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

[Anonymous]

Anonymous wrote: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.

How on earth is this relevant to anything that is being discussed?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:13:46, go back and read my comment above. And then STHU.

I've read it. Nothing there about the risk of the BABY's death.

She said she'd get the c-section. Let it go.

Not the PP you are responding to, but she said she would get the c-section rather than put her own life at risk.

Your implication is really sickening. Seriously, STFU.

He who curses loudest wins? Not a very good debating strategy there. I find your post sickening.

Not debating, just pointing out what a jerk you are.

Takes one to know one , I guess.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

How on earth is this relevant to anything that is being discussed?

How it is relevant is someone earlier pointed out you don't have to stay home to have a midwife attend your birth - you can do it in the hospital and then went on to list midwives in hospitals! I was merely stating it was NOT the same! Read ALL the posts!

[Anonymous]

Ah, yes, the paranoia of the NCB advocate. How dare those women with actual medical training pretend to be midwifes! Much better to have the CPM who may not have a college degree and may have obtained her credentials via an uncredited correspondence course..

[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".

This. The fact that there is only one man in the mid-atlantic that has the skills to do ANY breech birth-not even a perfectly positioned frank- is DISGUSTING. Isn't that what obstetrics is for? To manage high-risk birth while leaving the low-risk births to the midwives? What exactly are OB/GYNs learning in school? It's completely opposite of what it is supposed to be in this country- OB/GYNS abandon VBAC and twins and breech- "high risk" according to them- and foist them off on homebirth midwives who seem to have more skills. All local OB/GYNs seem to know how to do is c-sections, which don't seem to require much skill, as evidenced by my cousin's baby, who nearly had her nose cut off during a c-section. Maimed for life because of "failure to progress." I know that's not as bad as death, but, honestly, I have never in all my years as a doula seen any OB-GYN display half the level of delicate, technical skill as the homebirth midwives...to include Karen.

Regarding studies about breech vs. c- here's a discussion about the research:
http://www.lamaze.org/Research/WhenResearchisFlawed/VaginalBreechBirth/tabid/167/Default.aspx

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

How on earth is this relevant to anything that is being discussed?

How it is relevant is someone earlier pointed out you don't have to stay home to have a midwife attend your birth - you can do it in the hospital and then went on to list midwives in hospitals! I was merely stating it was NOT the same! Read ALL the posts!

That actually wasn't what was posted, that I'm aware of - I am the PP who posted names of midwives who attend hospital births (a number of whom also attend birth center births, btw). I did it as a service to a PP who wanted a midwife at Sibley but was unable to find one - that PP didn't say anything about midwives being able to "do it all in the hospital" either. I had a homebirth with a CNM, and I am a strong homebirth advocate, and don't appreciate words/intentions being put in my mouth.

Also, regarding supervision - this may be true, but Maryland recently passed a law allowing CNMs to practice without a signed written agreement from an OB.

In any case, I'm all for people choosing the birth options that feel right for them and their family, whether that is at home, at a birth center or in the hospital - there are risks and benefits to all options.

And I agree - this particular thread is going slightly off topic...

[Anonymous]

Anonymous wrote:

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".

This. The fact that there is only one man in the mid-atlantic that has the skills to do ANY breech birth-not even a perfectly positioned frank- is DISGUSTING. Isn't that what obstetrics is for? To manage high-risk birth while leaving the low-risk births to the midwives? What exactly are OB/GYNs learning in school? It's completely opposite of what it is supposed to be in this country- OB/GYNS abandon VBAC and twins and breech- "high risk" according to them- and foist them off on homebirth midwives who seem to have more skills. All local OB/GYNs seem to know how to do is c-sections, which don't seem to require much skill, as evidenced by my cousin's baby, who nearly had her nose cut off during a c-section. Maimed for life because of "failure to progress." I know that's not as bad as death, but, honestly, I have never in all my years as a doula seen any OB-GYN display half the level of delicate, technical skill as the homebirth midwives...to include Karen.

Regarding studies about breech vs. c- here's a discussion about the research:
http://www.lamaze.org/Research/WhenResearchisFlawed/VaginalBreechBirth/tabid/167/Default.aspx

I had had a severed frank breech birth with Dr. Udwin at G'town in 2002. It wasn't even a discussion. He calmly told me my baby would be fine. He was. I then went on to have two VBACs at G'town with other doctors, again, no push for anything. So there are other very dedicated OB/GYNs out there, great technical skills and LICENSED!

[Anonymous]

All local OB/GYNs seem to know how to do is c-sections, which don't seem to require much skill,

That's not true of all local OB/GYNs. I had an unmedicated childbirth at Alexandria INOVA, the doctors were very nice and helpful, and no one suggested a C-section. They did ask me if I wanted my water broken, and offered an epidural but when I said no, they accepted it.

[Anonymous]

http://www.inservicetowomen.org/

Click on the link in the righthand corner of the page.

[Anonymous]

What is a severed frank breech?

Dr. Udwin only practices a bit on call now. He was great. Huge VBAC supporter too. I think he does something with computers now.

[Anonymous]

Dr. Udwin just called it "severe." I don't know if that is an actual medical term but my son's legs were behind his ears (seen in u/s) rather than next to or in front of his ears.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Sorry, I just realized that whole schpiel didn't actually answer your question.

I think that it is a woman's right to choose where she gives birth. Yes, "no matter what". I don't think that what this woman wanted to do is smart or safe. I wouldn't do it myself and I wouldn't recommend that any of my close friends or family do it either. If asked for advice by a stranger, I wouldn't recommend it. I would try to educate that person. It sounds like that's what Tchabo and the BirthCare midwives tried to do. Clearly their efforts did not work.

But it is her right to choose. To me, imposing requirements like this is a short step away from saying, "You're over 35, so you must birth in a hospital" or "You're over 35, so you must have a C section". I think that the best you can do is make recommendations and then allow people to make their own decisions, however wrong those decisions may be.

Disagree. If the baby is full-term and definitely viable, then it has a right to the best possible care to preserve life and function. Why do you think parents who withhold medical care from their children due to religious objections are routinely prosecuted? They are endangering the life of a child.

NO NO NO NO! I don't care what your own personal belief is, but the LAW currently places the life of a mother ahead of the life of a fetus if the mother so chooses. There are a few cases of court-ordered c-sections; those that were followed by a civil trial were determined to have been improper. ACOG ethics guidelines state that it's never right for health care providers to subject pregnant women to physical force, even with a court order authorizing a c-section or other procedure, and that seeking such orders against a patient's wishes is "rarely if ever acceptable." The American Medical Association has a similar policy.

You can't be legally compelled to undergo any other medical procedure for the benefit of another person (for example, you can't be forced to donate a kidney to your own child, etc.) so I don't know why this would be any different. Totally different from withholding medical care from a child that doesn't involve your own medical care.

[Anonymous]

ACOG Committee Opinion No. 340. Mode of term singleton breech delivery.
ACOG Committee on Obstetric Practice.

Abstract
In light of recent studies that further clarify the long-term risks of vaginal breech delivery, the American College of Obstetricians and Gynecologists recommends that the decision regarding mode of delivery should depend on the experience of the health care provider Cesarean delivery will be the preferred mode for most physicians because of the diminish-ing expertise in vaginal breech delivery. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for both eligibility and labor management. Before a vaginal breech delivery is planned, women should be informed that the risk of peri-natal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned, and the patient's informed con-sent should be documented.

Docs have made it that you don't have more choices in vaginal breech birth in the hospital in limiting it and then not training others in it, and then say, well, guess it is ok, because research supports breech vaginal birth.

Society of Obstetricians and Gynaecologists of Canada. http://www.sogc.org/media/advisories-20090617a_e.asp Halifax – June 17, 2009 – Physicians should no longer automatically opt for caesarean sections in the event of breech birth, according to new guidelines for Canadian health professionals released today by the Society of Obstetricians and Gynaecologists of Canada.

[Anonymous]

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...

Anonymous wrote:The fact that there is only one man in the mid-atlantic that has the skills to do ANY breech birth-not even a perfectly positioned frank- is DISGUSTING. Isn't that what obstetrics is for? To manage high-risk birth while leaving the low-risk births to the midwives? What exactly are OB/GYNs learning in school? It's completely opposite of what it is supposed to be in this country- OB/GYNS abandon VBAC and twins and breech- "high risk" according to them- and foist them off on homebirth midwives who seem to have more skills. All local OB/GYNs seem to know how to do is c-sections, which don't seem to require much skill, as evidenced by my cousin's baby, who nearly had her nose cut off during a c-section. Maimed for life because of "failure to progress." I know that's not as bad as death, but, honestly, I have never in all my years as a doula seen any OB-GYN display half the level of delicate, technical skill as the homebirth midwives...to include Karen.

http://www.newyorker.com/archive/2006/10/09/061009fa_fact?currentPage=all

This really interesting article in the New Yorker helped me understand some other reasons why c-sections have risen in frequency over the last decades. They way I understand it--it used to be that for every different problem with birth, there was a different technique the doctor had to learn to solve it (all much harder to learn than a section because you can't SEE what you're doing). Individually, they were safer than a c-section, but as the techniques added up, it got harder and harder to learn them all. As c-sections got safer, and could be used for ALL of these problems, it became statistically safer to focus on that one procedure rather than learning, possibly badly, all these other procedures. So while it might be safer for one woman to undergo a forceps delivery at the hands of an experienced OB than have a c-section, over hundreds of births with some less experienced or skilled OBs in the mix, c-sections start to win out.

The question facing obstetrics was this: Is medicine a craft or an industry? If medicine is a craft, then you focus on teaching obstetricians to acquire a set of artisanal skills—the Woods corkscrew maneuver for the baby with a shoulder stuck, the Lovset maneuver for the breech baby, the feel of a forceps for a baby whose head is too big. You do research to find new techniques. You accept that things will not always work out in everyone’s hands.
But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts. You seek reliability. You begin to wonder whether forty-two thousand obstetricians in the U.S. could really master all these techniques. You notice the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received. After Apgar, obstetricians decided that they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble. They found it in the Cesarean section.

Now, I still think the pendulum has swung too far in the other direction, but this article and explanation helped me to stop demonizing the OB field for the increase and to feel beter about the possibility of a c-section for my own delivery.

[Anonymous]

Hell, here is another reason to move to Canada. You can get a vaginal breech birth in Canada, with lots of trained OBs or midwives, no problem. It's embarrassing that US medical training standards are so low.