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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

I don't know enough about breech babies myself, but I can't help to think that there is probably a legitimate reason for why more OBs don't deliver breech babies vaginally. I'm no c-section advocate, and I hate how they are resorted to in situations where labor has simply stalled, etc., but I just can't believe that almost the entire medical establishment (which says breech baby = c-section) is somehow wrong...

It's absolutely driven by the insurance companies. Doctors routinely deliver breech babies in Europe.

Well, the REAL driver behind the wheel is the fear of lawsuits.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I don't know enough about breech babies myself, but I can't help to think that there is probably a legitimate reason for why more OBs don't deliver breech babies vaginally. I'm no c-section advocate, and I hate how they are resorted to in situations where labor has simply stalled, etc., but I just can't believe that almost the entire medical establishment (which says breech baby = c-section) is somehow wrong...

It's absolutely driven by the insurance companies. Doctors routinely deliver breech babies in Europe.

Well, the REAL driver behind the wheel is the fear of lawsuits.

Well, one of the main reasons we have so many lawsuits because so many people lack adequate health insurance. Most other industrialized nations have universal health care and therefore don't practice risk-averse medicine to the same degree that doctors do here...

but that's a whole other debate.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I don't know enough about breech babies myself, but I can't help to think that there is probably a legitimate reason for why more OBs don't deliver breech babies vaginally. I'm no c-section advocate, and I hate how they are resorted to in situations where labor has simply stalled, etc., but I just can't believe that almost the entire medical establishment (which says breech baby = c-section) is somehow wrong...

It's absolutely driven by the insurance companies. Doctors routinely deliver breech babies in Europe.

Well, the REAL driver behind the wheel is the fear of lawsuits.

Well, one of the main reasons we have so many lawsuits because so many people lack adequate health insurance. Most other industrialized nations have universal health care and therefore don't practice risk-averse medicine to the same degree that doctors do here...

but that's a whole other debate.

Eh. You're entitled to your opinion of course, but I disagree. Too many lawsuits against medical providers are brought forth just to get a lot of money, with the attorney(s) getting a pretty good chunk. John Edwards is a prime perfect example. His lawsuits were not brought because people didn't have adequate health insurance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I don't know enough about breech babies myself, but I can't help to think that there is probably a legitimate reason for why more OBs don't deliver breech babies vaginally. I'm no c-section advocate, and I hate how they are resorted to in situations where labor has simply stalled, etc., but I just can't believe that almost the entire medical establishment (which says breech baby = c-section) is somehow wrong...

It's absolutely driven by the insurance companies. Doctors routinely deliver breech babies in Europe.

Well, the REAL driver behind the wheel is the fear of lawsuits.

And why shouldn't people sue when a caregiver negligently advises a client on decision that ultimately results in the death/injury of their child? I'd wager if OBs were focusing on evidence based practice and TRULY informing their patients, so that they felt more in control of whatever outcome occurred, you'd see the rate of lawsuits go down. You'd probably also see infant and maternal deaths decline. Actually, I think there is evidence out there that this is the case in other countries. As it is, most people give birth in situations where they have completely abdicated responsibility to their OBs...of course they blame them for whatever goes wrong. Blaming families for the fear of lawsuits that insurers and OBs have is pretty crappy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I don't know enough about breech babies myself, but I can't help to think that there is probably a legitimate reason for why more OBs don't deliver breech babies vaginally. I'm no c-section advocate, and I hate how they are resorted to in situations where labor has simply stalled, etc., but I just can't believe that almost the entire medical establishment (which says breech baby = c-section) is somehow wrong...

It's absolutely driven by the insurance companies. Doctors routinely deliver breech babies in Europe.

Well, the REAL driver behind the wheel is the fear of lawsuits.

And why shouldn't people sue when a caregiver negligently advises a client on decision that ultimately results in the death/injury of their child? I'd wager if OBs were focusing on evidence based practice and TRULY informing their patients, so that they felt more in control of whatever outcome occurred, you'd see the rate of lawsuits go down. You'd probably also see infant and maternal deaths decline. Actually, I think there is evidence out there that this is the case in other countries. As it is, most people give birth in situations where they have completely abdicated responsibility to their OBs...of course they blame them for whatever goes wrong. Blaming families for the fear of lawsuits that insurers and OBs have is pretty crappy.

OBs have a really tough job, and I can appreciate why many medical students choose not to become one. Dermatology and radiology are two areas that are far less stressful. Btw, I didn't say lawsuits shouldn't ever occur. I said they're the reason for the prevalence of C-sections.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To settle things once and for all. Dr. Tchabo was consulted. He said he would attend her birth if he was in town (apparently he was going to be away briefly), otherwise she would have to have a c/s because no one else in the hospital had enough experience attending breeches. THe baby was NOT footling. The parents did not like those odds. They chose Karen. The baby got stuck, it was NOT footling. The baby got out, was resuscitated and sent to the hospital. They put the baby on life support. 3 days later the parents decided to take the baby off life support. The charges are practicing medicine w/out a license, practicing midwifery w/out a license, child endangerment and manslaughter. She is facing 30 years.

Very sad. The OB/GYNs and the insurance companies that wiggle the docs' arms and legs like puppets should be ashamed. Why are there not more OBs that can do breeches? Why can Dr. Tchabo be the only one in this area? Why is he not teaching his skills to everyone? How was it that my brother and I were born breech (frank for me, incomplete for my younger brother) in the 1980s, and it's a fact that my mom often forgets to mention when recounting our births because it happened all the time and was nothing to talk about ? The pain and burden that everyone involved in this must be feeling is beyond comprehension.

I don't know enough about breech babies myself, but I can't help to think that there is probably a legitimate reason for why more OBs don't deliver breech babies vaginally. I'm no c-section advocate, and I hate how they are resorted to in situations where labor has simply stalled, etc., but I just can't believe that almost the entire medical establishment (which says breech baby = c-section) is somehow wrong...

Do you seriously think the entire medical establishment has never been wrong about anything? Amazing that anyone could think that.

[Anonymous]

I was natural birth advocate and wanted to do everything in my power to avoid a C, but when it seemed that DS was going to stay breech (footling at that) I did research and felt that a c-section was safest for all involved. Necessary? I'm not sure, but we ran the numbers and did a gut check (like we did over whether to amnio or not) and made our decision accordingly. There was one statistic--cord compression--that really stuck out with me. This occurs in about .005 percent of cases of head first vaginal birth but something like 15-18 percent in breech (or maybe it was footling breech) delivered vaginally. Cord compression, even for short time, can lead to brain damage or other issues for the baby. While I understood the risk of C sections and was definitely wary of having it pushed on me, we decided that a C would be safest. Yes, unneccesary Cs are given all the time and I did not want to be part of that statistic, nor be compelled by fear. And yet, we kept coming back to the relatively high percentage of vaginal breech deliveries with cord compression--someitmes it is no big deal, but since I have a good friend whose baby suffered from that (not breech, it can happen elsewhere) and it lead to a host of problems, I could not dismiss this possibility. DS turned in week 41 and I had a head first vaginal drug free birth, for which I was grateful, but I do think that while certainly it is possible to have a safe breech vaginal delivery, there are demonstrated higher risks and any couple facing that decision (and any ob or midwife) has to take that into account.

It is a tragedy all around--for the parents who lost their baby, but also for the midwife. I'm sure she did the best of her abilities, and had ony the well being and happiness of everyone in mind, but I think it was a questionable judgment call, esp to do it as a home birth. Then again, since midwives are not allowed to attend in most hospitals, it makes things even more starkly divided. DH would love to use a midwife for #2, but also wanted to have a hospital birth at Sibley and literally did not understand (he is a smart man, too) why that was not going to be possible...

[Anonymous]

Anonymous wrote:

Anonymous wrote:Don't know specifics about this case
http://www.kentuckymidwives.com/NARM.html

This website is SPAM -- put out by anti-midwife activists. Do not be fooled by this inflammatory spam website.

www.narm.org is the actual website representing CPMs in this country.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Don't know specifics about this case
http://www.kentuckymidwives.com/NARM.html

This website is SPAM -- put out by anti-midwife activists. Do not be fooled by this inflammatory spam website.

www.narm.org is the actual website representing CPMs in this country.

And the website you listed is put out by pro-midwife activists? I'm not against mid-wives, but do you think the other site is including false stories?

[Anonymous]

Anonymous wrote: I was natural birth advocate and wanted to do everything in my power to avoid a C, but when it seemed that DS was going to stay breech (footling at that) I did research and felt that a c-section was safest for all involved. Necessary? I'm not sure, but we ran the numbers and did a gut check (like we did over whether to amnio or not) and made our decision accordingly. There was one statistic--cord compression--that really stuck out with me. This occurs in about .005 percent of cases of head first vaginal birth but something like 15-18 percent in breech (or maybe it was footling breech) delivered vaginally. Cord compression, even for short time, can lead to brain damage or other issues for the baby. While I understood the risk of C sections and was definitely wary of having it pushed on me, we decided that a C would be safest. Yes, unneccesary Cs are given all the time and I did not want to be part of that statistic, nor be compelled by fear. And yet, we kept coming back to the relatively high percentage of vaginal breech deliveries with cord compression--someitmes it is no big deal, but since I have a good friend whose baby suffered from that (not breech, it can happen elsewhere) and it lead to a host of problems, I could not dismiss this possibility. DS turned in week 41 and I had a head first vaginal drug free birth, for which I was grateful, but I do think that while certainly it is possible to have a safe breech vaginal delivery, there are demonstrated higher risks and any couple facing that decision (and any ob or midwife) has to take that into account.

It is a tragedy all around--for the parents who lost their baby, but also for the midwife. I'm sure she did the best of her abilities, and had ony the well being and happiness of everyone in mind, but I think it was a questionable judgment call, esp to do it as a home birth. Then again, since midwives are not allowed to attend in most hospitals, it makes things even more starkly divided. DH would love to use a midwife for #2, but also wanted to have a hospital birth at Sibley and literally did not understand (he is a smart man, too) why that was not going to be possible...

PP - there are a number of midwives in the area who deliver at DC hospitals. Here are a few I found from the Birth Options Alliance list:

A number of midwives, including Whitney Pinger and all of the midwives at the Family Health & Birth Center deliver at Washington Hospital Center
Providence Hospital has a number of midwives from Planned Parenthood
Kim Severn delivers at Sibley

There are also a number of midwives who deliver at hospitals in MD and VA.

Here's a link to the complete list:
http://www.birthoptionsalliance.org/MidwifeList.pdf

[Anonymous]

I think this was a tragedy. I also think it was a wrong judgment call on the part of the parents and the midwife. Home birth for breech is not something I can get behind--and my child was a home birth.

HOWEVER--that said, for supporters of all kinds of choice in reproduction, it seems to me that this midwife's defense fund is a worthy cause.

The situation around birth in this country is messed up and possibly helped lead to this event. Would criminal charges against this midwife lead to any kind of justice? If not, don't you think she deserves an excellent lawyer?

[Anonymous]

STUDIES HAVE SHOWN - there is no greater risk of death with breech in vaginal birth vs surgical birth. This is a fact. Study after study has shown it. But doctors now are not trained in the US to manage vaginal breech and it is far more lucrative to do a c/s. In other countries vaginal breech are the norm but you must know how to deal with it. It says a lot that doctors in the US do not have adequate training to manage breech and twin births. Still, women flock to surgeons in droves, expecting a good outcome and instead getting surgery. 1 in 3 babies born by c/s. Really? How then are obstetricians the best to manage normal birth? Surgery is NOT normal. Babies die every day in hospitals, some for no known reason and many for iatrogenic causes (physician caused) due to the myriad of interventions. But when a baby dies in the hospital everyone assumes everyone did "all they could do". When a baby dies at home, "it was the midwifes fault".

[Anonymous]

You mention midwife Whitney Pinger, CNM. She had ALL her children at home including her last which was a Down's baby. She is a strong homebirth advocate and support breech birth as well.

[Anonymous]

Anonymous wrote:STUDIES HAVE SHOWN - there is no greater risk of death with breech in vaginal birth vs surgical birth. This is a fact. Study after study has shown it. But doctors now are not trained in the US to manage vaginal breech and it is far more lucrative to do a c/s. In other countries vaginal breech are the norm but you must know how to deal with it. It says a lot that doctors in the US do not have adequate training to manage breech and twin births. Still, women flock to surgeons in droves, expecting a good outcome and instead getting surgery. 1 in 3 babies born by c/s. Really? How then are obstetricians the best to manage normal birth? Surgery is NOT normal. Babies die every day in hospitals, some for no known reason and many for iatrogenic causes (physician caused) due to the myriad of interventions. But when a baby dies in the hospital everyone assumes everyone did "all they could do". When a baby dies at home, "it was the midwifes fault".

Can you like to some of these studies? Maybe there is no greater "risk of death" than with breech vaginal, but how about risk of brain damage, or a myriad of other issues from a prolapsed cord, or some other common complication with a breech birth.?

[Anonymous]

Many midwives in hospitals are actually MEDwives - they are no different from OBs and can be wolves in sheeps clothing. Not all, but many. So beware. They have to tow the company line and prove themselves to the "good ole boys club". They are supervised and have to answer to an OB. It is nothing at all like a homebirth midwife.