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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:And Karen is so knowledgable that she told a newspaper in an interview that she 1) didn't recognize the importance of respiratory distress in a newborn, and 2) didn't bother to find out what caused it even after the newborn died. That's not the kind of knowledgable practitioner I want anywhere near my baby. Again, to choose otherwise is your right.

Don't bother. I've said this in 4 separate posts and NOT ONE Carr advocate has addressed it.

At the risk of being told again that I need a kick in the ass or that i'm stupd, I'll address this question again. The above are not correct quotes from the newspaper. Copied directly from the Post's webiste:

In November, Carr attended to a mother pregnant with twins in rural Maryland. One was having trouble breathing after delivery, so paramedics were called, but by the time they got there, 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.”

---
Now you could read the I'm not sure what happened as the final word but is it possible that the author of the article left something out. Maybe they did an autoposy and the results were inconclusive? Now I have no idea if that is correct, but neither do you or anyone else for that matter. It is possible that what was actually put in the Post and what was left out was done to make Karen sound like she doesn't care. Unless you can have a copy of the full interview done with Karen, you don't really know all that was said. Regardless, it doesn't quote Karen as saying she didn't care enough to find out and it doesn't prove that she did anything wrong in that situation. And accrding to her supporters there were factual errors about some of the events described. (and no not the mom that had complaints about Karen).

But go ahead and tell me how stupid I am for accepting the fact that realize that I don't have enough information about this case or Karen's practice in general to damn her the way many posters have on this board.

She "didn't do anything wrong"??!! The baby was having trouble breathing. Good, she recognized that. But she COMPLETELY MISSED the relevance of that fact! It DOESN'T MATTER if the baby seemed to start breathing better; anyone who knows anything at all about neonates (especially twins, who are often born not quite as mature as singletons) knows that you NEVER, NEVER, NEVER ignore respiratory problems in a neonate. That baby should have been rushed to a NICU for observation at the first thought of problems, but instead she chose to trust her instincts or whatever and turn away the ambulance. The fact that she "didn't know what happened" is just the icing on the cake. As someone who actually knows something about caring for sick newborns, this aspect of her "service to women" really makes me ill.

And you know for a fact that is exactly what happened?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:And Karen is so knowledgable that she told a newspaper in an interview that she 1) didn't recognize the importance of respiratory distress in a newborn, and 2) didn't bother to find out what caused it even after the newborn died. That's not the kind of knowledgable practitioner I want anywhere near my baby. Again, to choose otherwise is your right.

Don't bother. I've said this in 4 separate posts and NOT ONE Carr advocate has addressed it.

At the risk of being told again that I need a kick in the ass or that i'm stupd, I'll address this question again. The above are not correct quotes from the newspaper. Copied directly from the Post's webiste:

In November, Carr attended to a mother pregnant with twins in rural Maryland. One was having trouble breathing after delivery, so paramedics were called, but by the time they got there, 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.”

---
Now you could read the I'm not sure what happened as the final word but is it possible that the author of the article left something out. Maybe they did an autoposy and the results were inconclusive? Now I have no idea if that is correct, but neither do you or anyone else for that matter. It is possible that what was actually put in the Post and what was left out was done to make Karen sound like she doesn't care. Unless you can have a copy of the full interview done with Karen, you don't really know all that was said. Regardless, it doesn't quote Karen as saying she didn't care enough to find out and it doesn't prove that she did anything wrong in that situation. And accrding to her supporters there were factual errors about some of the events described. (and no not the mom that had complaints about Karen).

But go ahead and tell me how stupid I am for accepting the fact that realize that I don't have enough information about this case or Karen's practice in general to damn her the way many posters have on this board.

She "didn't do anything wrong"??!! The baby was having trouble breathing. Good, she recognized that. But she COMPLETELY MISSED the relevance of that fact! It DOESN'T MATTER if the baby seemed to start breathing better; anyone who knows anything at all about neonates (especially twins, who are often born not quite as mature as singletons) knows that you NEVER, NEVER, NEVER ignore respiratory problems in a neonate. That baby should have been rushed to a NICU for observation at the first thought of problems, but instead she chose to trust her instincts or whatever and turn away the ambulance. The fact that she "didn't know what happened" is just the icing on the cake. As someone who actually knows something about caring for sick newborns, this aspect of her "service to women" really makes me ill.

And you know for a fact that is exactly what happened?

Unless the paper got the part wrong where she turned the ambulance away, I'm sticking with my opinion of this. You do not play with respiratory distress in a newborn, precisely because it can kill them quickly. If the paper got it wrong, and she actually rushed that newborn to the nearest NICU as soon as breathing trouble started, I will reform my opinion.

[Anonymous]

Anonymous wrote:
Unless the paper got the part wrong where she turned the ambulance away, I'm sticking with my opinion of this. You do not play with respiratory distress in a newborn, precisely because it can kill them quickly. If the paper got it wrong, and she actually rushed that newborn to the nearest NICU as soon as breathing trouble started, I will reform my opinion.

For the record: I am not the vehement Karen Carr supporter involved in this debate. I support home birth in general and midwives in general. I think this case is a tragedy with multiple points of failure.

I think that we do not have enough information about the situation with the twin in respiratory distress and the ambulance that was sent away to really make any fully informed decisions about what happened. My understanding is that this happened in a rural home, so how long did it take the ambulance to show up? Maybe it took the 33 minutes Carr is being demonized for wasting while the Alexandria baby was in distress. If a baby was having breathing trouble, an ambulance was called right then, CPR was performed while waiting, and in the half hour the ambulance took, that baby rebounded, then I can understand why one person's assessment might be "But the baby is fine now". We also don't know what role the paramedics who responded had in the decision to not bring the baby to the hospital. Maybe their assessment was that the baby was no longer in danger and could remain at home. We don't know what the role the parents played either. Maybe they decided that since the baby was breathing fine again, they did not wish to go to the hospital. It's not the decision I would make, but it wasn't my decision to make, and since I wasn't there, I don't know all the details.

I think that many posters are also not allowing for hindsight in a lot of these decisions. We can make as many sweeping statements about how we would act in a given situation, but until we are in that situation, we never really know how we will act. It is also easy to assume that all the players in this situation had all the information at the same time, to fully inform their decisions. This is almost never the case in reality. I think that your preference, assuming that you were one of the players in a situation with a baby in distress and a team of paramedics on the way, would be to err on the side of caution and take the baby to the hospital. That would also be my choice in this situation, but I know people who would say "But the baby is fine now" and that would be enough to convince them. Again, not the decision I'd make, but not my decision to make.

You are, of course, entitled to your opinion. For what it's worth, I mostly agree with you, but would also caution against incomplete information.

I think it's possible that the paper got the skeleton of the details correct - baby having breathing troubles, ambulance

[Anonymous]

Anonymous wrote:

Anonymous wrote:
Unless the paper got the part wrong where she turned the ambulance away, I'm sticking with my opinion of this. You do not play with respiratory distress in a newborn, precisely because it can kill them quickly. If the paper got it wrong, and she actually rushed that newborn to the nearest NICU as soon as breathing trouble started, I will reform my opinion.

For the record: I am not the vehement Karen Carr supporter involved in this debate. I support home birth in general and midwives in general. I think this case is a tragedy with multiple points of failure.

I think that we do not have enough information about the situation with the twin in respiratory distress and the ambulance that was sent away to really make any fully informed decisions about what happened. My understanding is that this happened in a rural home, so how long did it take the ambulance to show up? Maybe it took the 33 minutes Carr is being demonized for wasting while the Alexandria baby was in distress. If a baby was having breathing trouble, an ambulance was called right then, CPR was performed while waiting, and in the half hour the ambulance took, that baby rebounded, then I can understand why one person's assessment might be "But the baby is fine now". We also don't know what role the paramedics who responded had in the decision to not bring the baby to the hospital. Maybe their assessment was that the baby was no longer in danger and could remain at home. We don't know what the role the parents played either. Maybe they decided that since the baby was breathing fine again, they did not wish to go to the hospital. It's not the decision I would make, but it wasn't my decision to make, and since I wasn't there, I don't know all the details.

I think that many posters are also not allowing for hindsight in a lot of these decisions. We can make as many sweeping statements about how we would act in a given situation, but until we are in that situation, we never really know how we will act. It is also easy to assume that all the players in this situation had all the information at the same time, to fully inform their decisions. This is almost never the case in reality. I think that your preference, assuming that you were one of the players in a situation with a baby in distress and a team of paramedics on the way, would be to err on the side of caution and take the baby to the hospital. That would also be my choice in this situation, but I know people who would say "But the baby is fine now" and that would be enough to convince them. Again, not the decision I'd make, but not my decision to make.

You are, of course, entitled to your opinion. For what it's worth, I mostly agree with you, but would also caution against incomplete information.

I think it's possible that the paper got the skeleton of the details correct - baby having breathing troubles, ambulance

I agree, we don't have all of the facts in EITHER case, making it difficult to know what really happened. Still, two dead (presumably healthy, full term) babies in the span of two months is a lot for ANY provier. Perhaps more than just "bad luck" at play here.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:YAnd Karen is so knowledgable that she told a newspaper in an interview that she 1) didn't recognize the importance of respiratory distress in a newborn, and 2) didn't bother to find out what caused it even after the newborn died. That's not the kind of knowledgable practitioner I want anywhere near my baby. Again, to choose otherwise is your right.

Don't bother. I've said this in 4 separate posts and NOT ONE Carr advocate has addressed it.

At the risk of being told again that I need a kick in the ass or that i'm stupd, I'll address this question again. The above are not correct quotes from the newspaper. Copied directly from the Post's webiste:

In November, Carr attended to a mother pregnant with twins in rural Maryland. One was having trouble breathing after delivery, so paramedics were called, but by the time they got there, 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.”

---
Now you could read the I'm not sure what happened as the final word but is it possible that the author of the article left something out. Maybe they did an autoposy and the results were inconclusive? Now I have no idea if that is correct, but neither do you or anyone else for that matter. It is possible that what was actually put in the Post and what was left out was done to make Karen sound like she doesn't care. Unless you can have a copy of the full interview done with Karen, you don't really know all that was said. Regardless, it doesn't quote Karen as saying she didn't care enough to find out and it doesn't prove that she did anything wrong in that situation. And accrding to her supporters there were factual errors about some of the events described. (and no not the mom that had complaints about Karen).

But go ahead and tell me how stupid I am for accepting the fact that realize that I don't have enough information about this case or Karen's practice in general to damn her the way many posters have on this board.

It amazes me how anti-Carr posters are told over and over that they shouldn't speculate by the very people who attack their judgement of what they DO know (Karen Carr said this, that we know) by speculating on a possible (though rather improbable) defense. The woman TURNED AWAY paramedics. Midwives and OBs alike agree that any respitory distress in a newborn requires monitoring the kind of pediatric experts they themselves are NOT. She turned them away. That child might very well have survived if it'd been properly monitored by the second time this happened, by which time they might have already found and treated the cause. Maybe not. But don't tell me all that COULD be done for that child was done, and don't tell me that Carr researched this case to learn from it the way she addressed it. Case in point: In a riskier than "low-risk" case, she still did NOT have any OB or ped in the wings to intervene in case the warnings from both midwives and OBs came true. I'm far from calling you stupid. Carr, on the other hand...

[Anonymous]

Someone please stick a fork in this thread.

[Anonymous]

Anonymous wrote:Someone please stick a fork in this thread.

What's it to you? I guess the owner of the board can lock it if he doesn't want to use any more resources on it.

[Anonymous]

Of course NCB advocates want to sweep this under the carpet. Nothing to see here folks, move along please!

Why don't we discuss this? In the comment section from the Unnecesearan's "Colorado Midwives Win" post:

"Colorado licensed midwives have been required to submit their statistics for each of the past 4 years and the results are nothing short of appalling. In each and every year since licensure began, the perinatal death rate for planned homebirth with a licensed midwife exceed the death rate for the ENTIRE state, including premature babies and high risk pregnancies. Even worse, the number has risen each and every year.

In 2009 Colorado licensed midwives provided care for 799 women. Nine (9) babies died for a homebirth death rate of 11.3/1000! That is nearly DOUBLE the perinatal death rate of 6.3/1000 for the entire state (including all pregnancy complications and premature births).

The data is conveniently broken down by type of death and place of death. For example, there were three intrapartum deaths for an intrapartum death rate of 3.8/1000, more than TEN TIMES HIGHER than the intrapartum death rate commonly experienced in hospitals. There were 4 neonatal deaths for a neonatal death rate of 5/1000. That's TEN TIMES HIGHER than the national neonatal mortality rate for low risk hospital birth with a CNM. On hundred women were transferred in labor or after delivery for a transfer rate of 12.5%. The neonatal death rate in the transfer group was 50/1000, an appalling neonatal death rate ONE HUNDRED TIMES HIGHER than that expected in a group of low risk women."

[Anonymous]

Anonymous wrote:Of course NCB advocates want to sweep this under the carpet. Nothing to see here folks, move along please!

Why don't we discuss this? In the comment section from the Unnecesearan's "Colorado Midwives Win" post:

"Colorado licensed midwives have been required to submit their statistics for each of the past 4 years and the results are nothing short of appalling. In each and every year since licensure began, the perinatal death rate for planned homebirth with a licensed midwife exceed the death rate for the ENTIRE state, including premature babies and high risk pregnancies. Even worse, the number has risen each and every year.

In 2009 Colorado licensed midwives provided care for 799 women. Nine (9) babies died for a homebirth death rate of 11.3/1000! That is nearly DOUBLE the perinatal death rate of 6.3/1000 for the entire state (including all pregnancy complications and premature births).

The data is conveniently broken down by type of death and place of death. For example, there were three intrapartum deaths for an intrapartum death rate of 3.8/1000, more than TEN TIMES HIGHER than the intrapartum death rate commonly experienced in hospitals. There were 4 neonatal deaths for a neonatal death rate of 5/1000. That's TEN TIMES HIGHER than the national neonatal mortality rate for low risk hospital birth with a CNM. On hundred women were transferred in labor or after delivery for a transfer rate of 12.5%. The neonatal death rate in the transfer group was 50/1000, an appalling neonatal death rate ONE HUNDRED TIMES HIGHER than that expected in a group of low risk women."

So what is it that you want to discuss?

[Anonymous]

Anonymous wrote:Of course NCB advocates want to sweep this under the carpet. Nothing to see here folks, move along please!

Why don't we discuss this? In the comment section from the Unnecesearan's "Colorado Midwives Win" post:

"Colorado licensed midwives have been required to submit their statistics for each of the past 4 years and the results are nothing short of appalling. In each and every year since licensure began, the perinatal death rate for planned homebirth with a licensed midwife exceed the death rate for the ENTIRE state, including premature babies and high risk pregnancies. Even worse, the number has risen each and every year.

In 2009 Colorado licensed midwives provided care for 799 women. Nine (9) babies died for a homebirth death rate of 11.3/1000! That is nearly DOUBLE the perinatal death rate of 6.3/1000 for the entire state (including all pregnancy complications and premature births).

The data is conveniently broken down by type of death and place of death. For example, there were three intrapartum deaths for an intrapartum death rate of 3.8/1000, more than TEN TIMES HIGHER than the intrapartum death rate commonly experienced in hospitals. There were 4 neonatal deaths for a neonatal death rate of 5/1000. That's TEN TIMES HIGHER than the national neonatal mortality rate for low risk hospital birth with a CNM. On hundred women were transferred in labor or after delivery for a transfer rate of 12.5%. The neonatal death rate in the transfer group was 50/1000, an appalling neonatal death rate ONE HUNDRED TIMES HIGHER than that expected in a group of low risk women."

If statistics like these were more widely available, THEN women could truly make informed choices. Thanks for posting.

[Anonymous]

Anonymous wrote:Of course NCB advocates want to sweep this under the carpet. Nothing to see here folks, move along please!

Why don't we discuss this? In the comment section from the Unnecesearan's "Colorado Midwives Win" post:

"Colorado licensed midwives have been required to submit their statistics for each of the past 4 years and the results are nothing short of appalling. In each and every year since licensure began, the perinatal death rate for planned homebirth with a licensed midwife exceed the death rate for the ENTIRE state, including premature babies and high risk pregnancies. Even worse, the number has risen each and every year.

In 2009 Colorado licensed midwives provided care for 799 women. Nine (9) babies died for a homebirth death rate of 11.3/1000! That is nearly DOUBLE the perinatal death rate of 6.3/1000 for the entire state (including all pregnancy complications and premature births).

The data is conveniently broken down by type of death and place of death. For example, there were three intrapartum deaths for an intrapartum death rate of 3.8/1000, more than TEN TIMES HIGHER than the intrapartum death rate commonly experienced in hospitals. There were 4 neonatal deaths for a neonatal death rate of 5/1000. That's TEN TIMES HIGHER than the national neonatal mortality rate for low risk hospital birth with a CNM. On hundred women were transferred in labor or after delivery for a transfer rate of 12.5%. The neonatal death rate in the transfer group was 50/1000, an appalling neonatal death rate ONE HUNDRED TIMES HIGHER than that expected in a group of low risk women."

OMG!!!!! Scary.

[Anonymous]

As for the respiratory distress, many 'normal' babies have respiratory distress. Per the NRP (neonatal resusication something) guidelines, a baby just has to be observed for x amount of time (can't come up with it off the top of my head) if certain conditions exist (i.e. HR <100, Color is blue, etc). Once that time has passed, the infant doesn't require close observation.

I don't know whether she followed the guidelines or not, but neither does the poster who thinks she's a doctor.

P.S. I havenn't practiced L and D for a while, so that's why I don't remember NRP step by step. But ya'll can google it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Of course NCB advocates want to sweep this under the carpet. Nothing to see here folks, move along please!

Why don't we discuss this? In the comment section from the Unnecesearan's "Colorado Midwives Win" post:

"Colorado licensed midwives have been required to submit their statistics for each of the past 4 years and the results are nothing short of appalling. In each and every year since licensure began, the perinatal death rate for planned homebirth with a licensed midwife exceed the death rate for the ENTIRE state, including premature babies and high risk pregnancies. Even worse, the number has risen each and every year.

In 2009 Colorado licensed midwives provided care for 799 women. Nine (9) babies died for a homebirth death rate of 11.3/1000! That is nearly DOUBLE the perinatal death rate of 6.3/1000 for the entire state (including all pregnancy complications and premature births).

The data is conveniently broken down by type of death and place of death. For example, there were three intrapartum deaths for an intrapartum death rate of 3.8/1000, more than TEN TIMES HIGHER than the intrapartum death rate commonly experienced in hospitals. There were 4 neonatal deaths for a neonatal death rate of 5/1000. That's TEN TIMES HIGHER than the national neonatal mortality rate for low risk hospital birth with a CNM. On hundred women were transferred in labor or after delivery for a transfer rate of 12.5%. The neonatal death rate in the transfer group was 50/1000, an appalling neonatal death rate ONE HUNDRED TIMES HIGHER than that expected in a group of low risk women."

OMG!!!!! Scary.

On the face of it, it doesn't look good. But I'd like to know if one or two midwives and/or practices are skewing the numbers or if it's across the board. I'd also like to know if it's an indigent population that's scared to go to the hospital in fear of being deported. If the midwives in Colorado just suck, then that needs to be addressed.

[Anonymous]

Anonymous wrote:As for the respiratory distress, many 'normal' babies have respiratory distress. Per the NRP (neonatal resusication something) guidelines, a baby just has to be observed for x amount of time (can't come up with it off the top of my head) if certain conditions exist (i.e. HR <100, Color is blue, etc). Once that time has passed, the infant doesn't require close observation.

I don't know whether she followed the guidelines or not, but neither does the poster who thinks she's a doctor.

P.S. I havenn't practiced L and D for a while, so that's why I don't remember NRP step by step. But ya'll can google it.

Excuse me, but your post is scaring me. A baby with a heart rate less than 100 is BRADYCARDIC, and probably HYPOXIC as well.
Depending on the situation, the baby would need progressive interventions: stimulation, and oxygen for starters.
If the baby is depressed due to a traumatic delivery, he may well "pink-up" after stimulation, and oxygen.
But if you knew anything about newborns, you would know they can decompensate in the blink of an eye. Hypoxia at birth places them at risk for persistent pulmonary hypertension, a deadly condition where blood is shunted away from the lungs.
Best not to comment if you don't know what you are talking about.

[Anonymous]

Anonymous wrote:BS. licensing does more than keep midwives out of jail. NARM standards for CPMs require education, training, and clinical experience. NARM doesn't do this just to keep people out of jail. They do it to increase public safety by setting minimum standards for practicing.

Karen has a NARM CPM certification