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Midwife charged in DC? Karen Carr, CPM...
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Anonymous
| I have a sincere question that I hope someone can answer. I support home birth and have had two myself, attended by a CNM. I am struggling to understand the logic behind a CPM attending home births that are considered high-risk. Most of the research that I'm familiar with from other countries, which I've heard used to defend home birth, touts a system in which home births with midwives are the standard for normal pregnancies with no complications identified prior to the birth and OBs as the standard of care for situations with complications. I've learned from this thread that locally, CPMs are not permitted to bring medications and oxygen with them to home births. I guess I am just confused, and I don't know all the details of this particular case, but it seems that the Birthcare midwives (who are permitted to use those types of life-saving medical interventions, have umpteen years of experience among them, and face no hesitation or risk in transferring to a hospital) and Dr. Tchabo (a respected, progressive OB with a whole hospital at his disposal) deemed the birth too risky to be done vaginally at all, much less at home. Yet there are those who are arguing that it would be OK for a CPM who, however qualified she may be, is not permitted to have medications or oxygen and may face prosecution if transferring to a hospital, and doesn't have access to life-saving interventions, to attend the same birth. I know that I am making assumptions about this tragic situation, and assuming things I don't know. But it seems there are those on this thread who are defending a woman's right to birth at home no matter what, and I am having trouble discerning a comprehensive argument for that. |
Anonymous
Right, but by the point Tchabo saw her I assume the baby was footling, as he delivers complete breeches vaginally and wouldn't have turned away a frank breech unless there was also some other complicating factor, to my understanding. |
Anonymous
It's possible. It's also possible that he turned her down because he just couldn't fit her in. We can't rule that out. If she was trying to transfer to him very near her delivery date he might just not have had room for more patients on his schedule. |
Anonymous
I guess my thinking would be that the people jumping to Karen's defense would like this to be a discussion of this particular case, on its merits, rather than a condemnation of Karen as a person, her whole practice and history, home birth in general and midwives in general. I think a lot of people are quick to demonize all those things - I am not one of them by any stretch of the imagination. A good friend of mine in another state had a home birth with a couple of CPMs. In this state, home birth is illegal, but her pregnancy was low risk and in a state where home birth was legal, it would have been no big deal. Her labor was several days long and took a turn for the worse about midway through the second day. She was scared. She was in pain. She was a first time mom so she didn't know if what she was feeling was normal or not - which now that I have had a baby, I can completely sympathize with. The midwives did not make the recommendation that they go to the hospital until what, in my opinion and the opinions of every doctor who saw her in the hospital later, was way too late. Her baby aspirated meconium. He was in the NICU for close to two months. She herself almost died (though at the moment I don't remember what from). Thinking about the situation with Karen and this grieving mom, I have to wonder if something similar happened with them. That things were progressing relatively normally. That Mom wasn't sure about what she was feeling. That communication between midwife and Mom was not great. In the case of my friend, I place a large part of the blame on the CPMs who attended her birth, but also on the system they operate within. They can't be held to standards of professional conduct if their profession is deemed illegal. They will practice underground and there will be little to no accountability for them. When things go wrong, the medical establishment will be quick to point to those instances and say, "See? This is why it's not safe." The only thing that leads to is a lot of blame being bounced back and forth, while the home birth community circles the wagons and the medical birth community comes with their torches and pitchforks. All the while there is still a new mom whose life is ruined, a baby whose life never began, and a midwife who is clearly loved and respected whose practice will be forever tarnished with this horrible tragedy. |
Anonymous
|
Sorry, I just realized that whole schpiel didn't actually answer your question.
I think that it is a woman's right to choose where she gives birth. Yes, "no matter what". I don't think that what this woman wanted to do is smart or safe. I wouldn't do it myself and I wouldn't recommend that any of my close friends or family do it either. If asked for advice by a stranger, I wouldn't recommend it. I would try to educate that person. It sounds like that's what Tchabo and the BirthCare midwives tried to do. Clearly their efforts did not work. But it is her right to choose. To me, imposing requirements like this is a short step away from saying, "You're over 35, so you must birth in a hospital" or "You're over 35, so you must have a C section". I think that the best you can do is make recommendations and then allow people to make their own decisions, however wrong those decisions may be. |
Anonymous
Replying to myself, to the bold part. Perhaps Karen's thought process went along the lines of "This couple is so set on a home birth that they will do it alone if no one will take them. I will go so that there is someone there who knows what she's doing." |
Anonymous
|
"But it seems there are those on this thread who are defending a woman's right to birth at home no matter what, and I am having trouble discerning a comprehensive argument for that."
Actually, I would say that I am one of those who believe a woman should have a RIGHT to birth at home no matter what. I won't say that it's advisable or ethical for a woman to do so, or ethical for any caregiver to advise such ultra high risk birth at home, but I'm certainly not in favor of dictating that a woman be forced to have a birth in a hospital in any situation. I'm not sure if I think it should be illegal for lay midwives to attend such births either. I do believe that if a family chooses to have an unassisted high-risk birth at home, contrary to all professional advice they've been given, they should be prepared to shoulder the consequences of their own decision (provided they weren't given bad advice by any caregivers). But, no, I'm not going to support make it illegal for them to do it. I would never make their choice, but I wouldn't make them criminals either. And yes, I think a lay midwife, who has been paid for her expertise, that attends such a birth assumes some responsibility for the outcomes as well if it can be shown that she didn't provide adequate guidance to the family with regard to the risks/benefits of their choices. What "adequate" means is definitely up for debate...what is the standard of care for lay midwives? It's not clear to me, which is why I'm probably pro-licensing and regulation. This whole thing is so sad and I'm wondering what will ultimately happen as a result of all of this. Of course, none of us have all the facts. My thoughts are just based on a whole lot of assumptions about what might have happened here. I almost feel bad discussing it at all. |
Anonymous
|
Completely agree that it is a woman's/familiy's right to choose where they birth. No matter what. But that's where informed consent becomes very important. They have to be willing accept the consequences related to high-risk deliveries.
---- On another note, if anyone is interested in following campaigns to get all states to legally allow regulated, licensed CPMs to practice The Big Push is doing a lot of work in this area. Below is some information from their site about why CPM licensing is important: CPM licensure protects and defends the rights of American women and families by: - Providing a mechanism for families choosing out-of-hospital birth to verify their midwife's training, skills, and educational credentials - Ensuring adherence to evidence-based practices and providing for transparency and accountability - Ensuring continuity of care and offering liability protection to physicians who collaborate with midwives Providing access to: - A family-centered model of maternity care that offers individualized education, counseling, screening, and pre-natal care - Continuous hands-on assistance during labor and delivery - Minimal use of costly technological interventions Support of the physical, psychological, and social well-being of mothers and families throughout the childbearing cycle - Ensuring that every family can choose their birth provider and setting based on their religious, cultural, and philosophical beliefs - Ensuring the availability of qualified and experienced out-of-hospital maternity care providers in the event of an emergency that makes hospital care inaccessible (e.g. a hurricane or other natural disaster, or flu epidemic). Access to out-of-hospital maternity care is in keeping with the mission of the National Working Group for Women and Infant Needs in Emergencies to ensure that the health care needs of pregnant women, new mothers, newborns and infants are adequately met during and after a disaster situation. |
Anonymous
This is precisely why Karen, and other CPM's, refuse licensing. The license (in Virginia) prohibits them from practicing midwifery in the safest way possible. As others have pointed out, the license is a formality with the state, and does not indicate in any way the degree of training, expertise or experience level of the lay midwife. |
Anonymous
Incorrect. The baby was not at any point a footling breech. |
Anonymous
Okay, it would be really helpful if someone who knows (you, perhaps) would explain the actual circumstances. I really don't want to speculate and get "nope! wrong!" every time I do. |
Anonymous
Do you know what the situation really was? Most of us are just discussing hypotheticals here, and it has been a pretty rigorous discussion. I understand if you don't want to share information, but just dropping in and giving selective bits isn't really taking this conversation anywhere. Though, I can understand why you would want to clear it up on Karen's behalf if it wasn't a footling birth, since most people would agree that it borders on reckless to attempt it at home. I think a lot of people are understandably concerned that a midwife would not advise a transfer in that circumstance. |
Anonymous
| Just as a point of information, I had a homebirth with a CPM in DC and she used oxygen on my baby and medicine (piton after the birth) on me. She also used an IV to replace lost fluids. Not sure if all that was "allowed" but it is commonly done. |
Anonymous
Folks are making a lot of assumptions here. Just because Tchabo is on the witness list, it does NOT mean that the mother ever met with him or that she was "turned away". Perhaps the prosecution considers him an expert witness. Lets stop jumping to conclusions without all the facts. |
Anonymous
I agree with you, to an extent. I think that we should stop jumping to conclusions about what happened, but I think that many of the conversations that have come up surrounding people's assumptions have been really positive, which frankly surprised me. I think that there have been a lot of thoughtful questions, which I know I have tried to answer in an equally thoughtful way. I think that talking about all the things that could possibly have occurred helps us to better understand these situations. I think that more of these conversations should occur. I think that some of the worst damage is done when we say "This was bad, it was wrong, it should never have happened, let's move on" and that being the whole story. |