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

[Anonymous]

Anonymous wrote:

Anonymous wrote:To those who know about the statistical aspects of this, will this sweet baby's death be reported as a home birth death or a hospital death (since he died at the hospital)?

In what regard? If it were part of a well done study, like the Canadian study, it would be included in the homebirth category as the mothers are grouped by intended place of birth.

That's only if the mothers have been recruited specifically for a study. In that case, the researchers in charge will be following everyone enrolled and making sure that the intent to treat model is followed. For a general, run-of-the-mill homebirth, in which no one has been recruited to be part of a study, the CPM can report or not report her data to MANA. A hospital can never choose to not report someone- it's illegal.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You're right, let's not focus on the OB. Instead, let's focus on the fact that an infant can be quickly resuscitated by the NICU attending, the NICU nurse, the pediatrician, etc. A midwife cannot intubate a newborn as far as I know. (you can correct me if I am wrong). Also, an OB can perform an emergency c-section to save the baby's life. A midwife at home cannot do that.

It amazes me that people are still acting like this would have worked in this particular situation. Seriously, a cesarean was NOT going to help this baby once it was realized to be stuck - the entire body had already been delivered! As for the resuscitation, midwives can perform NNR and some are extremely adept at it. It is a huge assumption that resuscitation would have magically worked had it been performed by a NICU nurse rather than the midwife. It seems like in this case, a baby stuck for that amount of time is not going to be revived, period. I know everyone wants to cling to the fact that "the hospital" could have worked a miracle in this case, and while I certainly wouldn't rule that out completely, I also wouldn't assume it to be true. It was a rare, horrific, and DIRE situation, one that certainly could have resulted in the same outcome regardless of where the birth took place.

Um, it's been stated many times here that in such a case, OBs will attempt to push the baby back up to a "safer point" and perform an emergency c-section before oxygen lack becomes dammaging or deadly. No, it doesn't always work, but just like homebirths are "usually" safe, this method "usually" works. It wasn't an option in this case b/c Carr could not perform a c-section nor did she align transfer precautions enough for it to be timely. She didn't even call for it at all. Gimme a break.

Agreed. Also the OB can place incisions in the cervix to widen the pathway for the baby's head to exit. This baby's death may well have been prevented. Very, very sad.

A midwife could also cut the cervix if it would be helpful. In this case, it was not a case of the cervix trapping the head. Cutting the cervix would have caused needless harm to the mother and would not have freed the baby.

Way to address what the midwife could do while ignoring what she could NOT do, and didn't prepare for the need to have done by others.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP here - my understanding is that the shoulders were born (all of the baby except the head was out) so pushing the baby back in was not an option at all. Maybe aggressive use of forceps could have gotten the head out sooner. But there would have been some kind of bad outcome with that as well.

Exactly. A severe head entrapment is a pretty awful situation to be in. No matter where you are, there is a high chance things are not going to end well.

So what you're basically saying here is... in a situation where this pretty awful situation is a stronger possibility than most, a preventive c-section is actually a genuine need? Or at least, preparing for one would be? Interesting. And I thought there was 0 situation where this were possible. Submitted for your consideration: If midwifery suddenly included training, certification, and licensing to perform c-sections, would they still be evil or suddenly a necessary procedure when a midwife calls for it?

[Anonymous]

Is it me or is anyone else out there noticing that both camps are doing the same disservice to women? The ob/gyn medical community is terrible in violating informed consent, performing unnecessary medical procedures and not respecting their patients. I do not know one woman who was informed of the risks to subsequent pregnancies by a c-section or who was told the statistical probabilty of having a c-section if she had an induction. It does not matter if this is still the best course of action, the patient needs to be informed. Information is withheld from patients because the ob/gyn knows best. This treatment is causing women to reject hospitals and ob/gyns.

However, the homebirth community seems to be violating women's choice just as much. The homebirth community hushes any discussion of negative homebirth experiences. There is an interesting discussion on mothering.com regarding speaking up about bad homebirth experiences being taboo. Women who have had bad homebirths report feeling blamed by their midwives for the bad outcome. Women are only told about positive homebirth experiences not the negative ones. This is no better than the ob/gyn practice of telling you that your baby will die if you do not ..insert anything not critical. The homebirth community is no different than the ob/gyn community in pushing their approach onto women and not allowing true informed consent.

Maternal and fetal outcomes would be better if a rationale blending of both approaches was available. If informed consent was actually respected women would be more knowledgable about the true risks, better able mentally prepare for complications, and have a better overall experience. Women are not children or sheep. We don't need to be led by arrogant ob/gyns or mid wives.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm sorry -- the idea that she left a mother suffering from PPH with an assistant, while going on to attend another birth is insane!!

Anyone who would defend her after hearing that is not rationale on the subject of Karen Carr or midwifery generally.

That is hysterical. What the hell do you think happens in a hospital? Where do you think your OB is during your labor?

OB Doc here and for the record, post partum hemorrhages are emergent situations that require interventions that sometimes require life saving surgeries.

I don't know of any OBs who manage these types of situations over the phone. It is fine to support home births in select patients, but can we stop the sweeping statements made about hospitals in general and the care OBs provide specifically? It only serves to dilute the meaningful dialogue that needs to happen so that tragic situations like this do not continue to happen.

Patients need to be properly informed about risks and "boogey-man" tales about OB care does not help to promote wellness and good decision making for anyone.

That's funny, when I had a hemorrhage in the hospital, my OB was nowhere to be found. The charge nurse stepped in and managed the bleeding. 20 minutes later a resident checked in on me, but I was stable by then.

Oh, and beside that, I saw my doctor for about 20 minutes total during my 18 hour labor. It was my nurse who help me move into better positions, it was my nurse who helped my get my labor moving faster, it was my nurse who helped encourage me to go without medications, and it was my nurse who got the OB in the room just in time to deliver my baby. It is insulting that you think that women's real-life experiences are "boogey-man tales".

Sounds like you had a good nurse. Wait... in a hospital? Impossible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:NP here - my understanding is that the shoulders were born (all of the baby except the head was out) so pushing the baby back in was not an option at all. Maybe aggressive use of forceps could have gotten the head out sooner. But there would have been some kind of bad outcome with that as well.

Exactly. A severe head entrapment is a pretty awful situation to be in. No matter where you are, there is a high chance things are not going to end well.

So what you're basically saying here is... in a situation where this pretty awful situation is a stronger possibility than most, a preventive c-section is actually a genuine need? Or at least, preparing for one would be? Interesting. And I thought there was 0 situation where this were possible. Submitted for your consideration: If midwifery suddenly included training, certification, and licensing to perform c-sections, would they still be evil or suddenly a necessary procedure when a midwife calls for it?

I'm not the pp you are quoting, but midwives DO call for c-sections (well, at least most midwives) even if they don't perform them. Many moms are much more agreeable to that c-section from a provider with a 7 or 10% section rate than someone with a 35% section rate (amongst low risk moms).

[Anonymous]

Anonymous wrote:Is it me or is anyone else out there noticing that both camps are doing the same disservice to women? The ob/gyn medical community is terrible in violating informed consent, performing unnecessary medical procedures and not respecting their patients. I do not know one woman who was informed of the risks to subsequent pregnancies by a c-section or who was told the statistical probabilty of having a c-section if she had an induction. It does not matter if this is still the best course of action, the patient needs to be informed. Information is withheld from patients because the ob/gyn knows best. This treatment is causing women to reject hospitals and ob/gyns.

However, the homebirth community seems to be violating women's choice just as much. The homebirth community hushes any discussion of negative homebirth experiences. There is an interesting discussion on mothering.com regarding speaking up about bad homebirth experiences being taboo. Women who have had bad homebirths report feeling blamed by their midwives for the bad outcome. Women are only told about positive homebirth experiences not the negative ones. This is no better than the ob/gyn practice of telling you that your baby will die if you do not ..insert anything not critical. The homebirth community is no different than the ob/gyn community in pushing their approach onto women and not allowing true informed consent.

Maternal and fetal outcomes would be better if a rationale blending of both approaches was available. If informed consent was actually respected women would be more knowledgable about the true risks, better able mentally prepare for complications, and have a better overall experience. Women are not children or sheep. We don't need to be led by arrogant ob/gyns or mid wives.

Great post! I also think that the "hospital birth community" is guilty of censoring negative experiences. When people have shared their negative hospital experiences in this thread they have been repeatedly accused of "fear mongering" and telling "boogey man tales." Let's all be open and hones that awful things can happen in EITHER setting.

[Anonymous]

I think what everyone is missing is that Karen Carr is one bad midwife giving home-birth and midwifery a bad name. She takes to many risks, accepts to many clients, and takes to long to call for help when more medical attention is needed. It makes me very sad that midwives are supporting her. Yes, she is very knowledgeable but that makes her poor judgement even worse because she should know better!

[Anonymous]

I think the PP could be true but how can we really know. Now KC is under the microscope and all her dirty laundry is being aired. Do we REALLY know for a fact that she has a higher than "normal" infant mortality or maternal mortality rate? If we put EVERYONE under the microscope, do you think we might find that she is just average like a lot of providers?

[Anonymous]

Anonymous wrote:I think what everyone is missing is that Karen Carr is one bad midwife giving home-birth and midwifery a bad name. She takes to many risks, accepts to many clients, and takes to long to call for help when more medical attention is needed. It makes me very sad that midwives are supporting her. Yes, she is very knowledgeable but that makes her poor judgement even worse because she should know better!

And you know this how? Do you have all the facts? Have you heard all sides?

Obviously not which makes your pronouncement that KC is "one bad midwife" utterly absurd.

Peoples' willingness to burn KC at the stake without knowing all sides/facts amazes me. Maybe we should just throw her into a pond and see if she sinks or floats. Maybe ask her to try to recite the Lord's Prayer?

[Anonymous]

Me and my family have been affected by my above issues with her. I have seen, heard, and witnessed enough to make the above statement.

I am sure there are other bad midwives out there but the point is this should not be a debate about home birth being safe. This is about one midwife making bad decisions.

She should not be burned at the stake but she should stop putting people's lives at risk.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think what everyone is missing is that Karen Carr is one bad midwife giving home-birth and midwifery a bad name. She takes to many risks, accepts to many clients, and takes to long to call for help when more medical attention is needed. It makes me very sad that midwives are supporting her. Yes, she is very knowledgeable but that makes her poor judgement even worse because she should know better!

And you know this how? Do you have all the facts? Have you heard all sides?

Obviously not which makes your pronouncement that KC is "one bad midwife" utterly absurd.

Peoples' willingness to burn KC at the stake without knowing all sides/facts amazes me. Maybe we should just throw her into a pond and see if she sinks or floats. Maybe ask her to try to recite the Lord's Prayer?

I wish the Amish had a voice. I would love to hear from her Amish families.

[Anonymous]

Anonymous wrote:Me and my family have been affected by my above issues with her. I have seen, heard, and witnessed enough to make the above statement.

I am sure there are other bad midwives out there but the point is this should not be a debate about home birth being safe. This is about one midwife making bad decisions.

She should not be burned at the stake but she should stop putting people's lives at risk.

I'm sorry that that was your experience. Really, not to be dismissive as I hear in your voice true concern, every provider has a certain amount of cases where they didn't do everything perfect and there are small and/or large consequences. Being accountable is important for public safety. The only recourse for accountability is the criminal courts in this case. So, her conduct is held out in the public forum (commented on anonymously in this venue). If a licensed provider's actions are in question, then there is a process in place to hear both sides and peers can decide if they are safe. The process is held behind closed doors. Go to the BOM in VA and you see the closed sessions on peer review. We, the public, only have access to the decision. The other process is a malpractice suit and that is just a big mess.

Again, if indeed you are being truthful (anonymous) i'm sorry you were one that didn't receive the excellent care all women (families) deserve.

[Anonymous]

Anonymous wrote:Me and my family have been affected by my above issues with her. I have seen, heard, and witnessed enough to make the above statement.

I am sure there are other bad midwives out there but the point is this should not be a debate about home birth being safe. This is about one midwife making bad decisions.

She should not be burned at the stake but she should stop putting people's lives at risk.

Then should you not address this through proper channels rather than throwing out an anonymous accusation?

[Anonymous]

Anonymous wrote:Is it me or is anyone else out there noticing that both camps are doing the same disservice to women? The ob/gyn medical community is terrible in violating informed consent, performing unnecessary medical procedures and not respecting their patients. I do not know one woman who was informed of the risks to subsequent pregnancies by a c-section or who was told the statistical probabilty of having a c-section if she had an induction. It does not matter if this is still the best course of action, the patient needs to be informed. Information is withheld from patients because the ob/gyn knows best. This treatment is causing women to reject hospitals and ob/gyns.

However, the homebirth community seems to be violating women's choice just as much. The homebirth community hushes any discussion of negative homebirth experiences. There is an interesting discussion on mothering.com regarding speaking up about bad homebirth experiences being taboo. Women who have had bad homebirths report feeling blamed by their midwives for the bad outcome. Women are only told about positive homebirth experiences not the negative ones. This is no better than the ob/gyn practice of telling you that your baby will die if you do not ..insert anything not critical. The homebirth community is no different than the ob/gyn community in pushing their approach onto women and not allowing true informed consent.

Maternal and fetal outcomes would be better if a rationale blending of both approaches was available. If informed consent was actually respected women would be more knowledgable about the true risks, better able mentally prepare for complications, and have a better overall experience. Women are not children or sheep. We don't need to be led by arrogant ob/gyns or mid wives.

Great posts, articulates many of my thoughts which I am not able to express nearly as well!