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

[Anonymous]

Commenting on the Lament post above.

From Anonymous on:
http://www.theunnecesarean.com/

I couldn't read the original article, I guess I'd have to pay to do so.

I will say, I agree with this doc 100%. "Safety requires skills, respect, transparency, and enough time. If physicians can’t provide those things, we shouldn’t balk when women seek them elsewhere." Precisely. I know a ton of women, myself included, who thought they were signing up for something reallly different from what they received, and not just because of nature. Far from it. I had NO reason to suspect what would unfold. And, usually it had both physical and emotional tolls.

I also agree and think it's ALL ultimately a woman's choice. Many doctors don't view it that way. You do, that's awesome. What to do about the ones who view womens' choices as making some sort of move AGAINST her fetus or the doctor when really she's thinking about both of them (the mom and baby)??? And, she's obviously NOT thinking much about the doctor - but she's also less biased in that respect. (For instance, an obese acquaintance who nearly died during her first c/s and had a horrific recovery, wanted to VBAC.. Was in great health for her size, probably better health than my skinny butt, U/S showed a strong scar.. was told NO NO NO you are TOO FAT, DEAD BABY THIS THAT.. so fearing for HER life in a surgery, she waited at home with a montrice and went in advanced labor fingers crossed and pen ready.. Successful VBAC, perfectly healthy baby, but not without being dehumanized, insulted, and achieving different sorts of battle scars... Even when women do "the right thing" (not VBACing at home) they are mistreated!! What are they supposed to do!?) I guess.. have doctors with more sense.. talk sense.. into them?

I think you are very right on another point. Using terror tactics besides in the utmost of horrible situations is, however usually effective, at the time, but it's usually unnecessarily brutal (probably the time thing again.. why waste time explaining your rationale for 30 minutes to an "illogical pregnant woman" when you can just mention c-section or dead baby or deadly infection or whatever?).. and if women discover it was made up/fudged... or they were manipulated/taken advantage of in a sensitive or even a truly decompensated (like a very high fever... like me...) state.. particularly if it causes them a great deal of mental anguish AND/OR harms them physically.. HOW are they supposed to trust the medical establishment? Why should they? Because they were alive at the end? What if next time things really are very dire, but now it is the boy who cried wolf??? (Maybe she's thinking of her and her babies safety in that regard .. She trusts a midwife at home or a birth center or a montrice in the hospital with her to tell her when shit really IS hitting the fan.. IMO that IS safer than a person that refuses to believe a word out of the nurses/doctors mouths and has no one to confirm anything for her.)

And, the stonewalling with medical records (editing them to the point of .. no point sending them on, like mine) and requesting no cameras has got to stop, too. I know, I know, only a lot of reform would take away the silver bullet known as the career-ending-lawsuit but come on.. I need to know what really happened. Not the severely abridged version. And, I'm personally not putting myself in a situation where the med pros are so terrified of me having evidence of malpractice a camera.. and knowing what was written down at the time.. is forbidden... not again. Not unless I can't help it.

Yeah.. I think women in first world countries do take how safe birth has become for granted a bit.. which is a point a lot of docs like to make.. but we (in the first world) tend to take everything for granted, and "everything", food, water, appropriate shelter, appropriate sterilizations, medical knowledge and safer surgery and anesthesia, as it were, is a huge part of why it's so much safer, SURE... It's not about all that, though. Since, it could be safer.

Docs seem to take for granted how what we think we know can change very quickly.

Safe is relative, safe is not so black and white. Safe is also -down to the individual-, not a statistic on a sheet. Hospital might statistically appear to be safer (at least in regards to neonatal mortality, which the stats for are murky and possibly incorrect in the first place) based on some studies which docs seem to buy, but assuming they were 100% right.. how much responsibility do they (the medical establishment) have in that, too... by severely alienating homebirth midwives/OOHB and the women who choose them? They just make it worse for themselves, women, and babies by being judgmental and receiving them with misplaced and innappropriate anger. They could also do better, anyway. You hit the nail on the head with that assessment..

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You know what's not a parody? At this very moment, Karen Carr is prepared to catch a baby inside a home with an anxious, excited, and frightened young mother-to-be. It's the young woman's first pregnancy. Odds are everything will go fine. If not, 911 will be called.

For 102 pages of comments and bluster, what has really changed?

According to Karen Carr's record, 911 won't be called fast enough.

No she will call but after the baby is dead because you know, some babies weren't meant to live outside the womb.

That is so wrong and uneducated. That was a live full term baby prior to delivery. If that mother had been properly advised and had undergone a planned c-section that baby would have been born alive and healthy, or at the very least alive with the ability to be properly rescusitated by a medical team with all the emergency equipment. This was an avoidable tragedy. Some babies aren't meant to live outside the womb but this baby should have lived if not for the inept care the mother received.

[Anonymous]

That is so wrong and uneducated. That was a live full term baby prior to delivery. If that mother had been properly advised and had undergone a planned c-section that baby would have been born alive and healthy, or at the very least alive with the ability to be properly rescusitated by a medical team with all the emergency equipment. This was an avoidable tragedy. Some babies aren't meant to live outside the womb but this baby should have lived if not for the inept care the mother received.

Have you not read anything on this thread? Nobody, nobody, can promise a live baby and a live mother. It would be the ultimate in hubris to do so. It is clinically unethical. I believe that this is one of the biggest problems here.

And - how do you know she wasn't advised to have a Cesarean? You don't know do you?

[Anonymous]

I believe the PP was being sarcastic.

[Anonymous]

Anonymous wrote:I believe the PP was being sarcastic.

ha ha

[Anonymous]

"She trusts a midwife at home or a birth center or a montrice in the hospital with her to tell her when shit really IS hitting the fan..."

YES!

[Anonymous]

Anonymous wrote:"She trusts a midwife at home or a birth center or a montrice in the hospital with her to tell her when shit really IS hitting the fan..."

YES!

I hope this is another sarcastic reply!

[Anonymous]

I wish the parodies and bad attempts at humor would stop. This has been an interesting thread with some good discussion. I think the issue of non-rational, overmedicalization of birth is extremely important and I am not a natural birth person at all. There is a dangerous polarization between medical and home birth providers that is only resulting in less choice for women. Most of the women that I know, myself included do not want to be in either extreme. We have no desire to be pressured into non-evidence procedures, or undergo unnecessary surgery. As educated women, we find it extremely insulting to be given false information to scare tactics by medical professionals. We also don't want to have to give birth on our living room couch just to avoid dealing with this non-sense but the trend seems to be polarizing.

Birth centers seem to be one of the few in between options but they still don't offer the quick access to a hospital. Birth centers are few and far between. Some hospitals do offer midwives which is a great option but many of these midwives have to work under the same non-evidence based protocals that created the problem with ob/gyns. Home birth is growing as a backlash but since almost all CNMs only practice in hospitals there is no way for a woman to hire a university trained CNM for a homebirth. A CPM is the only option.

[Anonymous]

Anonymous wrote:
Home birth is growing as a backlash but since almost all CNMs only practice in hospitals there is no way for a woman to hire a university trained CNM for a homebirth. A CPM is the only option.

This is not true - in our area especially there is the option of several highly trained homebirth CNMs. I had a homebirth in Maryland with an amazing CNM.

The following CNMs in MD/VA offer home births:

- all of the Birth Care midwives
- Evelyn Mulhahn
- Susan Dodge
- Joey Pascarella
- Erin Fulham
- Mairi Rothman

[Anonymous]

Anonymous wrote:

Anonymous wrote:
Home birth is growing as a backlash but since almost all CNMs only practice in hospitals there is no way for a woman to hire a university trained CNM for a homebirth. A CPM is the only option.

This is not true - in our area especially there is the option of several highly trained homebirth CNMs. I had a homebirth in Maryland with an amazing CNM.

The following CNMs in MD/VA offer home births:

- all of the Birth Care midwives
- Evelyn Mulhahn
- Susan Dodge
- Joey Pascarella
- Erin Fulham
- Mairi Rothman

Very good to know. Thanks for posting.

[Anonymous]

From the CDC. See how the US compares to other countries. We are NOT getting it right. 2009

I like the graph in which all the preemie babies are taken out of the equation and we STILL we are way down low.

The system is broken. Fighting won't fix it. Let's look and study who is doing it right (as measured by infant mortality) and let's work on seeing if we can alter our system so that it works better.

http://www.cdc.gov/nchs/data/databriefs/db23.pdf

[Anonymous]

Anonymous wrote:"She trusts a midwife at home or a birth center or a montrice in the hospital with her to tell her when shit really IS hitting the fan..."

YES!

I second the YES!!! Exactly why I would choose a midwife/ possible home birth for our next baby. Women should be able to get answers as to what went wrong without having to pursue litigation.

[Anonymous]

Anonymous wrote:Commenting on the Lament post above.

From Anonymous on:
http://www.theunnecesarean.com/

I couldn't read the original article, I guess I'd have to pay to do so.

I will say, I agree with this doc 100%. "Safety requires skills, respect, transparency, and enough time. If physicians can’t provide those things, we shouldn’t balk when women seek them elsewhere." Precisely. I know a ton of women, myself included, who thought they were signing up for something reallly different from what they received, and not just because of nature. Far from it. I had NO reason to suspect what would unfold. And, usually it had both physical and emotional tolls.

I also agree and think it's ALL ultimately a woman's choice. Many doctors don't view it that way. You do, that's awesome. What to do about the ones who view womens' choices as making some sort of move AGAINST her fetus or the doctor when really she's thinking about both of them (the mom and baby)??? And, she's obviously NOT thinking much about the doctor - but she's also less biased in that respect. (For instance, an obese acquaintance who nearly died during her first c/s and had a horrific recovery, wanted to VBAC.. Was in great health for her size, probably better health than my skinny butt, U/S showed a strong scar.. was told NO NO NO you are TOO FAT, DEAD BABY THIS THAT.. so fearing for HER life in a surgery, she waited at home with a montrice and went in advanced labor fingers crossed and pen ready.. Successful VBAC, perfectly healthy baby, but not without being dehumanized, insulted, and achieving different sorts of battle scars... Even when women do "the right thing" (not VBACing at home) they are mistreated!! What are they supposed to do!?) I guess.. have doctors with more sense.. talk sense.. into them?

I think you are very right on another point. Using terror tactics besides in the utmost of horrible situations is, however usually effective, at the time, but it's usually unnecessarily brutal (probably the time thing again.. why waste time explaining your rationale for 30 minutes to an "illogical pregnant woman" when you can just mention c-section or dead baby or deadly infection or whatever?).. and if women discover it was made up/fudged... or they were manipulated/taken advantage of in a sensitive or even a truly decompensated (like a very high fever... like me...) state.. particularly if it causes them a great deal of mental anguish AND/OR harms them physically.. HOW are they supposed to trust the medical establishment? Why should they? Because they were alive at the end? What if next time things really are very dire, but now it is the boy who cried wolf??? (Maybe she's thinking of her and her babies safety in that regard .. She trusts a midwife at home or a birth center or a montrice in the hospital with her to tell her when shit really IS hitting the fan.. IMO that IS safer than a person that refuses to believe a word out of the nurses/doctors mouths and has no one to confirm anything for her.)

And, the stonewalling with medical records (editing them to the point of .. no point sending them on, like mine) and requesting no cameras has got to stop, too. I know, I know, only a lot of reform would take away the silver bullet known as the career-ending-lawsuit but come on.. I need to know what really happened. Not the severely abridged version. And, I'm personally not putting myself in a situation where the med pros are so terrified of me having evidence of malpractice a camera.. and knowing what was written down at the time.. is forbidden... not again. Not unless I can't help it.

Yeah.. I think women in first world countries do take how safe birth has become for granted a bit.. which is a point a lot of docs like to make.. but we (in the first world) tend to take everything for granted, and "everything", food, water, appropriate shelter, appropriate sterilizations, medical knowledge and safer surgery and anesthesia, as it were, is a huge part of why it's so much safer, SURE... It's not about all that, though. Since, it could be safer.

Docs seem to take for granted how what we think we know can change very quickly.

Safe is relative, safe is not so black and white. Safe is also -down to the individual-, not a statistic on a sheet. Hospital might statistically appear to be safer (at least in regards to neonatal mortality, which the stats for are murky and possibly incorrect in the first place) based on some studies which docs seem to buy, but assuming they were 100% right.. how much responsibility do they (the medical establishment) have in that, too... by severely alienating homebirth midwives/OOHB and the women who choose them? They just make it worse for themselves, women, and babies by being judgmental and receiving them with misplaced and innappropriate anger. They could also do better, anyway. You hit the nail on the head with that assessment..

This is truly one of the wisest and most insightful posts in this entire thread. As a person who has gone from completely trusting OBs to having a deep seated mistrust I can identify with and confirm the truth behind this.

Long story short...when my HB turned into a hospital birth at 30 weeks, I had the "pleasure" of dealing with an OB that was the perfect example of why the PP is so right. While in active labor, the OB spent a great deal of time trying to talk me into consenting to a c/s instead of the VBA2C that I was determined to have (barring a *true* medical need). Thank God I had previously spent hours and hours pouring over research and knew the info backwards and forwards. The OB (while standing at the other side of the large room instead of at the bedside) continuously threw lies at me in order to get her way. Even from the depths of laborland, I was able to call her on her lie and she *eventually* backed down and admitted that she was wrong. Now tell me....how the heck can any Mama trust a HCP after they so boldly lied to her face? I know that the little bit of credibility she had prior (I had heard she was MW friendly) was completely gone. Nothing she said held any water whatsoever. How could I possibly believe her if she said I needed a c/s stat? This isn't a solitary case either.

While in a different hospital two weeks prior (for PTL), a different OB tried to lie about an EFT strip in order to get me to consent to a c/s (at just 28 weeks!). I kept asking to look at the strip and she kept ignoring me. Finally, a nurse called her on it and the OB backed off. Yes...and OB actually lied simply in order to get her way...a way that would have resulted (unnecessarily) in a birth at *28 weeks*.

However, had my MW said that a c/s would be the best course of action...I have absolute faith that her opinion would have come from an honest place.

After such appalling behavior by OBs (there are actually more "fun" OB stories), there's not much chance of me *ever* trusting an OB. Sadly, after reading birth story after birth story, I've found that my case is not unique.

People don't pull mistrust of OBs out of thin air. Such aversions are formed through experience.

[Anonymous]

Anonymous wrote:From the CDC. See how the US compares to other countries. We are NOT getting it right. 2009

I like the graph in which all the preemie babies are taken out of the equation and we STILL we are way down low.

The system is broken. Fighting won't fix it. Let's look and study who is doing it right (as measured by infant mortality) and let's work on seeing if we can alter our system so that it works better.

http://www.cdc.gov/nchs/data/databriefs/db23.pdf

It's been talked about repeatedly already, but infant mortality measures the death rate of live born infants from birth to age 1 year. It does not include late miscarriages or deaths that occur during labor, so it is not the preferred method for measuring obstetric care. Rather, it measures access to healthcare and socio-economic conditions. In that sense, I agree, we're not getting it right. Until all children have easy access to primary care providers and the socio-economic conditions of the poorest people are improved, the US infant mortality rate will not catch up to Europe.

I think the statistic you're looking for is the neonatal mortality rate. This one measures late miscarriages, deaths that occur during labor, and deaths of infants for the first few days of life (in other words, the quality of obstetric care). By that metric, the US is doing well.

It is interesting that people keep bringing up infant mortality rates as if they prove that US obstetricians aren't doing a good job. Is it out there on anti-doctor websites? I see it over and over, but it seems like the people who use it really don't understand what it means.

http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_06.pdf

[Anonymous]

Anonymous wrote:

Anonymous wrote:From the CDC. See how the US compares to other countries. We are NOT getting it right. 2009

I like the graph in which all the preemie babies are taken out of the equation and we STILL we are way down low.

The system is broken. Fighting won't fix it. Let's look and study who is doing it right (as measured by infant mortality) and let's work on seeing if we can alter our system so that it works better.

http://www.cdc.gov/nchs/data/databriefs/db23.pdf

It's been talked about repeatedly already, but infant mortality measures the death rate of live born infants from birth to age 1 year. It does not include late miscarriages or deaths that occur during labor, so it is not the preferred method for measuring obstetric care. Rather, it measures access to healthcare and socio-economic conditions. In that sense, I agree, we're not getting it right. Until all children have easy access to primary care providers and the socio-economic conditions of the poorest people are improved, the US infant mortality rate will not catch up to Europe.

I think the statistic you're looking for is the neonatal mortality rate. This one measures late miscarriages, deaths that occur during labor, and deaths of infants for the first few days of life (in other words, the quality of obstetric care). By that metric, the US is doing well.

It is interesting that people keep bringing up infant mortality rates as if they prove that US obstetricians aren't doing a good job. Is it out there on anti-doctor websites? I see it over and over, but it seems like the people who use it really don't understand what it means.

http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_06.pdf

Gah! PERINATAL mortality rate, not neonatal.