will acknowledge it's met with SOME resistence but it's nothing that takes more work to get your way than the work put into readying for your home birth. Pressure and criticism there is no worse than what home-birthers seem proud to take on about their home-birthing stance in blogs or real life. If I do it in a hospital, at least I know that i'm in a place that will take care of my child AND me and exhaust every option before calling it over. At least in that setting, i have the OPTION to being flexible about what I originally wanted v. what I suddenly might need.

To the PP 11:03, I must say I couldn't agree more with your first and second post.

Insist on going natural with your in hospital birth, if that is what you want, and there is no reason to think you shouldn't. Yes, it can be done!
There is no hospital policy that will not allow you to walk around during labor, that insists to take your healthy newborn away from you...etc.. I'm really not aware of any, unless your wishes are life threatening for yourself or for your baby you will and should not have any problems. There are many women who posted in this thread, who have experienced that it will be OK.
If you want to birth somewhere else, make an informed decision listening to what several different providers have to say, not just the ones that are dead-set on homebirth no matter what, meaning: listen to all sides for your particular situation, then decide, and also don't be afraid to change your mind.

To me, the most disheartening thing is to read how many people see this case and simply go: 'the baby would have died anyways', 'going homebirth in this case was safe and hospitals are deathtraps', 'calling 911 would have been useless' 'there was nothing a surgeon could have done at that point' 'they would have only maimed the mother' 'Karen Carr is infallible', 'midwives should not be licensed, should not require overview, should be unregulated, need no formal education, and all they need is experience that they will gather during their apprenticeship'.

You can't save the ones that don't want to be saved I guess, but I do hope that for some, the debate has shed some light into different aspects of our choices, it certainly has for me.

[Anonymous]

Anonymous wrote:

PP here: I will acknowledge it's met with SOME resistence but it's nothing that takes more work to get your way than the work put into readying for your home birth. Pressure and criticism there is no worse than what home-birthers seem proud to take on about their home-birthing stance in blogs or real life. If I do it in a hospital, at least I know that i'm in a place that will take care of my child AND me and exhaust every option before calling it over. At least in that setting, i have the OPTION to being flexible about what I originally wanted v. what I suddenly might need.

To the PP 11:03, I must say I couldn't agree more with your first and second post.

Insist on going natural with your in hospital birth, if that is what you want, and there is no reason to think you shouldn't. Yes, it can be done!
There is no hospital policy that will not allow you to walk around during labor, that insists to take your healthy newborn away from you...etc.. I'm really not aware of any, unless your wishes are life threatening for yourself or for your baby you will and should not have any problems. There are many women who posted in this thread, who have experienced that it will be OK.
If you want to birth somewhere else, make an informed decision listening to what several different providers have to say, not just the ones that are dead-set on homebirth no matter what, meaning: listen to all sides for your particular situation, then decide, and also don't be afraid to change your mind.

To me, the most disheartening thing is to read how many people see this case and simply go: 'the baby would have died anyways', 'going homebirth in this case was safe and hospitals are deathtraps', 'calling 911 would have been useless' 'there was nothing a surgeon could have done at that point' 'they would have only maimed the mother' 'Karen Carr is infallible', 'midwives should not be licensed, should not require overview, should be unregulated, need no formal education, and all they need is experience that they will gather during their apprenticeship'.

You can't save the ones that don't want to be saved I guess, but I do hope that for some, the debate has shed some light into different aspects of our choices, it certainly has for me.

This is an intellectually dishonest summation of this thread. I would hope that you realize that.

[Anonymous]

This was by no means intended to be a summary at all!

[Anonymous]

Anonymous wrote:This was by no means intended to be a summary at all!

The second to last paragraph is clearly an attempt to summarize statements made. Too bad these statements were not made.