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

[Anonymous]

I used to be an L and D nurse and I have seen doctors greatly exaggerate the facts. An innocent variable decel suddenly becomes your child is not getting enough oxygen, we need to take the next step. And these poor mothers don't know any better, they put total trust into the OBs.

This is the very reason I got out of L and D. I couldn't stand the misleading communication, couldn't stand the patient's lack of power, couldn't stand how nurse management didn't stand up to the doctors, could'nt even stand some of the senior L and D nurses who knew nothing different than to keep a woman on her back and push.

[Anonymous]

On Friday - The Washington Post had a big article on it....you should look it up.

[Anonymous]

Anonymous wrote:
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?

And no one can promise you won't choke to death on a piece of food but it doesn't stop us from eating with small bites and chewing well rather than starving to death! It doesn't stop us from learning and performing the HM when it happens! And we DO know she was advised to have c/s - she just took it to be a "default" kind and didn't want it. She didn't seem to want to attempt a vaginal deliv and be flexible as it progressed - she wanted only vaginal. She didn't want the hospital setting, either.

[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

This country is not into doing it the "right" way, but its "own" way. And in this thread, I have noticed a certain pride from midwives in being "rogue", almost a desire to keep it that way for many reasons (excuses) rather than improving the system overall. The tone of this should be regretful, not IN YOUR FACE!!!!ish.

[Anonymous]

Anonymous wrote:

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 adanced 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.

They don't, but plenty of happy mothers don't trust their OBs out of thin air either. Horror stories about the opposite camp are handed out left and right by BOTH camps. And I don't really understand why you trust your midwife's intentions any more/less than your OB. You trusted your OB before she crossed you - what happens the day your midwife crosses you too? Will all midwives be bad? I still maintain that as much work/prep/energy/education can go into merging the two worlds. Midwife for labor, OB for delivery. I think if more of us did this and fought to have it, the system would be forced to change due to their clientele and $ needs anyway, and the approach would be changed permanently.

[Anonymous]

Midwife for labor and OB for delivery? Doesn't work for me. Midwife in a hospital, certainly.

Many many things go wrong before the moment mom starts pushing. As someone who has twice birthed with midwives I can tell you while pushing would be the last time I'd want my midwife to step aside.

[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

Yes, we are very fortunate. I had 3 of the above present at my homebirth and all 3 were incredible and very skilled.

Apparently homebirth CNMs are quite uncommon in the nation as a whole, however. CPMs definitely outnumber, which is too bad.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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 adanced 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.

They don't, but plenty of happy mothers don't trust their OBs out of thin air either. Horror stories about the opposite camp are handed out left and right by BOTH camps. And I don't really understand why you trust your midwife's intentions any more/less than your OB. You trusted your OB before she crossed you - what happens the day your midwife crosses you too? Will all midwives be bad? I still maintain that as much work/prep/energy/education can go into merging the two worlds. Midwife for labor, OB for delivery. I think if more of us did this and fought to have it, the system would be forced to change due to their clientele and $ needs anyway, and the approach would be changed permanently.

No way. I personally do not want an OB anywhere near my vagina while I'm trying to push a baby out. I have seen first-hand, far too many times, the type of damage they do as a result of their fear and lack of education about normal birth.

[Anonymous]

Anonymous wrote:Midwife for labor and OB for delivery? Doesn't work for me. Midwife in a hospital, certainly.

Many many things go wrong before the moment mom starts pushing. As someone who has twice birthed with midwives I can tell you while pushing would be the last time I'd want my midwife to step aside.

I didn't say she should leave the room.

[Anonymous]

From NPR this morning http://mdmorn.wordpress.com/2011/05/11/511111/

For the record, I think Karen's belief that all CNMs are "medicalized" and have far too little experience with unmedicalized birth is untrue. Yes, many CNMs have taken a more medicalized approach to childbirth, but I think it's funny how she wants to talk about CNM education and training and how it's not adequate with respect to normal, physiologic birth, yet really wouldn't know the first thing about what type of education a CNM receives in the university setting. Almost every CNM I know spends a good portion of her clinical rotations in an out of hospital birth center setting. Some CNM students are not permitted to work with homebirth midwives depending on the level of malpractice insurance carried by the provider, but this is not to say that she can't have a fulfilling learning experience working in a birth center.

[Anonymous]

Anonymous wrote:From NPR this morning http://mdmorn.wordpress.com/2011/05/11/511111/

For the record, I think Karen's belief that all CNMs are "medicalized" and have far too little experience with unmedicalized birth is untrue. Yes, many CNMs have taken a more medicalized approach to childbirth, but I think it's funny how she wants to talk about CNM education and training and how it's not adequate with respect to normal, physiologic birth, yet really wouldn't know the first thing about what type of education a CNM receives in the university setting. Almost every CNM I know spends a good portion of her clinical rotations in an out of hospital birth center setting. Some CNM students are not permitted to work with homebirth midwives depending on the level of malpractice insurance carried by the provider, but this is not to say that she can't have a fulfilling learning experience working in a birth center.

Why did the Carr supporters earlier in this thread keep saying that she WAS licensed in Maryland?

[Anonymous]

Anonymous wrote:From NPR this morning http://mdmorn.wordpress.com/2011/05/11/511111/

For the record, I think Karen's belief that all CNMs are "medicalized" and have far too little experience with unmedicalized birth is untrue.

Completely agree. I know some CNMs are more medicalized than others, just as some OBs are more interventive than others. I had my birth attended by multiple CNMs who were not over-medicalized, but the proper amount of medicalized, thanks. I chose to have an ultrasound, we did do bloodwork to check things like iron, yet I had no vaginal exams during labor (or pregnancy), intermittent monitoring via doppler, etc, the very handsoff birthing experience.

[Anonymous]

Anonymous wrote:

Anonymous wrote:From NPR this morning http://mdmorn.wordpress.com/2011/05/11/511111/

For the record, I think Karen's belief that all CNMs are "medicalized" and have far too little experience with unmedicalized birth is untrue. Yes, many CNMs have taken a more medicalized approach to childbirth, but I think it's funny how she wants to talk about CNM education and training and how it's not adequate with respect to normal, physiologic birth, yet really wouldn't know the first thing about what type of education a CNM receives in the university setting. Almost every CNM I know spends a good portion of her clinical rotations in an out of hospital birth center setting. Some CNM students are not permitted to work with homebirth midwives depending on the level of malpractice insurance carried by the provider, but this is not to say that she can't have a fulfilling learning experience working in a birth center.

Why did the Carr supporters earlier in this thread keep saying that she WAS licensed in Maryland?

I think this was a "misunderstanding" arising from language in the original WaPo article. MD does not offer licensure for CPMs and people in this thread commented about how if the WaPo reporters were confused on this point, many patients may be confused about this as well.

[Anonymous]

I don't think her quotes in that interview all reflect the deepest of thought/knowledge. I mean, avoidance of amniocentesis requires homebirth with a midwife trained outside the medical system? (Rhetorical question... answer is no.)

[Anonymous]

Anonymous wrote:

Anonymous wrote:From NPR this morning http://mdmorn.wordpress.com/2011/05/11/511111/

For the record, I think Karen's belief that all CNMs are "medicalized" and have far too little experience with unmedicalized birth is untrue. Yes, many CNMs have taken a more medicalized approach to childbirth, but I think it's funny how she wants to talk about CNM education and training and how it's not adequate with respect to normal, physiologic birth, yet really wouldn't know the first thing about what type of education a CNM receives in the university setting. Almost every CNM I know spends a good portion of her clinical rotations in an out of hospital birth center setting. Some CNM students are not permitted to work with homebirth midwives depending on the level of malpractice insurance carried by the provider, but this is not to say that she can't have a fulfilling learning experience working in a birth center.

Why did the Carr supporters earlier in this thread keep saying that she WAS licensed in Maryland?

I don't think anyone claimed she was licensed. Many people said she was certified, and according to her certification, she is allowed to practice anywhere. Technically, she is NOT licensed in any state, but is certified to work in every state. The license is a state regulatory issue, while the certification reflects the particular training she has had and her type of midwifery practice.