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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Where have folks read that this breech birth was in the footling position? Or is that an assumption?

Unfortunately, I think people jumped to that because we were talking about what kind of breech babies Dr. Tchabo and others would and wouldn't consider.

I don't think it was necessarily a footling breech, at least not to begin with. The reviewer on the link a couple pages back (if it is this mother) mentions that the baby moved during labor to no longer being in optimum position for breech delivery. From that I infer the baby probably started out frank or complete breech and then moved to footling. I've read in other places that complete breech babies can often shift to footling breech during labor.

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.

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.

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.

I think out of respect for everyone involved it's probably best not to pass judgment on anyone, especially since it's clear that no one here knows or is willing to share what happened. But, I don't think it's wrong for people to discuss the larger issues at stake here, even if they are based on some speculation about what might have happened based on the facts we do know.

[Anonymous]

This is from a few pages back:

"NP. The mom was risked out by Birth Care and called the local midwives and Dr. Tchabo to see who could serve her in doing a breech vaginal birth. "

Until someone can start providing some of the details, which are woefully lacking from her defense fund page, people are going to talk about possible scenarios.

I was the one who pointed out it was interesting that he was called as a witness, considering he was one of the only doctors in the area who will consider vaginal breech. At first I thought they might be considering him an expert witness. But with the post about the parents contacting him about delivering her, that may not be the case.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

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.

There's nothing wrong with discussing the pros and cons of homebirth, but people are saying things like, "She was turned away by Tchabo! Karen shouldn't have attended a footling birth at all!" as if these are facts, when this is all utter speculation. It's becoming a game of telephone.

[Anonymous]

Anonymous wrote: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.

So the answer is no licensure at all? When a midwife, practicing unlicensed, can't use medications anyway, too? It is illegal for unlicensed midwives to practice, which includes the use of medications.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

So the answer is no licensure at all? When a midwife, practicing unlicensed, can't use medications anyway, too? It is illegal for unlicensed midwives to practice, which includes the use of medications.

I had the exact same thought. I don't really understand why you would choose to go unlicensed if it just meant that you'd end up breaking the law anyway. And well, I also don't understand why anyone would choose an unlicensed midwife to begin with. Virginia is a contributory negligence state...if you choose a caregiver you know is unlicensed, how can you possibly hold them accountable when things go wrong? Maybe this is why the family might be suing BirthCare...if they referred them to an unlicensed midwife. Ugh.

[Anonymous]

Anonymous wrote: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.

Just curious, if something goes wrong, who do you think should pay the related costs of her emergency care and/or that of the baby?

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

Just curious, if something goes wrong, who do you think should pay the related costs of her emergency care and/or that of the baby?

Not the PP you're responding to, but ...

If you are trying to make an argument that home births are making health care more expensive for the rest of us, it's not a very good one. Seriously, the cost to society of "home births gone awry" are completely dwarfed by the costs of hospital births.

To answer your question, the families insurance company would pay, unless the insurance contract barred payment for complications arising out of homebirths...which would probably never be the case. And if they had no insurance? Well, we'd all be paying for them anyway.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Just curious, if something goes wrong, who do you think should pay the related costs of her emergency care and/or that of the baby?

Not the PP you're responding to, but ...

If you are trying to make an argument that home births are making health care more expensive for the rest of us, it's not a very good one. Seriously, the cost to society of "home births gone awry" are completely dwarfed by the costs of hospital births.

To answer your question, the families insurance company would pay, unless the insurance contract barred payment for complications arising out of homebirths...which would probably never be the case. And if they had no insurance? Well, we'd all be paying for them anyway.

One more thing: if a caregiver (midwife or dr.) did not adequately advise their clients, they end up getting sued and paying because of their negligence. If they weren't negligent, and the parents did it anyway, the law pretty much puts the responsibility to pay on the parents.

[Anonymous]

"Virginia is a contributory negligence state...if you choose a caregiver you know is unlicensed, how can you possibly hold them accountable when things go wrong?"

The reality is that virtually no CPMs (and certainly no CPMs practicing illegally) have malpractice insurance.

So, what you're signing up for, if they commit malpractice is absolutely no way to help insure that your baby, brain injured due to malpractice during birth, has additional economic resources to make up for never being to live independently, or earn a living wage or whatever.

[Anonymous]

Anonymous wrote: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.

Disagree. If the baby is full-term and definitely viable, then it has a right to the best possible care to preserve life and function. Why do you think parents who withhold medical care from their children due to religious objections are routinely prosecuted? They are endangering the life of a child.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Just curious, if something goes wrong, who do you think should pay the related costs of her emergency care and/or that of the baby?

Not the PP you're responding to, but ...

If you are trying to make an argument that home births are making health care more expensive for the rest of us, it's not a very good one. Seriously, the cost to society of "home births gone awry" are completely dwarfed by the costs of hospital births.

To answer your question, the families insurance company would pay, unless the insurance contract barred payment for complications arising out of homebirths...which would probably never be the case. And if they had no insurance? Well, we'd all be paying for them anyway.

One more thing: if a caregiver (midwife or dr.) did not adequately advise their clients, they end up getting sued and paying because of their negligence. If they weren't negligent, and the parents did it anyway, the law pretty much puts the responsibility to pay on the parents.

Not trying to present an argument, truly just curious. I don't know anyone who's had a homebirth and don't know enough about it to really make a judgment. I was curious after reading comments that indicated possibilities of not being licensed, the situation possibly not being "smart or safe," etc. That didn't sound like a situation that an insurance company would cover, so I was trying to understand who would/should pay for the associated costs. Believe me, I understand that there's nothing economical about a hospital delivery! I can also see why an insurance company wouldn't want to cover a procedure with a lot of variables in a rather uncontrolled setting.

[Anonymous]

Anonymous wrote:"Virginia is a contributory negligence state...if you choose a caregiver you know is unlicensed, how can you possibly hold them accountable when things go wrong?"

The reality is that virtually no CPMs (and certainly no CPMs practicing illegally) have malpractice insurance.

So, what you're signing up for, if they commit malpractice is absolutely no way to help insure that your baby, brain injured due to malpractice during birth, has additional economic resources to make up for never being to live independently, or earn a living wage or whatever.

Huh, didn't know that. Thanks. I assumed insurance would be a condition of the license, as with other licensed professions. So, you'd be limited to going after the midwife personally, or whatever deep pockets you could possibly claim was negiligent. This is a good enough reason for many to not choose an at home birth, despite the obvious pitfalls of hospital births. At least it is for me. I want some reassurance that the person giving me advice is accountable.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Just curious, if something goes wrong, who do you think should pay the related costs of her emergency care and/or that of the baby?

Not the PP you're responding to, but ...

If you are trying to make an argument that home births are making health care more expensive for the rest of us, it's not a very good one. Seriously, the cost to society of "home births gone awry" are completely dwarfed by the costs of hospital births.

To answer your question, the families insurance company would pay, unless the insurance contract barred payment for complications arising out of homebirths...which would probably never be the case. And if they had no insurance? Well, we'd all be paying for them anyway.

One more thing: if a caregiver (midwife or dr.) did not adequately advise their clients, they end up getting sued and paying because of their negligence. If they weren't negligent, and the parents did it anyway, the law pretty much puts the responsibility to pay on the parents.

Not trying to present an argument, truly just curious. I don't know anyone who's had a homebirth and don't know enough about it to really make a judgment. I was curious after reading comments that indicated possibilities of not being licensed, the situation possibly not being "smart or safe," etc. That didn't sound like a situation that an insurance company would cover, so I was trying to understand who would/should pay for the associated costs. Believe me, I understand that there's nothing economical about a hospital delivery! I can also see why an insurance company wouldn't want to cover a procedure with a lot of variables in a rather uncontrolled setting.

Oh, didn't mean to jump all over you. These are questions I'm learning more about myself, and I'm surprised about what I'm learning about who is held responsible in an at home birth. I'm sure there are arguments against requiring midwives to carry insurance...but it doesn't really change the fact that there's very little recourse for a family that has had a negligently attended homebirth. Do you know if in countries where midwives are the norm what options a family has? I'm wondering their tort law is like and whether they have nationalized healthcare and other safety nets that cover expenses for families in this situation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"Virginia is a contributory negligence state...if you choose a caregiver you know is unlicensed, how can you possibly hold them accountable when things go wrong?"

The reality is that virtually no CPMs (and certainly no CPMs practicing illegally) have malpractice insurance.

So, what you're signing up for, if they commit malpractice is absolutely no way to help insure that your baby, brain injured due to malpractice during birth, has additional economic resources to make up for never being to live independently, or earn a living wage or whatever.

Huh, didn't know that. Thanks. I assumed insurance would be a condition of the license, as with other licensed professions. So, you'd be limited to going after the midwife personally, or whatever deep pockets you could possibly claim was negiligent. This is a good enough reason for many to not choose an at home birth, despite the obvious pitfalls of hospital births. At least it is for me. I want some reassurance that the person giving me advice is accountable.

Malpractice insurance is a requirement for licensure in Florida for midwives, and in Washington state it is necessary to carry it if you want to bill Medicaid. But, the state of Florida subsidizes it, otherwise most midwives could not afford it. The problem with malpractice insurance is that, as we see with OBs, the insurance company has too much power to dictate your scope of practice and you have to live in fear of a bad outcome and the economic consequences of that for your premiums or ability to maintain insurance, which leads to defensive practice, which leads to ... so it's a slippery slope.

[Anonymous]

sooo, what do you all think about the Jewish belief that the mother's life always comes before the unborn baby's? This is my view as well. Even though I am not Jewish, I will do everything to protect my own life before the life of my fetus. For me, this means homebirth. If that makes me a selfish monster, fine.