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

[Anonymous]

Anonymous wrote:I guess I just don't understand her ability to go on delivering babies right now. To have been through that breech birth scenario (with having lost another infant in close proximity) -- I just have to ask what sort of person doesn't take a deep breath and perhaps decide to take a break and re-examine some choices, work on some skill sets, etc.

I could never be a doctor or a midwife. I have a job that has some heavy responsibilities, but I could not assume that level of responsibility for someone's well-being. The fact that Karen can seem to do it so lightly, with so little apparent sense of responsibility for outcomes (per the WaPo, she says she's not guilty because she didn't intend the outcome -- there's someone confused about the concept of negligence!) is very troubling.

Shouldn't OB's also "take a break and re-examine some choices, work on some skill sets, etc." after losing a baby? There may be many OB's with a worse track record than Karen, but for some reason the death of a baby in an OB's care seems to be more accepted by some folks on this board. I guess if a baby dies in a hospital birth the parents are seen to have done everything they could for the baby by giving birth in the hospital, even though the baby *may have* survived at home.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I guess I just don't understand her ability to go on delivering babies right now. To have been through that breech birth scenario (with having lost another infant in close proximity) -- I just have to ask what sort of person doesn't take a deep breath and perhaps decide to take a break and re-examine some choices, work on some skill sets, etc.

I could never be a doctor or a midwife. I have a job that has some heavy responsibilities, but I could not assume that level of responsibility for someone's well-being. The fact that Karen can seem to do it so lightly, with so little apparent sense of responsibility for outcomes (per the WaPo, she says she's not guilty because she didn't intend the outcome -- there's someone confused about the concept of negligence!) is very troubling.

Shouldn't OB's also "take a break and re-examine some choices, work on some skill sets, etc." after losing a baby? There may be many OB's with a worse track record than Karen, but for some reason the death of a baby in an OB's care seems to be more accepted by some folks on this board. I guess if a baby dies in a hospital birth the parents are seen to have done everything they could for the baby by giving birth in the hospital, even though the baby *may have* survived at home.

I don't think that is it. I think it is because a baby's death at a hospital is: 1.)reported 2.)investigated 3.)peer reviewed 4.)recourse/punishment available.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I guess I just don't understand her ability to go on delivering babies right now. To have been through that breech birth scenario (with having lost another infant in close proximity) -- I just have to ask what sort of person doesn't take a deep breath and perhaps decide to take a break and re-examine some choices, work on some skill sets, etc.

I could never be a doctor or a midwife. I have a job that has some heavy responsibilities, but I could not assume that level of responsibility for someone's well-being. The fact that Karen can seem to do it so lightly, with so little apparent sense of responsibility for outcomes (per the WaPo, she says she's not guilty because she didn't intend the outcome -- there's someone confused about the concept of negligence!) is very troubling.

Shouldn't OB's also "take a break and re-examine some choices, work on some skill sets, etc." after losing a baby? There may be many OB's with a worse track record than Karen, but for some reason the death of a baby in an OB's care seems to be more accepted by some folks on this board. I guess if a baby dies in a hospital birth the parents are seen to have done everything they could for the baby by giving birth in the hospital, even though the baby *may have* survived at home.

First of all, if you think OBs do things wrong, then how is saying they do the same thing as midwives a defense? Two wrongs don't make a right.

Also, even though i agree that hospital-specific procedures can bring on risks that natural approaches do not, it is regulated and standardized. It can safely be assumed that when in a hospital, you have surrounded yourself with immediate access to all the means we currently have to save your life, or at least all the means available to you at this time. The same cannot be said when at home, so of course there will be investigation to establish how it went down. And yes, there WILL be one in a hospital as well to 1) make sure the assumption of having everything available and being done was true and 2) that it was carried out properly. If the death of a patient is ruled as the result of negligence and such a pattern paints the doc as incompetent or unethical, then yes, this doc will lose his license (not that "right to practice" matters to Carr, even when available since she'd rather "protest").

If anything, one should say that midwives get the better treatment. Carr didn't do any jail time for her actions leading (legally) to the death of an unwilling participant (baby). Kavorkian practiced WITH a license with WILLING participants, lost his license and went to jail. How exactly is Carr being treated worse than docs?

[Anonymous]

Homebirth midwives should be treating the lowest of the low-risk. Given that fact, their outcomes should be sterling.

I am not convinced that they are.

I feel that most babies that die in the hospital would have died at a homebirth as well (that 22 weeker or the baby with a hole in its heart isn't going to do too well in the homebirth setting). However, I do not feel that most dead homebirth babies would have died in the hospital.

I believe it is the micropreemies, the babies with major malformations or genetic diseases that are the ones dying in the hospital.

The ones dying at home appear to be perfecting formed, term infants who are injured during the birthing process itself.

[Anonymous]

"The ones dying at home appear to be perfecting formed, term infants who are injured during the birthing process itself."

Well, I think you may be overgeneralizing here, but you do raise an important point that has me stymied in this discussion... L&D is one thing in the home setting, but what about pediatrics? That's what really freaks me out, b/c in my experience, our little guy came out wailing, super alert and all, but shortly later had to be treated in the NICU for grunting - which is somewhat serious but managable in a hospital setting... but at home!?! I seriously doubt we would have recognized anything and if midwife leaves a couple hours after birth then what in the world do you do? I'm not even anti-homebirth or anything, but obviously it's not for me b/c the idea of leaving me at home with my couple-of-hours-old baby with NO pediatric support or resources scares the hell out of me...

Anyway, I really don't know what the pediatric resources are in a birthing center, how they compare to hospital, but I'm genuinely curious to know what sort of peds background homebirth midwives are given, since they are the only ones assessing baby until your first ped appointment (I'm assuming - I could be wrong on that point). If anyone can speak to that I'm very interested.

[Anonymous]

Anonymous wrote:Homebirth midwives should be treating the lowest of the low-risk. Given that fact, their outcomes should be sterling.

I am not convinced that they are.

I feel that most babies that die in the hospital would have died at a homebirth as well (that 22 weeker or the baby with a hole in its heart isn't going to do too well in the homebirth setting). However, I do not feel that most dead homebirth babies would have died in the hospital.

I believe it is the micropreemies, the babies with major malformations or genetic diseases that are the ones dying in the hospital.

The ones dying at home appear to be perfecting formed, term infants who are injured during the birthing process itself.

So very, very, very AGREED!!! Not only can you not predict when "low risk" will change for the mother, but you're RIGHT. Midwives are NOT trained in pediatrics. Especially not neonatal pediatrics. SUCH A GOOD POINT.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Homebirth midwives should be treating the lowest of the low-risk. Given that fact, their outcomes should be sterling.

I am not convinced that they are.

I feel that most babies that die in the hospital would have died at a homebirth as well (that 22 weeker or the baby with a hole in its heart isn't going to do too well in the homebirth setting). However, I do not feel that most dead homebirth babies would have died in the hospital.

I believe it is the micropreemies, the babies with major malformations or genetic diseases that are the ones dying in the hospital.

The ones dying at home appear to be perfecting formed, term infants who are injured during the birthing process itself.

So very, very, very AGREED!!! Not only can you not predict when "low risk" will change for the mother, but you're RIGHT. Midwives are NOT trained in pediatrics. Especially not neonatal pediatrics. SUCH A GOOD POINT.

CNM type midwives care for women from adolescence through menopause as well as provide primary care of an infant up to 28 days of life. They are trained to consult, collaborate and refer when the infant or mother steps outside of normal. If out of hospital birth - the dyad is seen in the home over the next couple of days by both the midwife and the trained assistant. They also have a transfer of care to the infant's care provider usually within the first 24-48 hours of life. The parents are given postpartum instructions on how to care for themselves and their baby, what to look for that is not normal and have the CNM mobile phone at their fingertips. The CNMs are trained in neonatal resuscitation and are trained to stabilize both mother and infant in the case an emergency. If that doesn't make you comfortable, don't birth outside the hospital with a CNM. For some families this is a safe and healthy choice according to their own understanding and belief system, as well as their expressed and written consent that this is the type of care they desire.

[Anonymous]

Ok, but that is a CNM who has at least gone to nursing school, done additional training and is licensed by the state.

I believe the PP is talking about CNMs.

[Anonymous]

Exactly. Can a CPM entubate, give meds through the ET tube , suction below the vocal cords, place lines in the umbilical cord for rescuscitation? I highly doubt it. I'm not even sure if a CNM is trained in these procedures.
Can a CPM detect subtle signs of distress in a newborn? A newborn can go from perfectly fine to hell in a handbasket in a very short period of time. Are they trained in NALS? (neonatal advanced life support)

[Anonymous]

Yes. CNMs can choose to be trained in intubation as well as NALS. I was trained in both as many of my colleagues.

[Anonymous]

Somewhere buried in recent posts, someone asked if there is any research supporting the safety of homebirth with CPMs. I think this does - http://www.bmj.com/content/330/7505/1416.full?ehom.

One thing that bugs me about this case is that since it didn't go to trial, all we know is the prosecution's version of the facts. I would have liked to have heard the defense's version. Karen Carr pled guilty to practicing midwifery without a license and performing an invasive procedure without a license (she cut an episiotomy after the baby's head got stuck). She pled guilty to avoid the other more frightening charges, the possibility of a jury trial (in Virginia the jury determines sentencing so who knows what would have happened there), and the possibility of putting the birth mother on the stand. She didn't agree to everything that the prosecution was saying. I'm not paying much attention to anything she says in the press now because she must be a complete wreck from the whole experience and must be very much on the defensive.

[Anonymous]

Anonymous wrote:Somewhere buried in recent posts, someone asked if there is any research supporting the safety of homebirth with CPMs. I think this does - http://www.bmj.com/content/330/7505/1416.full?ehom.

One thing that bugs me about this case is that since it didn't go to trial, all we know is the prosecution's version of the facts. I would have liked to have heard the defense's version. Karen Carr pled guilty to practicing midwifery without a license and performing an invasive procedure without a license (she cut an episiotomy after the baby's head got stuck). She pled guilty to avoid the other more frightening charges, the possibility of a jury trial (in Virginia the jury determines sentencing so who knows what would have happened there), and the possibility of putting the birth mother on the stand. She didn't agree to everything that the prosecution was saying. I'm not paying much attention to anything she says in the press now because she must be a complete wreck from the whole experience and must be very much on the defensive.

And if you look waaaay back on page 30 or 40-something, this paper has already been discussed. It didn't use proper control groups (homebirth in 2000 was compared to non-low-risk hospital birth in the 70s and 80s), and the intrapartum death rate was pretty high.

Interestingly for this case, they also found that of 80 planned home breech births, there were 2 deaths of babies. There are also 3 deaths listed as SIDS of babies about 1 day old, which I don't believe for a second.

[Anonymous]

Anonymous wrote:Somewhere buried in recent posts, someone asked if there is any research supporting the safety of homebirth with CPMs. I think this does - http://www.bmj.com/content/330/7505/1416.full?ehom.

One thing that bugs me about this case is that since it didn't go to trial, all we know is the prosecution's version of the facts. I would have liked to have heard the defense's version. Karen Carr pled guilty to practicing midwifery without a license and performing an invasive procedure without a license (she cut an episiotomy after the baby's head got stuck). She pled guilty to avoid the other more frightening charges, the possibility of a jury trial (in Virginia the jury determines sentencing so who knows what would have happened there), and the possibility of putting the birth mother on the stand. She didn't agree to everything that the prosecution was saying. I'm not paying much attention to anything she says in the press now because she must be a complete wreck from the whole experience and must be very much on the defensive.

From your post, you seem to be a friend or colleague of Ms. Carr's, how else would you know what her intentions were in regards to the plea bargain?
And if you are not , your post is a bit of speculation. (granted, that is what most are posting here in regards to the actual details of the case) How can you possibly know what was in her mind?

Please do not stereotype Virginia juries--did you read the recent case about the teacher falsely accused of child molestation? He was offered a plea, but KNEW he was innocent. He wanted to fight for his reputation so proceeded to a jury trial. He was found innocent after 45 mins. of jury deliberation.

[Anonymous]

What I do not get is that this baby would have died even if they had had a hospital birth. Mistakes happen in hospitals and babies die there too.
A breech vaginal birth can be in a hospital. And sometimes they end in death and nothing happens.
I know some women who have had stillborn babies. It happens and the doctors and staff carry on working

[Anonymous]

Anonymous wrote:What I do not get is that this baby would have died even if they had had a hospital birth. Mistakes happen in hospitals and babies die there too.
A breech vaginal birth can be in a hospital. And sometimes they end in death and nothing happens.
I know some women who have had stillborn babies. It happens and the doctors and staff carry on working

http://skepticalob.blogspot.com/2011/05/no-homebirth-advocates-babies-dont-die.html