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

[Anonymous]

Anonymous wrote:

Anonymous wrote:Sounds to me like Carr is “great” when things would go right no matter what, but the minute things go wrong, she lacks everything required to attempt to improve matters (and even makes them worse).

If you fail someone’s bleeding to death and you neglect to take them to the hospital to be stitched up and they die, you’re still at fault for their death even if they were a hemophiliac – so saying that nothing could have saved that child (whether that’s true or not), doesn’t exonerate this woman from what she did wrong - without ever bothering to get and maintain a license, no less.

As for how she treated the quoted former client who felt Carr wasn’t present, gave her drugs, and bolted: sounds like every evil OB chastised here! And imploring her NOT to tell docs that she had Pitocin in her system because she hadn’t been allowed to administer it?! Yeah… real safe… and moral. Truly epitomizes the moral high-ground. Suuuuuure. But no, Carr doesn’t let “covering her ass” color ANY of her judgement.

“They both said everything was going well, until it wasn’t.” Yeah, see, that’s the kind of shit that hits the fan in birthin’ babies.

“the baby was doing better, and the ambulance was sent away. Some hours later, the baby started going down again, so I brought the baby to the hospital. And it didn’t make it,” Carr said. “I’m not sure what happened to that baby, why it wasn’t breathing.” “ You know who WOULD have known what was up with that baby? The NICU. The minute it struggled, it would have gone there and been monitored so this didn’t get a chance to happen. They wouldn’t have been turned away if the baby was suddenly doing better without looking for cause and observing closely to prevent recurring. Oh, the evil hospital “taking” your baby to the life-saving unit. And great follow-up so you can LEARN FROM THE EXPERIENCE, Carr.

And $3,200 per delivery is LESS than a hospital??? If you’re insured for preg and cb, it’s similar, if not WAY more.

Really tired of reading “we don’t know enough about the case”. Perhaps – but people here are judging what we DO know, which isn’t all that little. Seems like most details have come out. No medical professional approves of how this went down and that it wasn’t avoidable, and midwives are SPLIT on it. Sounds like opinions on this thread aren’t all that 50/50.

For NO OTHER SERVICE is there such a proud and blatant dissociation from laws and licensure. Midwives like Karen Carr do no favors to their movement and disgustingly take advantage of the vulnerability and “magical” thing that is giving birth. Way to go. And if it makes you so mad that an OB wouldn’t be facing the same persecution, then fight so that they do – not so that everyone gets such a supposed “pass”.

Posts like these are exactly why I used the term "witch hunt". People posting here are so overwhelmingly egotistical and arrogant that they cannot even comprehend the extent to which they DO NOT KNOW THE FACTS and have little to no understanding of the clients that CPMs typically serve.

This thread is rife with accusations, assumptions, lies and mockery about Karen Carr, CPMs, homebirths, and the women who choose homebirth over hospital birth. The whole thing is disgusting and many of the women here should be ashamed of themselves. The thing is, as mothers WE ALL want to do what we feel is best for ourselves and our babies. The choices we make do not harm other families, so why is it so difficult to allow others their choices, even if we personally would not make the same ones? Myself, I do not necessarily agree with the mother's choice but I am very much a fan of individual choice and the government staying OUT of our health care decisions.

What’s to argue against in this post?

Did Karen Carr NOT overly delay call for help? Did she not render such a call useless with her setup and delays? Does she NOT apparently have a history of being successful when things go according to plan and miserably failing when they do not?

Did she NOT get described by a former customer as having been less than attentive for her birth and leaving when she was bleeding out? Did she NOT admit to administering drugs illegally? Was she NOT accused by that former customer of asking her to lie about the drugs being in her system?

Did she NOT say HERSELF that “everything was going well, until it wasn’t?”

Did she NOT admit to turning away EMTs after a later-dead baby was breathing better without bothering to figure out WHY the baby had struggled to start with? Did she NOT recommend that child ginto a NICU for close monitoring in case it happened again? Did she NOT admit to “not knowing” what was wrong (or ever finding out)? Does that NOT show lack of follow-through on any level?

Are posters NOT split on this issue in this thread? Including midwives and who are then chastised as not being “genuine midwives” if they disagree with deifying Carr?

Are many here NOT comparing the issue with a hospital birth saying an OB would be protected against prosecution for manslaughter while Carr is not? Is it NOT justified to say that ALL should be investigated rather than all NOT being investigated?

It's not a witch hunt to have an opinion that challenges others' - nor is it a statement against freedom of choice for there to be representative regulations so that such a choice is made informatively. It's NOT taking away a profession to regulate it like all others or to ask that those who disagree with it IMPROVE IT FROM WITHIN rather than create their little utopia in which only believers are welcome. In the meantime, I'm GLAD posts like this influence the CHOICE women are freely making.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Who said anything about the government making peoples' health care decisions for them??!!

The argument is that there should be a way to regulate those who provide health care so that consumers can actually make INFORMED choices based on outcomes and provider competence. How could this not benefit ALL women?

Those who advocate against CPMs/DEMs are trying to take away that option...an option that many families want and do choose.

There ARE regulations in place and there is an oversight. In VA, CPMs are regulated by the legislature and overseen by the VA Board of Medicine.

What does DEM stand for, I'm not familiar with that term?

What you are saying doesn't make sense to me. You are stating that there IS oversight and regulation of CPM's in VA, yet of course KC would not be accountable to that oversight since she practices without licensure.

DEM = Direct entry midwife

When a MW is practicing without a license, the criminal justice system steps in which exactly what happened here.

I am not sure if you are the individual I was responding to earlier, but thanks for the explanation of DEM.

So the fact that the criminal justice system has stepped in, very appropriate in this situation, does not mean that "the government is trying to take away women's choices."
What kind of statement is that other than fear mongering?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Sounds to me like Carr is “great” when things would go right no matter what, but the minute things go wrong, she lacks everything required to attempt to improve matters (and even makes them worse).

If you fail someone’s bleeding to death and you neglect to take them to the hospital to be stitched up and they die, you’re still at fault for their death even if they were a hemophiliac – so saying that nothing could have saved that child (whether that’s true or not), doesn’t exonerate this woman from what she did wrong - without ever bothering to get and maintain a license, no less.

As for how she treated the quoted former client who felt Carr wasn’t present, gave her drugs, and bolted: sounds like every evil OB chastised here! And imploring her NOT to tell docs that she had Pitocin in her system because she hadn’t been allowed to administer it?! Yeah… real safe… and moral. Truly epitomizes the moral high-ground. Suuuuuure. But no, Carr doesn’t let “covering her ass” color ANY of her judgement.

“They both said everything was going well, until it wasn’t.” Yeah, see, that’s the kind of shit that hits the fan in birthin’ babies.

“the baby was doing better, and the ambulance was sent away. Some hours later, the baby started going down again, so I brought the baby to the hospital. And it didn’t make it,” Carr said. “I’m not sure what happened to that baby, why it wasn’t breathing.” “ You know who WOULD have known what was up with that baby? The NICU. The minute it struggled, it would have gone there and been monitored so this didn’t get a chance to happen. They wouldn’t have been turned away if the baby was suddenly doing better without looking for cause and observing closely to prevent recurring. Oh, the evil hospital “taking” your baby to the life-saving unit. And great follow-up so you can LEARN FROM THE EXPERIENCE, Carr.

And $3,200 per delivery is LESS than a hospital??? If you’re insured for preg and cb, it’s similar, if not WAY more.

Really tired of reading “we don’t know enough about the case”. Perhaps – but people here are judging what we DO know, which isn’t all that little. Seems like most details have come out. No medical professional approves of how this went down and that it wasn’t avoidable, and midwives are SPLIT on it. Sounds like opinions on this thread aren’t all that 50/50.

For NO OTHER SERVICE is there such a proud and blatant dissociation from laws and licensure. Midwives like Karen Carr do no favors to their movement and disgustingly take advantage of the vulnerability and “magical” thing that is giving birth. Way to go. And if it makes you so mad that an OB wouldn’t be facing the same persecution, then fight so that they do – not so that everyone gets such a supposed “pass”.

Posts like these are exactly why I used the term "witch hunt". People posting here are so overwhelmingly egotistical and arrogant that they cannot even comprehend the extent to which they DO NOT KNOW THE FACTS and have little to no understanding of the clients that CPMs typically serve.

This thread is rife with accusations, assumptions, lies and mockery about Karen Carr, CPMs, homebirths, and the women who choose homebirth over hospital birth. The whole thing is disgusting and many of the women here should be ashamed of themselves. The thing is, as mothers WE ALL want to do what we feel is best for ourselves and our babies. The choices we make do not harm other families, so why is it so difficult to allow others their choices, even if we personally would not make the same ones? Myself, I do not necessarily agree with the mother's choice but I am very much a fan of individual choice and the government staying OUT of our health care decisions.

What’s to argue against in this post?

Did Karen Carr NOT overly delay call for help? Did she not render such a call useless with her setup and delays? Does she NOT apparently have a history of being successful when things go according to plan and miserably failing when they do not?

Did she NOT get described by a former customer as having been less than attentive for her birth and leaving when she was bleeding out? Did she NOT admit to administering drugs illegally? Was she NOT accused by that former customer of asking her to lie about the drugs being in her system?

Did she NOT say HERSELF that “everything was going well, until it wasn’t?”

Did she NOT admit to turning away EMTs after a later-dead baby was breathing better without bothering to figure out WHY the baby had struggled to start with? Did she NOT recommend that child ginto a NICU for close monitoring in case it happened again? Did she NOT admit to “not knowing” what was wrong (or ever finding out)? Does that NOT show lack of follow-through on any level?

Are posters NOT split on this issue in this thread? Including midwives and who are then chastised as not being “genuine midwives” if they disagree with deifying Carr?

Are many here NOT comparing the issue with a hospital birth saying an OB would be protected against prosecution for manslaughter while Carr is not? Is it NOT justified to say that ALL should be investigated rather than all NOT being investigated?

It's not a witch hunt to have an opinion that challenges others' - nor is it a statement against freedom of choice for there to be representative regulations so that such a choice is made informatively. It's NOT taking away a profession to regulate it like all others or to ask that those who disagree with it IMPROVE IT FROM WITHIN rather than create their little utopia in which only believers are welcome. In the meantime, I'm GLAD posts like this influence the CHOICE women are freely making.

Couldn't agree with you more (and I had a homebirth)!

[Anonymous]

Anonymous wrote:

Anonymous wrote:Sounds to me like Carr is “great” when things would go right no matter what, but the minute things go wrong, she lacks everything required to attempt to improve matters (and even makes them worse).

If you fail someone’s bleeding to death and you neglect to take them to the hospital to be stitched up and they die, you’re still at fault for their death even if they were a hemophiliac – so saying that nothing could have saved that child (whether that’s true or not), doesn’t exonerate this woman from what she did wrong - without ever bothering to get and maintain a license, no less.

As for how she treated the quoted former client who felt Carr wasn’t present, gave her drugs, and bolted: sounds like every evil OB chastised here! And imploring her NOT to tell docs that she had Pitocin in her system because she hadn’t been allowed to administer it?! Yeah… real safe… and moral. Truly epitomizes the moral high-ground. Suuuuuure. But no, Carr doesn’t let “covering her ass” color ANY of her judgement.

“They both said everything was going well, until it wasn’t.” Yeah, see, that’s the kind of shit that hits the fan in birthin’ babies.

“the baby was doing better, and the ambulance was sent away. Some hours later, the baby started going down again, so I brought the baby to the hospital. And it didn’t make it,” Carr said. “I’m not sure what happened to that baby, why it wasn’t breathing.” “ You know who WOULD have known what was up with that baby? The NICU. The minute it struggled, it would have gone there and been monitored so this didn’t get a chance to happen. They wouldn’t have been turned away if the baby was suddenly doing better without looking for cause and observing closely to prevent recurring. Oh, the evil hospital “taking” your baby to the life-saving unit. And great follow-up so you can LEARN FROM THE EXPERIENCE, Carr.

And $3,200 per delivery is LESS than a hospital??? If you’re insured for preg and cb, it’s similar, if not WAY more.

Really tired of reading “we don’t know enough about the case”. Perhaps – but people here are judging what we DO know, which isn’t all that little. Seems like most details have come out. No medical professional approves of how this went down and that it wasn’t avoidable, and midwives are SPLIT on it. Sounds like opinions on this thread aren’t all that 50/50.

For NO OTHER SERVICE is there such a proud and blatant dissociation from laws and licensure. Midwives like Karen Carr do no favors to their movement and disgustingly take advantage of the vulnerability and “magical” thing that is giving birth. Way to go. And if it makes you so mad that an OB wouldn’t be facing the same persecution, then fight so that they do – not so that everyone gets such a supposed “pass”.

Posts like these are exactly why I used the term "witch hunt". People posting here are so overwhelmingly egotistical and arrogant that they cannot even comprehend the extent to which they DO NOT KNOW THE FACTS and have little to no understanding of the clients that CPMs typically serve.

This thread is rife with accusations, assumptions, lies and mockery about Karen Carr, CPMs, homebirths, and the women who choose homebirth over hospital birth. The whole thing is disgusting and many of the women here should be ashamed of themselves. The thing is, as mothers WE ALL want to do what we feel is best for ourselves and our babies. The choices we make do not harm other families, so why is it so difficult to allow others their choices, even if we personally would not make the same ones? Myself, I do not necessarily agree with the mother's choice but I am very much a fan of individual choice and the government staying OUT of our health care decisions.

How is it egotistical to put together things that we know from Karen Carr's own statements? How is that a witch hunt? And please, explain it to me, how on earth regulating midwives who have repeatedly shown a dangerous lack of judgment is limiting women's choices? Your children aren't your property; they are human beings who deserve the best care they can get. So please, stop claiming that expecting CPMs to adhere to some minimal requirements for knowledge and skills and judgment is "OMG the government is taking over my uterus!!"

Ridiculous.

[Anonymous]

"How is it egotistical to put together things that we know from Karen Carr's own statements? How is that a witch hunt? And please, explain it to me, how on earth regulating midwives who have repeatedly shown a dangerous lack of judgment is limiting women's choices? Your children aren't your property; they are human beings who deserve the best care they can get. So please, stop claiming that expecting CPMs to adhere to some minimal requirements for knowledge and skills and judgment is "OMG the government is taking over my uterus!!"

Ridiculous. "

Very well put!

[Anonymous]

Anonymous wrote:

Anonymous wrote:Wait -- so if you have a good experience with KC and are happy with her telling you her statistics (based in fact?) then you are free to anonymously post on DCUM.

But if have had a bad experience then you should....well keep your mouth shut. Because somehow your experience is less valid than the others?

IN SERVICE TO WOMEN my ass!

Perhaps she did complain to NARM and MANA and KC. Considering how many certifications they have pulled it seems like there is no recourse for these women who have a bad experience with midwives. Perhaps it is because of this woman (and others) that the authorities have finally decided to look at what is going wrong with this midwife.

Why is it that we are supposed to only believe anonymous posters who have good to say about KC but he ones who have something bad to say are on a witch hunt?

Nobody told this person to shut up. In fact, quite the opposite is true. S/He was told to talk to the authorities...to actually do something and be proactive. If there truly was negligence by KC while attending this family...it should be pursued via the proper channels where all sides have the opportunity to speak. Posting an incredibly vague accusation anonymously on a chat board only creates skepticism of the author's truthfulness and intentions.

And yes, there is a big difference between posting something positive and posting something negative...even the law recognizes this (ie libel, slander etc .).

Oh good grief. Are you serious?!?! Do you even know the definitions of either? First about the shut up comment -- on DCUM people told this woman to not speak up HERE on DCUM. That she should in fact not talk here (of or like shutting up) but just go to the authorities since that is a proper channel. Maybe she did go to the authorities and here. Maybe she did go to NARM and here. You don't know what she did so why would she not be able to speak up here? Because you don't want to hear what she has to say?

Second, perhaps it was libel for the PP to post KC's statistics. Perhaps KC's statistics are even better than what the poster put (doubtful but whatever.....) on DCUM. Is that libel according to your definition also?

I would actually like to hear more from the woman with the KC delivery story. I don't think she should shut up and if she is telling the truth than it isn't libel. We already know there is at least one other mother out there, willing to go to the authorities and media, who was unhappy with the care she received. Her story isn't libel either. Truth.

[Anonymous]

Anonymous wrote:"How is it egotistical to put together things that we know from Karen Carr's own statements? How is that a witch hunt? And please, explain it to me, how on earth regulating midwives who have repeatedly shown a dangerous lack of judgment is limiting women's choices? Your children aren't your property; they are human beings who deserve the best care they can get. So please, stop claiming that expecting CPMs to adhere to some minimal requirements for knowledge and skills and judgment is "OMG the government is taking over my uterus!!"

Ridiculous. "

Very well put!

Because YOU do NOT know all the facts. You have heard ONE side to the arguement. The only statements from KC have been filtered by the press. A few statments in a newspaper do not make for a proper/adequate rebuttal. In all too many cases, things have seemed clear on their face only to be flipped upside down by a explanation. All you hear is it took X amount of time to call 911. Other people (who are actually interested in the FULL story) are curious as to why. Is there enough here to question KC's actions? Yes. Is there here to convict her? No way.

Only those with egos big enough to believe they can fully understand the situation without the full story would say otherwise.

[Anonymous]

Just found this at http://www.dhp.virginia.gov/medicine/advisory/mw/Default.asp - regulations governing Virginia midwives:

18VAC85-130-120. Practitioner responsibility.
A. A practitioner shall:
1. Transfer care immediately in critical situations that are deemed to be unsafe to a client or infant and remain with the client until the transfer is complete;
2. Work collaboratively with other health professionals and refer a client or an infant to appropriate health care professionals when either needs care outside the midwife’s scope of practice or expertise; and
3. Base choices of interventions on empirical and/or research evidence that would indicate the probable benefits outweigh the risks.

B. A practitioner shall not:
1. Perform procedures or techniques that are outside the scope of the midwife’s practice or for which the midwife is not trained and individually competent;
2. Knowingly allow apprentices or subordinates to jeopardize client safety or provide client care outside of the apprentice’s or subordinate’s scope of practice or area of responsibility. Practitioners shall delegate client care only to those who are properly trained and supervised; and
3. Exploit the practitioner/client relationship for personal gain.


Just looking at the list, it looks like Karen Carr has violated several. Performing procedures outside her practice? Check. Allowing apprentices to provide care outside their scope of practice? Check. Not transferring care immediately in critical situations? Check. Not referring women and children with needs outside of midwife's scope? Check. Not choosing interventions for which benefits outweigh risks? Check.

She has, according to her own interviews, violated several standards of practice for CPMs in Virginia.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"How is it egotistical to put together things that we know from Karen Carr's own statements? How is that a witch hunt? And please, explain it to me, how on earth regulating midwives who have repeatedly shown a dangerous lack of judgment is limiting women's choices? Your children aren't your property; they are human beings who deserve the best care they can get. So please, stop claiming that expecting CPMs to adhere to some minimal requirements for knowledge and skills and judgment is "OMG the government is taking over my uterus!!"

Ridiculous. "

Very well put!

Because YOU do NOT know all the facts. You have heard ONE side to the arguement. The only statements from KC have been filtered by the press. A few statments in a newspaper do not make for a proper/adequate rebuttal. In all too many cases, things have seemed clear on their face only to be flipped upside down by a explanation. All you hear is it took X amount of time to call 911. Other people (who are actually interested in the FULL story) are curious as to why. Is there enough here to question KC's actions? Yes. Is there here to convict her? No way.

Only those with egos big enough to believe they can fully understand the situation without the full story would say otherwise.

Only those with egos big enough to believe that this midwife can do no wrong are using this argument. She screwed up. Several times. People died. Sure, tell me the other side of that one.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Wait -- so if you have a good experience with KC and are happy with her telling you her statistics (based in fact?) then you are free to anonymously post on DCUM.

But if have had a bad experience then you should....well keep your mouth shut. Because somehow your experience is less valid than the others?

IN SERVICE TO WOMEN my ass!

Perhaps she did complain to NARM and MANA and KC. Considering how many certifications they have pulled it seems like there is no recourse for these women who have a bad experience with midwives. Perhaps it is because of this woman (and others) that the authorities have finally decided to look at what is going wrong with this midwife.

Why is it that we are supposed to only believe anonymous posters who have good to say about KC but he ones who have something bad to say are on a witch hunt?

Nobody told this person to shut up. In fact, quite the opposite is true. S/He was told to talk to the authorities...to actually do something and be proactive. If there truly was negligence by KC while attending this family...it should be pursued via the proper channels where all sides have the opportunity to speak. Posting an incredibly vague accusation anonymously on a chat board only creates skepticism of the author's truthfulness and intentions.

And yes, there is a big difference between posting something positive and posting something negative...even the law recognizes this (ie libel, slander etc .).

Oh good grief. Are you serious?!?! Do you even know the definitions of either? First about the shut up comment -- on DCUM people told this woman to not speak up HERE on DCUM. That she should in fact not talk here (of or like shutting up) but just go to the authorities since that is a proper channel. Maybe she did go to the authorities and here. Maybe she did go to NARM and here. You don't know what she did so why would she not be able to speak up here? Because you don't want to hear what she has to say?

Second, perhaps it was libel for the PP to post KC's statistics. Perhaps KC's statistics are even better than what the poster put (doubtful but whatever.....) on DCUM. Is that libel according to your definition also?

I would actually like to hear more from the woman with the KC delivery story. I don't think she should shut up and if she is telling the truth than it isn't libel. We already know there is at least one other mother out there, willing to go to the authorities and media, who was unhappy with the care she received. Her story isn't libel either. Truth.

a bit of reading comprehension seems to be on order. Nobody said the post was libel....it was an *example* of why there is a difference between positive and negfative reviews. Further you can't know if the post amounted to libel as you don't, like KC's story, know the truth which is one of the elements of libel.

[Anonymous]

Anonymous wrote:Just found this at http://www.dhp.virginia.gov/medicine/advisory/mw/Default.asp - regulations governing Virginia midwives:

18VAC85-130-120. Practitioner responsibility.
A. A practitioner shall:
1. Transfer care immediately in critical situations that are deemed to be unsafe to a client or infant and remain with the client until the transfer is complete;
2. Work collaboratively with other health professionals and refer a client or an infant to appropriate health care professionals when either needs care outside the midwife’s scope of practice or expertise; and
3. Base choices of interventions on empirical and/or research evidence that would indicate the probable benefits outweigh the risks.

B. A practitioner shall not:
1. Perform procedures or techniques that are outside the scope of the midwife’s practice or for which the midwife is not trained and individually competent;
2. Knowingly allow apprentices or subordinates to jeopardize client safety or provide client care outside of the apprentice’s or subordinate’s scope of practice or area of responsibility. Practitioners shall delegate client care only to those who are properly trained and supervised; and
3. Exploit the practitioner/client relationship for personal gain.


Just looking at the list, it looks like Karen Carr has violated several. Performing procedures outside her practice? Check. Allowing apprentices to provide care outside their scope of practice? Check. Not transferring care immediately in critical situations? Check. Not referring women and children with needs outside of midwife's scope? Check. Not choosing interventions for which benefits outweigh risks? Check.

She has, according to her own interviews, violated several standards of practice for CPMs in Virginia.

Actually, having researched this, the MW sets the scope of her practice. Yes, it must stay within the bounds set by the law but the law in VA allows MWs to attend breech births. Further, we don't know the scope of the assistant's practice. The only unlawfull thing she did was to administer pit (ridiculous that MWs cannot administer) and practice w/o a license.

[Anonymous]

The most libel statements made have been by KC herself. Those quotes in the article did a lot of damage to her own reputation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Just found this at http://www.dhp.virginia.gov/medicine/advisory/mw/Default.asp - regulations governing Virginia midwives:

18VAC85-130-120. Practitioner responsibility.
A. A practitioner shall:
1. Transfer care immediately in critical situations that are deemed to be unsafe to a client or infant and remain with the client until the transfer is complete;
2. Work collaboratively with other health professionals and refer a client or an infant to appropriate health care professionals when either needs care outside the midwife’s scope of practice or expertise; and
3. Base choices of interventions on empirical and/or research evidence that would indicate the probable benefits outweigh the risks.

B. A practitioner shall not:
1. Perform procedures or techniques that are outside the scope of the midwife’s practice or for which the midwife is not trained and individually competent;
2. Knowingly allow apprentices or subordinates to jeopardize client safety or provide client care outside of the apprentice’s or subordinate’s scope of practice or area of responsibility. Practitioners shall delegate client care only to those who are properly trained and supervised; and
3. Exploit the practitioner/client relationship for personal gain.


Just looking at the list, it looks like Karen Carr has violated several. Performing procedures outside her practice? Check. Allowing apprentices to provide care outside their scope of practice? Check. Not transferring care immediately in critical situations? Check. Not referring women and children with needs outside of midwife's scope? Check. Not choosing interventions for which benefits outweigh risks? Check.

She has, according to her own interviews, violated several standards of practice for CPMs in Virginia.

Actually, having researched this, the MW sets the scope of her practice. Yes, it must stay within the bounds set by the law but the law in VA allows MWs to attend breech births. Further, we don't know the scope of the assistant's practice. The only unlawfull thing she did was to administer pit (ridiculous that MWs cannot administer) and practice w/o a license.

She attended home breech and twin births, when better-trained midwives wouldn't. She didn't transfer promptly with either the head entrapment or the respiratory distress babies, or with the hemorrhaging mother. In fact, she left a hemorrhaging mother with her assistant (I would call that outside the assistant's scope). She advised a mother to lie to her hospital care providers. And I do think it's reasonable that a midwife should be able to administer some drugs, but only after passing a strict pharmacology exam to be sure she knows what the heck she's doing.

[Anonymous]

on slate from susan jenkins

susanjenkins2348
It is illegal to practice midwifery or any other health profession without a license in Virginia, Maryland, and DC. There are two types of midwives, essentially -- certified nurse-midwives or CNMs who are licensed and regulated in VA, MD, and DC by the Board of Nursing in each jurisdiction, and direct-entry midwives (that is, midwives who are not required to first become a nurse before they may study to become a midwife. SOME direct-entry midwives, like Ms. Carr, have passed a national examination and, as a result, have been CERTIFIED as a Certified Professional Midwife or CPM. So, CPMs are one category of direct entry midwives and are distinct from CNMs, who have to be nurses as well as midwives.
Neither Maryland nor DC has a law that authorizes a state agency to grant a license to CPMs or any other kind of direct-entry midwife. Without any such law, it is impossible to get a midwifery license. So, Ms. Carr could not have gotten a license in either Maryland or DC. Anyone who practices as a midwife in either Maryland or DC is practicing illegally, because without a license, the midwife is engaged in unauthorized practice. The lack of a licensure law doesn't mean it's OK to practice without a license. It means, instead, that no one may practice midwifery -- unless they are nurse-midwives, in which case they can get a license from the Board of Nursing.
Ms. Carr COULD have applied for and been granted a license in VA, but for whatever reasons chose not to.
At the present time, CPMs practice legally through licensure or other official state recognition and permit in 27 states, including VA. A national campaign called the Big Push for Midwives Campaign works with state consumer groups to get laws passed that regulate and license midwives who have proven their qualifications to practice and are willing to be subject to state regulation. We hope that Maryland and DC consumers will join with us soon to seek laws like Virginia's, so that consumers will know who the midwives are, what their qualifications are, whether there are any complaints against any individual midwife, etc. Consumers are entitled to have midwives who are subject to the same kind of regulation that phyisicans, nurses, dentists, and psychologists have governing their practice. Midwives should be certified, licensed, and regulated by a state agency in the state where they practice.
A small but significant number of American women want to give birth at home for various reasons, including religious, financial, personal, and research that shows that home birth is safer for baby and mother. They will not be deterred just because the state doesn't have a licensing system. If the state wants to ensure high standards among providers of out-of-hospital birth, then the legislature must pass a law that provides for licenses and sets up a governing board to regulate midwives. I hope Ms. Carr will join with the consumers and midwives of MD and DC to advocate for these laws.

[Anonymous]

I think what the PP was trying to say is that people are posting things like, "My understanding, based on conversations directly with KC, is that her outcomes are very good. She is very open about the losses she has had - six or seven total, depending on how you count her statistics (yes, she includes this case). She also has a 3% cesarean rate, a 5% transfer rate, and serves women who are having twins, VBACs and breech babies."

Why should we believe you when you state this? If everyone is suspect in what they are saying then why should this statement carry any more weight than someone else's statement which isn't as positive?