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

[Anonymous]

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Anonymous wrote:In this day and age using a midwife why?

Oh o guess the dumb Bible thumping crowd not liking science

Being a parent means doing the best even in childbirth that means a hospital

There's variety in midwifery care. Both of my DDs were delivered by CNMs (Certified Nurse Midwives) in a hospital. I had to be induced, and I received epidurals both times. Prenatal and postnatal care was attentive, excellent, and evidence-based.

Delivery by CNMs in a hospital setting is best of both worlds, in my experience.

People need to understand that there is a tremendous difference between a CNM (tons of training) and a CPM (basically an apprenticeship). Karen Carr is a CPM.
Never ever hire a CPM.

+1 from the PP who linked to the (most recent) Post article, and who saw CNMs for all three pregnancies/L&D.

Also: I am livid with Maryland for deciding to "license" CPMs. I remember voting against this proposal when it was on the ballot and unfortunately, it passed. That Karen Carr can continue to legally practice in this state is unconscionable.

Why are you against licensing? The Wapo article says "Overall, full-term infants in the United States are more than twice as likely to die after planned home births attended by midwives as those delivered in hospitals by any providers, according to a Post analysis of CDC data over five years." Why wouldn't you want licensing? or am i missing something here?

I'm a healthcare professional myself, licensed in DC. Becoming licensed to practice independently should be a high bar to clear, with the requisite educational and supervised practice requirements. CPMs don't meet that standard, IMO. Licensure has implications for practice and for insurance reimbursement and validates the individual's credentials, even if they're specious AF. So, a woman looking for a home birth in MD, for example, could see that CPMs are licensed and think that equates with quality healthcare by a provider qualified to provide that service. In this case, again IMO, they would be wrong.

As I noted earlier, CNMs provided all of my prenatal care and delivered my three kids (in a hospital, with epidurals two out of three times). I am NOT against the midwifery model of care.

To summarize the argument against licensing CPM's: Should we license voodoo practitioners?

[Anonymous]

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Anonymous wrote:Let me ask you this. If this was you, and you were the midwife. Would you continue to practice as you were, after babies had died on your watch? Really ask yourself this question. if you had been charged with manslaughter? negligence? Watched the pain dawn on the parent's faces as the realization began to dawn in your mind that perhaps--just perhaps there was something you might have done or not done that contributed to that death and suffering?

At the time of the Timmerman ordeal, there was an article that touched on this, and part of her defense of her actions was essentially that sometimes babies die. As another PP said, she really doesn't believe it's her fault.

I cannot effing believe that that shrew FELT A FOOT - a footling breech! The one with the worst outcomes even in a hospital setting! And she thought she could just safely deliver that woman’s child?! It’s unconscionable.

Any OB or midwife can lose a baby. There are no guarantees in life. But she is sloppy. She is a murderer.

I couldn't believe this either. What kind of delusional hubris do you have to have to think you can handle this? Like WTF? And I do blame the parents too. When multiple people turn you away as too high risk, maybe they're onto something? They could go down the rabbit hole searching for a sketch provider to do what no one else would do but couldn't google "footling breach" and get it through their skulls there was a high probability of infant death delivering vaginally? Does not compute for me.

I’m the PP you’re replying to and the midwife (not Karen Carr) who turned me over to an OB was clear that the frank breeches she’d attended were straightforward and simple. I know that I was terrified of surgery, like terrrrrrified and that was motivating me. I read the article but I don’t remember; did Carr tell them she felt a foot or did she just bumble along thinking she was going to be the hero here?

Oh and from a place of deep pettiness nearly 13 years on: the only person to try and make me feel like I was a failure for having had a c-section was my Bradley Birth instructor, Julie Maimones. She really wanted to know what I could have done differently to have a vaginal birth and I’m still stunned, so many years after the fact, that that was her take.

I still think that at a lot of hospitals, you go in and you’re on a conveyor belt and it might not be best practices. At GW I felt like I was a valued human and not a vessel to be cut out of the way, but I don’t think a lot of women in other locales get those same choices I was presented with and I can see why, especially if someone has had birth or sexual trauma, that one of those highly medicalized, you’re getting your cervix checked as often as we see fit and one of the OBs still has a habit of cutting episiotomies births is terrifying enough to drive women to home births.

NP. I share your pettiness. The only person who was overtly nasty about my C-section was the leader of a babywearing group I attended briefly after birth. She was actually angry that I had a quick, easy recovery and was successfully breastfeeding, more than some of the women in the group who had had unmedicated birth, and berated me for my c-section in front of the group.

I’ve come to the conclusion that the natural birth community has a deeply misogynist strain of people who are actually angry when women don’t suffer.

I'm sorry this happened. I was a birth center patient turned hospital transfer and c-section and my CNM celebrated my baby like she did all the others.

Good for you. My friend had a CNM home birth that turned into a hospital transfer and the midwives dumped her at the door. After the birth they Ghosted her on calls, never followed up, and left the birthing pool full of water in their home and never came to get it. The baby had complications and needed the NICU and they didn’t even see if they were ok. Took her many months just to get her scrubbed medical records from them.

Yes. Good for me. I don't know why you would resent the fact my midwife stayed with me in a doula role until he was delivered and began nursing, but whatever makes you feel better (hint, it's not attacking a stranger).

[Anonymous]

I had a planned c-section that went exactly as planned and resulted in a healthy baby and healthy mom. I recommend it highly.

Cannot imagine what is going through the heads of people opting for utterly untrained birth assistants, but it must be bad.

[Anonymous]

I’m an RN in the star of MD and am disgusted that KC is currently licensed and allowed to practice in MD. I realize she was cleared by a judge, but where is the professional accountability?

[Anonymous]

Anonymous wrote:I had a planned c-section that went exactly as planned and resulted in a healthy baby and healthy mom. I recommend it highly.

Cannot imagine what is going through the heads of people opting for utterly untrained birth assistants, but it must be bad.

They know exactly what they are doing. And they pick Karen Carr specifically for her experience with high risk births that no one else will touch. The WaPo article was pretty disingenuous.

[Anonymous]

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Anonymous wrote:NP. When I saw the story on the WaPo website (https://www.washingtonpost.com/investigations/interactive/2023/home-birth-midwife-karen-carr/) right now, I remembered this thread and wondered if the midwife in today's story was the same as the one I'd read about on DCUM so many years ago, when I was pregnant with my midwife-delievered VBAC baby. I'm shocked that yet another baby has died, but in a way I'm relieved to know that there's only one notoriously dangerous midwife in our area. Maybe now something will be done.

My heart goes out to this family.

If you think that there is only one dangerous midwife in our area, you are sorely mistaken. There are CNMs in this area who are just as narcissistic and egomaniacal as Karen Carr. If you want to search you can find some cases in the DC Superior Court records - and those are just the instances of poor outcomes where the women filed suit, not the ones where women had bad outcomes and advocated against the negligence or mistreatment they experienced in other ways.

I’m not anti midwife. There are also some who are truly fantastic. But I could list off, by name, several CNMs in the DMV that I had care from personally who suffer from the same hubris as Carr did.

There was a great comment on the article by a retired OB or L and D nurse that said something to the effect of, there are women in this profession who really enjoy having power over other women, and it is so true. It’s not true of every provider, but it’s definitely true of some.

I have suffered terrible abuse at the hands of male and female OBs and female midwives.

Male OB/RE: botched saline sono and caused a horrific high risk pregnancy (very thin C section scar that was threatening to spontaneously rupture before the due date) against my wishes, horded records in an attempt to cover it up. The abnormality is so large is plainly visible on the memory FET ultrasound the nurse gave me not realizing what happened right in front of her
Male OB: asked if I needed to take my pants off for an ultrasound (which the above condition needed), he said "No, I'm keeping mine on" and told me to "trust me" about extremely dangerous VBAC, lied to me and said my uterus was normal, fired him and went to-->
Three female midwives: engaged in a group conspiracy to "run out the clock" on the above pregnancy, pretending the issue was being addressed when it was not
Male OB who did 2nd C section: Told him in plain English I thought I had an infection, gave me a deer in the headlight look then didn't do anything to help me. Refused to see me in person after because he's "high risk". Sent me to below OB-->
Female OB: "It doesn't matter" when I told her my baby almost died, tried to bully me out of having my uterus fixed. I walked on on this b--ch

Finally met a competent surgeon, turns out my uterine edges were 100% separated, spanned by thin adhesion only, and my uterus was infected with poop bacteria for over a year, and yes I did have symptoms and complained about them, everybody blew me off

As for this midwife, I am shocked she's being charged with a crime when partial birth abortions are legal. It's wrong to bully a woman for getting an abortion but it's fine to bully her for her birth choice? Total BS. This will just cause women to give birth at home unassisted. Why is there no consequences for the horrific behavior of these providers? Why is this culture of treating women like absolute s--t institutionalized in obstetrics? Those are the real questions that need to be asked.

Are we just BANNING all vaginal breech births? So mom has ONLY the choice between surgery or a late term abortion? What happened to that baby could have easily happened in a hospital attempted vaginal breech delivery. The baby was only stuck for 20 minutes and chances are even in a hospital a C section would not have been done in only 20 minutes

I have done alot of research on this topic and I am convinced that C sections cause more babies to not be born due to maternal choice and silent infertility than they save from fetal loss during birth, probably a 10:1 ratio. Just look at countries with the worst healthcare systems, they are teaming with babies.

99% of women who are asked to choose between TOLAC and repeat C are not being given the most critical piece of information to make that decision, namely their residual myometrium/lower uterine segment thickness, which highly inversely correlates with uterine rupture risk. There is a conspiracy to keep this information away from women because routinely scanning would expose the OBs with incompetent surgical technique and open them up to lawsuits. OBs would rather babies just die or bully women into repeat Cs, which carry a risk to their lives. "Just cut everybody" cannot and should not be the solution to every obstetric problem in the world.

You are blabbering on about *a lot* but I can say with 120% certainty this is not true. There is not a proven direct correlation and while uterine health examinations exist, no peer-reviewed studies have shown a direct relationship uterine rupture. This is why some doctors (rightfully) refuse VBAC.

I do however agree with you that doctors need to be much more forthcoming about the risks than they are, and honest that there is no single test that will put a former cesarean woman’s mind at complete ease.

Signed, I do this research as part of my job.

DP. Doctors refusing to do VBAC doesn’t seem to be something that’s based in science or research at all. I requested double layer sutures at my c -section and waited the two years my OB said would allow maximum healing before getting pregnant again. The first practice affiliated with Inova Fairfax that I found for my second birth paid lip service to me VBACing but by my second trimester it was clear I was going to get a repeat c-section, so I switched. The midwife at the second practice showed me my records on which the doctor had written, in all caps, by hand, do not allow VBAC. I ended up at GW with the OBs (though one of the midwives there was the second set of eyes for my resident, who was on the newer end) and had a safe VBAC.

I’m pretty staunchly opposed to home births, and I used to be all in on the cult. But honestly when you get a chance to personally see some of the voodoo and biases in obstetrics? Look at your post and then someone posts actual research - and you claim to do research for this field for a living? I’m glad I’m done having kids.

Wow. I’m not so sure I’d be that cavalier about such a clear recommendation against VBAC from a doctor. What was it based on? Just because you ended up with a successful vaginal birth does not mean the risk was low. You need to understand risk statistics before you start claiming that obstetrics is “voodoo.”

DP. For years, doctors were against VBACs for not-good reasons. Unless they could explain why clearly, I wouldn't put much weight in it.

[Anonymous]

Anonymous wrote:I had a planned c-section that went exactly as planned and resulted in a healthy baby and healthy mom. I recommend it highly.

Cannot imagine what is going through the heads of people opting for utterly untrained birth assistants, but it must be bad.

Pure arrogance. They believe they are somehow able to control medical outcomes with good vibes and a positive outlook. If that were the case 1 in 3 women wouldn't have died in childbirth up until the advent of modern medicine.

[Anonymous]

Anonymous wrote:I had a planned c-section that went exactly as planned and resulted in a healthy baby and healthy mom. I recommend it highly.

Cannot imagine what is going through the heads of people opting for utterly untrained birth assistants, but it must be bad.

The story of that man who still grieves the loss of his baby and can’t bear to be around children broke my heart.

[Anonymous]

Ugh, wapo. This story is incredibly sad, but it also was insanely slanted.

To arrive at the 2x as any deaths at home births vs hospital, ACOG, whose figure it is (of course it is) counts hospital transfered home births (in other words midwife or family recognizes emergency and goes to hospital) as “hospital” births regardless of the plan. And they don’t segment the homebirth data for those with prenatal care or not, high risk or not. Other studies have shown that low risk women who plan and intiate a homebirth actually have pretty equivalent outcomes. I had two hospital births. One with a doctor who medicalized the whole thing and stressed me out and made me push in lithotomu position (4th degree tear and 16 years later still have pain from the granuloma) and my second was a midwife (at a hospital). Second was easier and better and no tearing despite a bigger baby. I have lost count of friends who were restricted to bed, no movement, laid on their backs, told not to eat, told not to drink, and ultimately had the proverbial cascade of interventions. C sections are not NBD. They’re a massive surgery that often lead to more surgeries. I wasn’t personally comfortable with home birth but the simplistic dismissals or calling people who see risk on both sides of the equation and make an informed choice based on unskewed data as narcissist stupid or murderers is just too much. I wanted nothing more than a safe baby, but for me the hospital certainly has procedures that made my birth less safe and good for the baby. There’s so much failure to follow eveidence based medicine in obstetrics. Surgeons are trained to cut, and many do.

[Anonymous]

Anonymous wrote:Ugh, wapo. This story is incredibly sad, but it also was insanely slanted.

To arrive at the 2x as any deaths at home births vs hospital, ACOG, whose figure it is (of course it is) counts hospital transfered home births (in other words midwife or family recognizes emergency and goes to hospital) as “hospital” births regardless of the plan. And they don’t segment the homebirth data for those with prenatal care or not, high risk or not. Other studies have shown that low risk women who plan and intiate a homebirth actually have pretty equivalent outcomes. I had two hospital births. One with a doctor who medicalized the whole thing and stressed me out and made me push in lithotomu position (4th degree tear and 16 years later still have pain from the granuloma) and my second was a midwife (at a hospital). Second was easier and better and no tearing despite a bigger baby. I have lost count of friends who were restricted to bed, no movement, laid on their backs, told not to eat, told not to drink, and ultimately had the proverbial cascade of interventions. C sections are not NBD. They’re a massive surgery that often lead to more surgeries. I wasn’t personally comfortable with home birth but the simplistic dismissals or calling people who see risk on both sides of the equation and make an informed choice based on unskewed data as narcissist stupid or murderers is just too much. I wanted nothing more than a safe baby, but for me the hospital certainly has procedures that made my birth less safe and good for the baby. There’s so much failure to follow eveidence based medicine in obstetrics. Surgeons are trained to cut, and many do.

Other studies? You mean studies done by MANA? Lol. No, the death rate evidence is pretty solid, the other data you’re referring to is outside the Us in small European counties where only actual real CNMs or their equivalent are doing home births and that is in very homogenous populations with universal health care and strict criteria for homebirth candidates and transfer protocols where hospitals are geographically quite close. Comparing that to the heterogenous US population which is highly diverse, lacks universal health care, has many rural areas and health care deserts, and has a 3 tier midwifery system that includes one credential that basically is akin to “have a HS diploma and help out in a few homebirths” (which is what Jill Dillard did fWIW) who perform homebirths with super high risk patients and you are comparing, in essence, apples to elephants.

[Anonymous]

Anonymous wrote:Ugh, wapo. This story is incredibly sad, but it also was insanely slanted.

To arrive at the 2x as any deaths at home births vs hospital, ACOG, whose figure it is (of course it is) counts hospital transfered home births (in other words midwife or family recognizes emergency and goes to hospital) as “hospital” births regardless of the plan. And they don’t segment the homebirth data for those with prenatal care or not, high risk or not. Other studies have shown that low risk women who plan and intiate a homebirth actually have pretty equivalent outcomes. I had two hospital births. One with a doctor who medicalized the whole thing and stressed me out and made me push in lithotomu position (4th degree tear and 16 years later still have pain from the granuloma) and my second was a midwife (at a hospital). Second was easier and better and no tearing despite a bigger baby. I have lost count of friends who were restricted to bed, no movement, laid on their backs, told not to eat, told not to drink, and ultimately had the proverbial cascade of interventions. C sections are not NBD. They’re a massive surgery that often lead to more surgeries. I wasn’t personally comfortable with home birth but the simplistic dismissals or calling people who see risk on both sides of the equation and make an informed choice based on unskewed data as narcissist stupid or murderers is just too much. I wanted nothing more than a safe baby, but for me the hospital certainly has procedures that made my birth less safe and good for the baby. There’s so much failure to follow eveidence based medicine in obstetrics. Surgeons are trained to cut, and many do.

Citations, please.

[Anonymous]

I would be super interested in someone providing links and a deeper explanation of the studies as well. From my understanding, the Wax study that cited 2-3x mortality for home births was largely debunked because of various reasons, such as including congenital defects and unplanned home births. I thought MANA never actually released anything substantial, which has earned them criticism but their reporting has been entirely voluntary and they mostly just trying to get data from midwives—not just success rates. What I found interesting is in the WaPo footnote is that they say they based their numbers of higher mortality for home birth on CDC numbers, which weren’t linked. But they did say they excluded congenital defects and only included planned home births with midwives so it’s definitely worth looking more into.

FWIW, I’m firmly of the opinion that modern home births, when done properly, should have lower mortality and morbidity rates than the hospital. But only when the mother is low-risk and in the rare event something does happen for that low-risk mother/pregnancy, that the midwife have an existing relationship with the nearby hospital that the mother is also aware of so that transfers (including mother’s health information) can be done as smoothly as possible with communication between both sides. I know Karen Carr was revered as a goddess because she would take on high-risk clients no one else would take. Her success rate given the odds was high. I have very mixed feelings about it all and agree that WaPo’s coverage was biased (but Carr didn’t want to comment, so) but hope that this tragedy can help spur greater transparency, communication and research into the field.

[Anonymous]

Couldn’t agree more. This is PP who originally discussed wapo’s skewed data. I’m also mixed. Some women should give birth in hospitals. It seems Karen took those women on. It’s hard for me to fathom being on either side of the choice since I went to a hospital for my healthy pregnancies. (I was 40 for my second, so I was not low risk). But the data has big flaws because as pp says they compared unplanned, unassisted births in the home birth set and included successful hospital transfers in the hospital data. Overall it’s a complex issue and the reporting here was exceedingly biased.

[Anonymous]

I realize Karen Carr doesn’t carry malpractice insurance, but could the family file a wrongful death (or whatever the correct term is) civil suit? I think that’s what it might take drive her out of practice.

I would be willing to contribute to a legal fund for this.

[Anonymous]

Anonymous wrote:I realize Karen Carr doesn’t carry malpractice insurance, but could the family file a wrongful death (or whatever the correct term is) civil suit? I think that’s what it might take drive her out of practice.

I would be willing to contribute to a legal fund for this.

It would probably be a waste of money for the family and cause unnecessary strife. It’s really difficult to prosecute midwives for something like this unless you have proof that they were grossly negligent and even then it’s hard. Not all midwives are the same and it’s important to do your research. I was shocked that the couple did no research on Carr. Articles about her lawsuits and other controversies pop up right away on Google’s first page but they admitted they didn’t look anywhere past googling for her website.