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

[Anonymous]

Anonymous wrote:

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.

Ugh. The arguments you make go towards negligence.....NOT the scope of her practice.

Some precision here would be nice.

[Anonymous]

Anonymous wrote: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?

I will repeat what others have said. Call KC and ask her.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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?

I will repeat what others have said. Call KC and ask her.

Why should anyone call KC and ask her? What a ridiculous comment.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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?

I will repeat what others have said. Call KC and ask her.

You have her number? Actually I wouldn't call her because her rates don't interest me. But I do wonder how she tracks he own statistics. Without anything formal I really don't think I would believe them. That is just me though. It clearly seems to be good enough for others.

[Anonymous]

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

[Anonymous]

Anonymous wrote:
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.

Wait, wait, wait. What do you mean by "the midwife sets the scope of practice?" SHE is the one who decides that she's an expert in breech, twin, and HBAC births? Just because she says so and it feels good to her? With no guidance from, I don't know, RESEARCH that says that these situations lead to complications more often than singleton, cephalic births to mothers with no CS history?

So if the midwife gets to decide her own scope of practice, why can't my family practice nurse do a spinal tap on my infant? I'm sure she'd do fine! She's seen it done before, and I trust her more than a doctor I just met. And why can't my son's school nurse administer antibiotics to kids who clearly have ear and throat infections? She's seen it tons of times, and she knows what she's doing.

I think all of these other healthcare providers need to follow the example of the CPMs- no more restrictions! They all know what they're doing- when the government doesn't allow them to do what they want, it's interfering with my right to choose!

[Anonymous]

Anonymous wrote:

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

Yes, the midwife model of care is very different. Some might kiss a Mama on the forehead, some will greet a Mama with a big hug, some are more reserved. It varies with each person (which is why people interview midwives...to find the right match). It is usually a *much* more personal approach. Instead of the usual 10 minute appt., a prenatal with a MW can often take an hour or longer. It is not paternalistic...it's supportive and caring

The MW model of care isn't for everyone but it is definitly a perfect fit for some which is why it must remain an option.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

Yes, the midwife model of care is very different. Some might kiss a Mama on the forehead, some will greet a Mama with a big hug, some are more reserved. It varies with each person (which is why people interview midwives...to find the right match). It is usually a *much* more personal approach. Instead of the usual 10 minute appt., a prenatal with a MW can often take an hour or longer. It is not paternalistic...it's supportive and caring

The MW model of care isn't for everyone but it is definitly a perfect fit for some which is why it must remain an option.

And it is an option. CNMs are well-trained and can work in hospitals and birth centers in every state. They also do home births, but not as often, presumably because they've seen the speed at which babies can be injured in birth.

I just find it interesting that pateralistic behavior from doctors is evil, while paternalistic behavior from a midwife is "the midwife model of care." And if your OB only has 10 minutes for you, even when you want more, then find another OB. Most do not rush you out when you have questions, but they won't hold you there for 30-60 minutes if you don't have questions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

Yes, the midwife model of care is very different. Some might kiss a Mama on the forehead, some will greet a Mama with a big hug, some are more reserved. It varies with each person (which is why people interview midwives...to find the right match). It is usually a *much* more personal approach. Instead of the usual 10 minute appt., a prenatal with a MW can often take an hour or longer. It is not paternalistic...it's supportive and caring

The MW model of care isn't for everyone but it is definitly a perfect fit for some which is why it must remain an option.

And speaking of paternalistic, if anyone other than my kids calls me "mama," we won't be having a professional relationship for much longer.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

Yes, the midwife model of care is very different. Some might kiss a Mama on the forehead, some will greet a Mama with a big hug, some are more reserved. It varies with each person (which is why people interview midwives...to find the right match). It is usually a *much* more personal approach. Instead of the usual 10 minute appt., a prenatal with a MW can often take an hour or longer. It is not paternalistic...it's supportive and caring

The MW model of care isn't for everyone but it is definitly a perfect fit for some which is why it must remain an option.

And speaking of paternalistic, if anyone other than my kids calls me "mama," we won't be having a professional relationship for much longer.

You see the term Mama as paternalistic....I see it as a term of respect. You clearly want a cold wall between yourselfb and your HCP...fine. If it's your thing, go for it. There are certainly plenty who will provide just that. Others, however, do not and that is absolutely their choice to make.

There are also those who choose to birth at home with a CPM. Again, that should be their choice to make. You may not like it...you may think it's a bad choice; however, that it completely irrelevant to them. Just as you should have the ability to have the birth attendant of your choice...so should they.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

Yes, the midwife model of care is very different. Some might kiss a Mama on the forehead, some will greet a Mama with a big hug, some are more reserved. It varies with each person (which is why people interview midwives...to find the right match). It is usually a *much* more personal approach. Instead of the usual 10 minute appt., a prenatal with a MW can often take an hour or longer. It is not paternalistic...it's supportive and caring

The MW model of care isn't for everyone but it is definitly a perfect fit for some which is why it must remain an option.

And speaking of paternalistic, if anyone other than my kids calls me "mama," we won't be having a professional relationship for much longer.

You see the term Mama as paternalistic....I see it as a term of respect. You clearly want a cold wall between yourselfb and your HCP...fine. If it's your thing, go for it. There are certainly plenty who will provide just that. Others, however, do not and that is absolutely their choice to make.

There are also those who choose to birth at home with a CPM. Again, that should be their choice to make. You may not like it...you may think it's a bad choice; however, that it completely irrelevant to them. Just as you should have the ability to have the birth attendant of your choice...so should they.

Well, I don't think anyone is saying that licensed CPM's don't have a place in certain low risk settings, but we are discussing KC here, and the fact that she was found guilty of two felonies related to home birth. Yes, I guess it is a woman's right to choose, but it doesn't mean that the rest of us have to agree with her choice.
If a teacher at your child's school had pled guilty to child abuse or endangerment, it would be your choice if you wanted to invite him into your home to tutor your child , for example. Doesn't mean that I wouldn't think you were nuts to make that choice--your choice to make.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

Yes, the midwife model of care is very different. Some might kiss a Mama on the forehead, some will greet a Mama with a big hug, some are more reserved. It varies with each person (which is why people interview midwives...to find the right match). It is usually a *much* more personal approach. Instead of the usual 10 minute appt., a prenatal with a MW can often take an hour or longer. It is not paternalistic...it's supportive and caring

The MW model of care isn't for everyone but it is definitly a perfect fit for some which is why it must remain an option.

And speaking of paternalistic, if anyone other than my kids calls me "mama," we won't be having a professional relationship for much longer.

You see the term Mama as paternalistic....I see it as a term of respect. You clearly want a cold wall between yourselfb and your HCP...fine. If it's your thing, go for it. There are certainly plenty who will provide just that. Others, however, do not and that is absolutely their choice to make.

There are also those who choose to birth at home with a CPM. Again, that should be their choice to make. You may not like it...you may think it's a bad choice; however, that it completely irrelevant to them. Just as you should have the ability to have the birth attendant of your choice...so should they.

Is it also my right to have a nurse practitioner to my brain surgery?

How does wanting to be addressed by my actual name and not "mama" mean that I want a cold wall between myself and my care provider? I think that using my actual, real name shows a lot more respect than a generic term that addresses only my reproductive function. And I think that my care providers show a lot more respect for me by remembering my real name than by using one generic name for every, single person there. But as you say, your opinion is different, and that's fine.

I don't think that homebirth should be illegal. Women can do what they want to their own bodies. However, I do believe that women should know what they're signing up for, which includes the fact that the CPM credential requires very little in terms of training and skills, as compared to CNMs. Your CPM may have gone above and beyond the requirements, but do most women know to even ask? And it's also good to know that all homebirth transfers MUST be counted among hospital statistics, but that your homebirth midwife may not be counting the outcomes after hospital transfers in hers. I've seen it here (in TX), and I really doubt it's different there. So please, choose whatever care provider makes you feel happy, but do it knowing that there is a huge variability in skill, judgment, and training in CPMs, and that if your baby dies in a homebirth with a CPM due to negligence, there's very little you can do to keep her from attending more births, or to even have her license revoked (again, we've seen it in TX, and I doubt it's all that different there).

[Anonymous]

So basically, Karen's numbers aren't that great. She is probably serving a lower-risk population (not birthing micropreemies, mothers with pre-eclampsia, babies with significant genetic problems or physical malformities (spina bifida, etc.), not attending higher order multiples (trips/quads)) and her numbers are average (assuming that they count from 22 weeks on, which I highly doubt and assuming they don't just count babies who died under her actual care, rather than babies who were extremely damaged under her care and then died a couple of days later at the hospital).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

Yes, the midwife model of care is very different. Some might kiss a Mama on the forehead, some will greet a Mama with a big hug, some are more reserved. It varies with each person (which is why people interview midwives...to find the right match). It is usually a *much* more personal approach. Instead of the usual 10 minute appt., a prenatal with a MW can often take an hour or longer. It is not paternalistic...it's supportive and caring

The MW model of care isn't for everyone but it is definitly a perfect fit for some which is why it must remain an option.

And speaking of paternalistic, if anyone other than my kids calls me "mama," we won't be having a professional relationship for much longer.

You see the term Mama as paternalistic....I see it as a term of respect. You clearly want a cold wall between yourselfb and your HCP...fine. If it's your thing, go for it. There are certainly plenty who will provide just that. Others, however, do not and that is absolutely their choice to make.

There are also those who choose to birth at home with a CPM. Again, that should be their choice to make. You may not like it...you may think it's a bad choice; however, that it completely irrelevant to them. Just as you should have the ability to have the birth attendant of your choice...so should they.

Is it also my right to have a nurse practitioner to my brain surgery?

How does wanting to be addressed by my actual name and not "mama" mean that I want a cold wall between myself and my care provider? I think that using my actual, real name shows a lot more respect than a generic term that addresses only my reproductive function. And I think that my care providers show a lot more respect for me by remembering my real name than by using one generic name for every, single person there. But as you say, your opinion is different, and that's fine.

I don't think that homebirth should be illegal. Women can do what they want to their own bodies. However, I do believe that women should know what they're signing up for, which includes the fact that the CPM credential requires very little in terms of training and skills, as compared to CNMs. Your CPM may have gone above and beyond the requirements, but do most women know to even ask? And it's also good to know that all homebirth transfers MUST be counted among hospital statistics, but that your homebirth midwife may not be counting the outcomes after hospital transfers in hers. I've seen it here (in TX), and I really doubt it's different there. So please, choose whatever care provider makes you feel happy, but do it knowing that there is a huge variability in skill, judgment, and training in CPMs, and that if your baby dies in a homebirth with a CPM due to negligence, there's very little you can do to keep her from attending more births, or to even have her license revoked (again, we've seen it in TX, and I doubt it's all that different there).

. Who said a MW wouldn't call you by your first name? So far here (unless I missed it) I'm the only person who's used the term and I'm not a MW.

I do think it's sad that so many here presume that Mamas who birth at home are ignorant and don't do research when choosing where and with whom to birth. I'm sure there are some who don't give the decision its due diligence; however, I've found that those who do choose to give birth at home have done *extensive* research.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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

Yes, I was shocked by her statements. She does not come across very credibly, she was wise to take the plea.

I was somewhat repelled to read that she "kisses her clients on the forehead". In many professions, that would be considered misconduct.


I prefer to receive my health care from professionals who do not kiss me. Talk about paternalistic behavior!

Yes, the midwife model of care is very different. Some might kiss a Mama on the forehead, some will greet a Mama with a big hug, some are more reserved. It varies with each person (which is why people interview midwives...to find the right match). It is usually a *much* more personal approach. Instead of the usual 10 minute appt., a prenatal with a MW can often take an hour or longer. It is not paternalistic...it's supportive and caring

The MW model of care isn't for everyone but it is definitly a perfect fit for some which is why it must remain an option.

And speaking of paternalistic, if anyone other than my kids calls me "mama," we won't be having a professional relationship for much longer.

You see the term Mama as paternalistic....I see it as a term of respect. You clearly want a cold wall between yourselfb and your HCP...fine. If it's your thing, go for it. There are certainly plenty who will provide just that. Others, however, do not and that is absolutely their choice to make.

There are also those who choose to birth at home with a CPM. Again, that should be their choice to make. You may not like it...you may think it's a bad choice; however, that it completely irrelevant to them. Just as you should have the ability to have the birth attendant of your choice...so should they.

Is it also my right to have a nurse practitioner to my brain surgery?

How does wanting to be addressed by my actual name and not "mama" mean that I want a cold wall between myself and my care provider? I think that using my actual, real name shows a lot more respect than a generic term that addresses only my reproductive function. And I think that my care providers show a lot more respect for me by remembering my real name than by using one generic name for every, single person there. But as you say, your opinion is different, and that's fine.

I don't think that homebirth should be illegal. Women can do what they want to their own bodies. However, I do believe that women should know what they're signing up for, which includes the fact that the CPM credential requires very little in terms of training and skills, as compared to CNMs. Your CPM may have gone above and beyond the requirements, but do most women know to even ask? And it's also good to know that all homebirth transfers MUST be counted among hospital statistics, but that your homebirth midwife may not be counting the outcomes after hospital transfers in hers. I've seen it here (in TX), and I really doubt it's different there. So please, choose whatever care provider makes you feel happy, but do it knowing that there is a huge variability in skill, judgment, and training in CPMs, and that if your baby dies in a homebirth with a CPM due to negligence, there's very little you can do to keep her from attending more births, or to even have her license revoked (again, we've seen it in TX, and I doubt it's all that different there).

Why do you think you have the power, information, or authority to make that determination? CPMs are ALLOWED to deliver breech babies at home. Some women, after very thorough research, CHOOSE to birth their breech baby at home. This is not negligence. It is informed decision making. The risks of breech birth are only marginally higher than the risks of vertex birth. Unfortunately in this particular case, everyone lost their gamble - it doesn't mean that anyone did anything negligent.

In your opinion, if Karen Carr had her VA license, and the entire rest of the story was the same, would you consider her negligent? Deserving of jail time?