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

[Anonymous]

Anonymous wrote:"The NICU is notorious for following non-evidence-based practices. For example, one family I worked with was only allowed to hold their preemie twins for 10 minutes a day, when ALL of the available evidence says long periods of skin-to-skin, kangaroo care improves preemies health. Kangaroo care has saved lives, but many NICUs don't allow it. Also there are practices regarding bottle vs. breast feeding, how to train preemies to latch onto the breast or prevent nipple confusion altogether, and feeding of formula vs. donated breastmilk and the use of the various human milk fortifiers that are not evidence-based, and parents really, really need to advocate for themselves on those things if they know what the evidence says."

OK, whew, I thought you were having to correct the doctor's about their medical management of the babies. Of course nutrition is extremely important and skin-to-skin touch is therapeutic, but not knowing your client's situation (are you a doulah or lactation consultant by the way?) there is no way to know what was going on. Perhaps the baby had an ET tube that was positional and the baby was de-satting while being held. Perhaps his/her IV's were in danger of infiltrating. Perhaps the baby was hypothermic/hypoglycemic/hypoxic.
There are a multitude of medical reasons that could have explained why the baby needed to go back to the isolette/warmer.
These are things that a doula type individual would not be aware of .

None of the above. Babies only had a feeding tube and were on room air. No contraindications to being held, it was just the policy. Hypothermia/hypoglycemia/hypoxemia are often helped greatly by kangaroo care.

[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!

Yes, and as a student midwife in the DC area, I'm wondering how far this case has taken us back in terms of people accepting and supporting the work of midwives? Karen Carr did more than hurt a few families with her negligence, rather she's hurt and entire group of other midwives.

Problem is that on this thread, there are numerous posters who do NOT believe that Carr is a bad midwife and that it’s either our understanding of the profession that’s wrong or our a lack of knowing the facts about her cases. Such posters make me defensive of the home birth movement (not Carr herself). Without having “all the facts”, they go straight to defending her like crazy (as if the entire movement is made up of only perfect people). They get very defensive of the idea of regulating the movement so that people like Carr don’t REPEAT their bad work. Makes me think that since it dissociates itself 100% from the law and sets its own ethics, and is so blindly defensive of a woman who may not be as amazing as she professes herself to be, that this movement is too rogue to be reliable as it stands. Saying OBs are worse than you doesn't make YOU good.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"The NICU is notorious for following non-evidence-based practices. For example, one family I worked with was only allowed to hold their preemie twins for 10 minutes a day, when ALL of the available evidence says long periods of skin-to-skin, kangaroo care improves preemies health. Kangaroo care has saved lives, but many NICUs don't allow it. Also there are practices regarding bottle vs. breast feeding, how to train preemies to latch onto the breast or prevent nipple confusion altogether, and feeding of formula vs. donated breastmilk and the use of the various human milk fortifiers that are not evidence-based, and parents really, really need to advocate for themselves on those things if they know what the evidence says."

OK, whew, I thought you were having to correct the doctor's about their medical management of the babies. Of course nutrition is extremely important and skin-to-skin touch is therapeutic, but not knowing your client's situation (are you a doulah or lactation consultant by the way?) there is no way to know what was going on. Perhaps the baby had an ET tube that was positional and the baby was de-satting while being held. Perhaps his/her IV's were in danger of infiltrating. Perhaps the baby was hypothermic/hypoglycemic/hypoxic.
There are a multitude of medical reasons that could have explained why the baby needed to go back to the isolette/warmer.
These are things that a doula type individual would not be aware of .

None of the above. Babies only had a feeding tube and were on room air. No contraindications to being held, it was just the policy. Hypothermia/hypoglycemia/hypoxemia are often helped greatly by kangaroo care.

Yeah, the local NICU has that same policy...limited holding (one of the reasons I drove over an hour to a different hospital). The evidence points in exactly the opposite direction. In fact, my daughter's developmental specialist said she did so well because she was worn skin-to-skin, everyday, in a wrap.

FTR...things like nutrition and skin-to-skin *is* medical management.

As the original poster...the first thing that pops into my head was when they switched her to formula (without consulting me) when she had mucous in her poop (no other symptoms...weight gain was fine). The occasional mucousy poop in a breastfeed baby is *normal* (especially when using pumped milk). When I confronted the doctor, she was combative and rude....even used the term "Missy" which is never a polite term. She said she was concerned about NEC. The problem with that, of course, is that research clearly shows that formula increases the risk of NEC. While standing behind their colleague's actions, the other doctors where in agreement with me that she should be on breastmilk and not formula. There are other things but this thread isn't about the NICU so I'll leave it at that.

Now as for correcting OBs....I saw many, many different ones while dealing w/ PTL....not one had the most current stats WRT uterine rupture. They weren't even close. Oh, except for one. After much back and forth, she finally admitted that I was right....which meant she knew all along and was just lying in order to get me to consent to unnecessary major abdominal surgery. Thank God my CPM and I had spent so much time making darn sure we had the most accurate and up-to-date information available.

[Anonymous]

We should be defending home-birth and midwives! Just because we don't support KC doesn't mean we don't support home-birth and midwives!

[Anonymous]

Anonymous wrote:We should be defending home-birth and midwives! Just because we don't support KC doesn't mean we don't support home-birth and midwives!

There is a significant collective "We" who think that home birth is akin to child neglect. Again, the home-birthers - 1% and women who choose midwives 5-8%.

[Anonymous]

Anonymous wrote:

Anonymous wrote:We should be defending home-birth and midwives! Just because we don't support KC doesn't mean we don't support home-birth and midwives!

There is a significant collective "We" who think that home birth is akin to child neglect. Again, the home-birthers - 1% and women who choose midwives 5-8%.

To include ACOG

[Anonymous]

Anonymous wrote:

Anonymous wrote:"The NICU is notorious for following non-evidence-based practices. For example, one family I worked with was only allowed to hold their preemie twins for 10 minutes a day, when ALL of the available evidence says long periods of skin-to-skin, kangaroo care improves preemies health. Kangaroo care has saved lives, but many NICUs don't allow it. Also there are practices regarding bottle vs. breast feeding, how to train preemies to latch onto the breast or prevent nipple confusion altogether, and feeding of formula vs. donated breastmilk and the use of the various human milk fortifiers that are not evidence-based, and parents really, really need to advocate for themselves on those things if they know what the evidence says."

OK, whew, I thought you were having to correct the doctor's about their medical management of the babies. Of course nutrition is extremely important and skin-to-skin touch is therapeutic, but not knowing your client's situation (are you a doulah or lactation consultant by the way?) there is no way to know what was going on. Perhaps the baby had an ET tube that was positional and the baby was de-satting while being held. Perhaps his/her IV's were in danger of infiltrating. Perhaps the baby was hypothermic/hypoglycemic/hypoxic.
There are a multitude of medical reasons that could have explained why the baby needed to go back to the isolette/warmer.
These are things that a doula type individual would not be aware of .

None of the above. Babies only had a feeding tube and were on room air. No contraindications to being held, it was just the policy. Hypothermia/hypoglycemia/hypoxemia are often helped greatly by kangaroo care.

That was one of the greatest regrets I had when my son was in the NICU. I followed their policy although I had a late preemie who very much wanted to be held. No desats, no oxygen, and yet they told me not to hold him too much. If I was ever in that situation again with the same circumstances (no desats etc) I would print out every last bit of evidence that my holding him benefits both him and me.

[Anonymous]

Anonymous wrote:We should be defending home-birth and midwives! Just because we don't support KC doesn't mean we don't support home-birth and midwives!

But how can anyone trust the "movement" when IT defends Carr tooth and nail no matter her past, actions, and own words? How can we trust a movement that's so self-monitoring when IT endorsed Carr 100%, despite the Alexandria case NOT being the first time concerns were raised on her practices? Of course hospitals and OBs aren't perfect, but it seems to me that MOST consequences of their bad actions lead to "a bad experience" where at least mom and baby are sent home alive (MOST), whereas homebirth questionable actions lead to DEATH.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:"The NICU is notorious for following non-evidence-based practices. For example, one family I worked with was only allowed to hold their preemie twins for 10 minutes a day, when ALL of the available evidence says long periods of skin-to-skin, kangaroo care improves preemies health. Kangaroo care has saved lives, but many NICUs don't allow it. Also there are practices regarding bottle vs. breast feeding, how to train preemies to latch onto the breast or prevent nipple confusion altogether, and feeding of formula vs. donated breastmilk and the use of the various human milk fortifiers that are not evidence-based, and parents really, really need to advocate for themselves on those things if they know what the evidence says."

OK, whew, I thought you were having to correct the doctor's about their medical management of the babies. Of course nutrition is extremely important and skin-to-skin touch is therapeutic, but not knowing your client's situation (are you a doulah or lactation consultant by the way?) there is no way to know what was going on. Perhaps the baby had an ET tube that was positional and the baby was de-satting while being held. Perhaps his/her IV's were in danger of infiltrating. Perhaps the baby was hypothermic/hypoglycemic/hypoxic.
There are a multitude of medical reasons that could have explained why the baby needed to go back to the isolette/warmer.
These are things that a doula type individual would not be aware of .

None of the above. Babies only had a feeding tube and were on room air. No contraindications to being held, it was just the policy. Hypothermia/hypoglycemia/hypoxemia are often helped greatly by kangaroo care.

That was one of the greatest regrets I had when my son was in the NICU. I followed their policy although I had a late preemie who very much wanted to be held. No desats, no oxygen, and yet they told me not to hold him too much. If I was ever in that situation again with the same circumstances (no desats etc) I would print out every last bit of evidence that my holding him benefits both him and me.

My daughter had significantly fewer desats when held.

[Anonymous]

Ahem. Kangaroo care is recognized as a great thing, especially in third world countries, where there is little medical support for premies. We routinely save babies much younger than the age recommended for kangaroo care: a 28 weeker, complete with umbilical lines, ET tube, nitrous, an NGT--if that!--and skin so fragile it peels at a touch, is hardly a candidate for kangaroo care.

[Anonymous]

Anonymous wrote:Ahem. Kangaroo care is recognized as a great thing, especially in third world countries, where there is little medical support for premies. We routinely save babies much younger than the age recommended for kangaroo care: a 28 weeker, complete with umbilical lines, ET tube, nitrous, an NGT--if that!--and skin so fragile it peels at a touch, is hardly a candidate for kangaroo care.

Nobody mentioned a 28 weeker. I know the local hospital had it as a standard for ALL babies in the NICU. FTR, I started skin-to-skin with my 30 weeker at about one week of age. Oh, and she started breastfeeding at what would have been just 32 weeks...despite no HCP believing it would happen. You can "Ahem" all you want....skin-to-skin is an essential part of NICU care....and research backs this up.

[Anonymous]

Anonymous wrote:

Yes, and as a student midwife in the DC area, I'm wondering how far this case has taken us back in terms of people accepting and supporting the work of midwives? Karen Carr did more than hurt a few families with her negligence, rather she's hurt and entire group of other midwives.

Totally agree! I had my 10lb 4 oz son at home with a fantastic pair of CNMs (and am hoping to do it again soon!) and I'm baffled by all of the support and rallying around her that this woman is getting. By going against the law she really put the profession in a bad spot.

[Anonymous]

To the posters referencing NICU and Kangaroo care . . . which hospitals are you talking about? Children's National Medical Center supports Kangaroo Care, when appropriate, and they even gave me a copy of the groundbreaking book to read.

Exactly where are these NICU's.

[Anonymous]

I had a 34 weeker in the NICU at Inova Fairfax and while in theory I was encouraged to nurse and hold her, in reality the nurses discouraged both of these practices in MANY MANY ways because it was inconvenient for them. Especially the night shift nurses. I had to get "breastmilk only" written into my DD's chart by the neo because the nurses found it easier to just give her formula rather than bother to use the breastmilk I was bringing in. FWIW, I was producing FAR more than she needed at the time and there was plenty there. The nurse flat out told me it was easier for her to just pop open a bottle of formula.

And then they were irritated with me for wanting to nurse her at every feeding because that screwed up their timing/schedule.

Some of the nurses were fabulous, most were meh and a couple were wretched excuses for human beings.

[Anonymous]

Most NICU's DO recognize the importance of kangaroo care. When I was pregnant, I made sure to research the NICU's as well as the OB care at the various hospitals. That is what most of us are talking about, doing your research so that you will be in a facility that you are happy with. There are many of them out there to choose from.

To the poster who said a doctor recommended formula for her baby because of concerns about NEC, I would like to know what hospital this occurred at. Pretty hard to believe, IMO. MOst babies being worked up for nec are NPO, and BM would be milk of choice when feedings were resumed.