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

[Anonymous]

You can die from a vaginal breech birth. Yay, Canada!

[Anonymous]

Even in Canada...

"The SOGC stresses that because of complications that may arise, many breech deliveries will still require a cesarean section."

[Anonymous]

Anonymous wrote:

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?

It's the NORTH AMERICAN REGISTRY OF MIDWIVES - their professional organization. There's a difference between anti-midwife propaganda (which the other one CLEARLY is) and the organizational website for a professional organization.

[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.

You have a right to your opinion. We do not share it. I personally believe that life starts at birth, not at the viability threshold and not at conception. If I was in a situation where it was my life or the baby's life, I would choose my life. Sorry if you find that to be offensive, but it is what I believe. As for parents who withhold care for their already born children on the basis of religious grounds, I feel that that is also their right. I do not consider that to be smart or safe either, but I will stand by their right to make their own (in my opinion) wrong decisions, because that's the only way I know that my decisions, which other people might think are wrong, are going to be respected as well.

[Anonymous]

Anonymous wrote:You can die from a vaginal breech birth. Yay, Canada!

You can die from a cesarean birth. Yay, United States of America!

[Anonymous]

Is this the same Karen Carr in the link? It says she was charged with a transportation violation.
http://www.jailbase.com/en/arrested/oh-mcso/2011-04-03/karen-carr-1107120

[Anonymous]

Anonymous wrote:Is this the same Karen Carr in the link? It says she was charged with a transportation violation.
http://www.jailbase.com/en/arrested/oh-mcso/2011-04-03/karen-carr-1107120

That is not her, sorry.

[Anonymous]

I do think it is worth discussing the lack of obstetrical skill we require from OBs. Vacuum and forceps, for example, while not ideal, are a vast improvement on a CS when done well. I don't buy the "too many skills to learn" for an OB argument. It is your job. Do it well or don't practice. It is interesting to note that Whitney Pinger is pushing for more education at GW in the skilled use of forceps, and she is a MW, not OB. Her and WISDOM's CS rate is 5%. So learning these other "many skills" reduces CS and leaves them to when they are truly necessary.

[Anonymous]

Anonymous wrote:I do think it is worth discussing the lack of obstetrical skill we require from OBs. Vacuum and forceps, for example, while not ideal, are a vast improvement on a CS when done well. I don't buy the "too many skills to learn" for an OB argument. It is your job. Do it well or don't practice. It is interesting to note that Whitney Pinger is pushing for more education at GW in the skilled use of forceps, and she is a MW, not OB. Her and WISDOM's CS rate is 5%. So learning these other "many skills" reduces CS and leaves them to when they are truly necessary.

I feel that is a false argument. You cannot accurately compare C-section rates between a low risk practice and a university hospital. The university hospital will be managing care for multiple high risk patients--preterm labor, pre-eclampsia, patients with little to no prenatal care, and patients with complicating medical conditions such as Type 1 diabetes, asthma, etc. Of course the c-section rate for these patients will be higher.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I do think it is worth discussing the lack of obstetrical skill we require from OBs. Vacuum and forceps, for example, while not ideal, are a vast improvement on a CS when done well. I don't buy the "too many skills to learn" for an OB argument. It is your job. Do it well or don't practice. It is interesting to note that Whitney Pinger is pushing for more education at GW in the skilled use of forceps, and she is a MW, not OB. Her and WISDOM's CS rate is 5%. So learning these other "many skills" reduces CS and leaves them to when they are truly necessary.

I feel that is a false argument. You cannot accurately compare C-section rates between a low risk practice and a university hospital. The university hospital will be managing care for multiple high risk patients--preterm labor, pre-eclampsia, patients with little to no prenatal care, and patients with complicating medical conditions such as Type 1 diabetes, asthma, etc. Of course the c-section rate for these patients will be higher.

Not the PP you're quoting, but I agree with you that it's not a great comparison. That said, it would be really great if more of the midwife model of care could be integrated into the training of obstetricians - more focus on the individual patient, more means of easing discomfort without medication, less focus on the rate of dilation per hour, etc. I understand that not all OBs are as scalpel happy as some. I also understand that many OBs, as surgeons, are more interested in surgery than they are in waiting around for a lady to push the baby out on her own.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I do think it is worth discussing the lack of obstetrical skill we require from OBs. Vacuum and forceps, for example, while not ideal, are a vast improvement on a CS when done well. I don't buy the "too many skills to learn" for an OB argument. It is your job. Do it well or don't practice. It is interesting to note that Whitney Pinger is pushing for more education at GW in the skilled use of forceps, and she is a MW, not OB. Her and WISDOM's CS rate is 5%. So learning these other "many skills" reduces CS and leaves them to when they are truly necessary.

I feel that is a false argument. You cannot accurately compare C-section rates between a low risk practice and a university hospital. The university hospital will be managing care for multiple high risk patients--preterm labor, pre-eclampsia, patients with little to no prenatal care, and patients with complicating medical conditions such as Type 1 diabetes, asthma, etc. Of course the c-section rate for these patients will be higher.

Why do those conditions always necessitate a c-section? They don't. Asthma an indication for c-sec? Seriously? No prenatal care = automatic c-sec? Why? The World Health Organization recommends a MAXIMUM c-sec rate of 15 percent for EVERYONE total- high risk, low risk, the whole world. (Althabe and Belizan 2006). it's an inverted bell curve: the lowest rate of maternal/fetal demise is with 5-10 percent c-sections. Any less c-sections than that and mortality rises. Any MORE c-sections than that and...mortality rises again. We are at over 30 percent right now. You can't tell me that 30 percent of our women are high risk and or physically can't give birth.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I do think it is worth discussing the lack of obstetrical skill we require from OBs. Vacuum and forceps, for example, while not ideal, are a vast improvement on a CS when done well. I don't buy the "too many skills to learn" for an OB argument. It is your job. Do it well or don't practice. It is interesting to note that Whitney Pinger is pushing for more education at GW in the skilled use of forceps, and she is a MW, not OB. Her and WISDOM's CS rate is 5%. So learning these other "many skills" reduces CS and leaves them to when they are truly necessary.

I feel that is a false argument. You cannot accurately compare C-section rates between a low risk practice and a university hospital. The university hospital will be managing care for multiple high risk patients--preterm labor, pre-eclampsia, patients with little to no prenatal care, and patients with complicating medical conditions such as Type 1 diabetes, asthma, etc. Of course the c-section rate for these patients will be higher.

Why do those conditions always necessitate a c-section? They don't. Asthma an indication for c-sec? Seriously? No prenatal care = automatic c-sec? Why? The World Health Organization recommends a MAXIMUM c-sec rate of 15 percent for EVERYONE total- high risk, low risk, the whole world. (Althabe and Belizan 2006). it's an inverted bell curve: the lowest rate of maternal/fetal demise is with 5-10 percent c-sections. Any less c-sections than that and mortality rises. Any MORE c-sections than that and...mortality rises again. We are at over 30 percent right now. You can't tell me that 30 percent of our women are high risk and or physically can't give birth.

Nope, not what I said. Just stating that if you have a population that is higher risk (and I only provided a small partial list of conditions), you will automatically have a higher rate of c-sections. I did NOT say that those conditions require c-section. And if you have a population of low risk patients, of course your rate will be lower. The total rate would be a combination of ALL deliveries, high and low risk.

[Anonymous]

Which she/he said should be NO MORE than 15 percent. Thus 15 percent or more of those c-sections at these university and large hospitals are unnecessary.

[Anonymous]

Anonymous wrote:Which she/he said should be NO MORE than 15 percent. Thus 15 percent or more of those c-sections at these university and large hospitals are unnecessary.

No, the person who quoted the WHO stated the rate should be 15 percent TOTAL. I'm not disagreeing that the c-section rate in our country is WAY too high and that the medical profession needs to make more of an effort to not alienate women. I'm just saying you can't compare c-section rates between a high risk practice and a low risk one.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I do think it is worth discussing the lack of obstetrical skill we require from OBs. Vacuum and forceps, for example, while not ideal, are a vast improvement on a CS when done well. I don't buy the "too many skills to learn" for an OB argument. It is your job. Do it well or don't practice. It is interesting to note that Whitney Pinger is pushing for more education at GW in the skilled use of forceps, and she is a MW, not OB. Her and WISDOM's CS rate is 5%. So learning these other "many skills" reduces CS and leaves them to when they are truly necessary.

I feel that is a false argument. You cannot accurately compare C-section rates between a low risk practice and a university hospital. The university hospital will be managing care for multiple high risk patients--preterm labor, pre-eclampsia, patients with little to no prenatal care, and patients with complicating medical conditions such as Type 1 diabetes, asthma, etc. Of course the c-section rate for these patients will be higher.

Not the PP you're quoting, but I agree with you that it's not a great comparison. That said, it would be really great if more of the midwife model of care could be integrated into the training of obstetricians - more focus on the individual patient, more means of easing discomfort without medication, less focus on the rate of dilation per hour, etc. I understand that not all OBs are as scalpel happy as some. I also understand that many OBs, as surgeons, are more interested in surgery than they are in waiting around for a lady to push the baby out on her own.

I agree there should be more of the midwife model for those who want it. Not everyone wants it. Some women choose c-section for convenience reasons--that is their right. For example, there used to be a poster on these forums who elected to have c-sections so that her babies would have perfectly rounded heads. I don't agree with that, but again, her choice.