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

[Anonymous]

Anonymous wrote:Very interesting thread with some extremely thoughtful posts.

I'm a nurse practitioner--to clear up the giving medication at home question, CNMs can, CPMs can't. Certified nurse midwives are a type of nurse practitioner; they are eligible to have DEA licenses and prescribing privileges. CPMs will never be allowed to carry medications--they don't have the education to make them eligible for prescriptive abilities. Also, oxygen is considered to be a "medication", so it falls under that umbrella.

With respect to breech births, it is very much a malpractice insurance issue where hospital based providers (OBs and CNMs) are concerned. The hospital typically pays malpractice insurance for its providers. For any procedure that is deemed too risky (either based on research data or based on in-house outcomes/lawsuits/payouts to families), the hospital can refuse to cover it because of the increased cost of the malpractice insurance. In turn, residency programs are not teaching the skills needed for breech birth (beyond the basics), as they most likely won't be put to regular use.

Also, I have to comment on the PPs discussion of "the woman's right to choose where to give birth." Totally, agree. But the OB midwife also has the right to choose his or her patients. If they do not feel safe and comfortable, they have the right to refer the patient elsewhere. There are some situations that just aren't safe for home birth in the eyes of the provider, no matter what the preference of the parents.

CPMs are trained (and certified via their credential) to carry and administer certain medications (yes, oxygen, too). In many states they do just that. Virginia is working on allowing that for their licensed CPMs. It is different to carry/administer vice have prescriptive privileges.

It is because CNMs have prescriptive privileges in VA that requires a form of collaboration with a doctor that many CNMs' hands are tied in attending primary VBAC, breech, twins, etc. It is at the mercy of that collaborating doctor.

[Anonymous]

Anonymous wrote:I can't help but wonder how much her not being licensed in VA is playing into these charges. Are they trying to make an example of her? CPMs lobbied the state very hard to get a licensing process in place to allow them to legally attend homebirths - prior to that they could be arrested for just attending a homebirth.

I am certain there have been other cases of homebirth related deaths in VA in recent years. It's hard to determine as they aren't separately reported as far as I can tell. But I haven't really heard anything (and can't find any stories) of other midwives in VA being charged for a baby's death. At least not since VA started licensing CPMs and allowing them to legally deliver in 2005.

If Karen were licensed, then they would go after her license, which wouldn't mean jail time. Because she is unlicensed, it had to be turned over to the local authorities, I am suspecting.

[Anonymous]

Anonymous wrote:I think I this earlier, but just because it was mentioned by the CNM above. I had a homebirth with a CPM and she had oxygen, pitocin and an IV. So maybe they're not allowed to have them, but they frequently do.

Shhh!!!!!!!

[Anonymous]

Anonymous wrote:I think I this earlier, but just because it was mentioned by the CNM above. I had a homebirth with a CPM and she had oxygen, pitocin and an IV. So maybe they're not allowed to have them, but they frequently do.

Didn't you say that was in DC? The rules are probably different there than VA. I actually have no idea what the CPM regulations in DC are, so I don't know.

[Anonymous]

Anonymous wrote:

Anonymous wrote: CPMs are trained (and certified via their credential) to carry and administer certain medications (yes, oxygen, too). In many states they do just that. Virginia is working on allowing that for their licensed CPMs. It is different to carry/administer vice have prescriptive privileges.It is because CNMs have prescriptive privileges in VA that requires a form of collaboration with a doctor that many CNMs' hands are tied in attending primary VBAC, breech, twins, etc. It is at the mercy of that collaborating doctor.

This is excellent news. I hope this happens soon. I've never understood why VA would allow CPMs to practice, but then tie their hands in a way that they can't practice as safely as possible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think I this earlier, but just because it was mentioned by the CNM above. I had a homebirth with a CPM and she had oxygen, pitocin and an IV. So maybe they're not allowed to have them, but they frequently do.

Didn't you say that was in DC? The rules are probably different there than VA. I actually have no idea what the CPM regulations in DC are, so I don't know.

I did say this was in DC - thanks for clarifying. But I also know that midwives (at least the one I used) also practices in VA and MD and carries these items, which I would argue are absolutely necessary (and were at my homebirth).

[Anonymous]

So why again would a CPM not be licensed in VA? Why would they just not get licensed and then do whatever they want anyway?

[Anonymous]

Did anyone read this recent article about Stillbirth? While I agree that birth has become over-medicalized, I think that there is also a tendency to romanticize homebirth and the natural process:

http://www.reuters.com/article/2011/04/13/us-stillbirth-idUSTRE73C85120110413

"Over half of the stillbirths occur when the woman is in labor," Dr. Elizabeth Mason of the WHO, who worked on the report, said in a telephone interview.

"These are really related to the care a women gets during labor," she said.

[Anonymous]

Anonymous wrote:

Anonymous wrote:
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.

It is sad.

Do you see all the questions on this forum about malpractice? That is why no one in the OB field is doing breech - people want a pocketbook to hit when less than perfection occurs. Docs can't afford to have anything less than a perfect birth, or the lawyers come flying after that malpractice money.
Hope that the midwives don't have to start practicing like that - because of families and their attorneys out for malpractice $ when bad things happen with no one at fault.

This is so very true!!! Less than perfection is just not acceptable in our time in this country! And that is the difference to what you remember from your parent's parents or what the statistics show of other countries. In Europe people don't sue even nearly as often (and awards in the multimillions are pretty much unheard of) , this goes for all areas of life, not just related to medicine. OT: Every time Europeans travel to the USA the first time and see all the warning signs put up for legal reasons, for example in amusement parks; 'don't ride if you have back pain, heart conditions, are frail or ...' they take pictures of them, because it's a curiosity. We don't even notice anymore how absolutely crazy our legal system is here!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
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.

It is sad.

Do you see all the questions on this forum about malpractice? That is why no one in the OB field is doing breech - people want a pocketbook to hit when less than perfection occurs. Docs can't afford to have anything less than a perfect birth, or the lawyers come flying after that malpractice money.
Hope that the midwives don't have to start practicing like that - because of families and their attorneys out for malpractice $ when bad things happen with no one at fault.

This is so very true!!! Less than perfection is just not acceptable in our time in this country! And that is the difference to what you remember from your parent's parents or what the statistics show of other countries. In Europe people don't sue even nearly as often (and awards in the multimillions are pretty much unheard of) , this goes for all areas of life, not just related to medicine. OT: Every time Europeans travel to the USA the first time and see all the warning signs put up for legal reasons, for example in amusement parks; 'don't ride if you have back pain, heart conditions, are frail or ...' they take pictures of them, because it's a curiosity. We don't even notice anymore how absolutely crazy our legal system is here!

The legal system is the way it is because there are no social safety nets for families who suffer from birth tragedies...preventable or not. Unfortunately this has resulted in a system where we want to see negligence where there wasn't necessarily any, just so that someone can be held responsible. It's very telling that developed countries that provide adequate healthcare for families have different malpractice paradigms. They don't need malpractice awards because someone is already paying. Yes, there's no such thing as perfection, but there's also no reason why a family that has a less than perfect birth outcome should be left hanging without any support. All of us should be willing to contribute to supporting these families, because it's not helping any of us not to.

[Anonymous]

Does anyone know of any similar legal cases and what their outcomes were for the midwife?

[Anonymous]

At the home births with a CPM's that I know of, Pitocin, oxygen, IV supplies and sutures (for perineal tears) were present and used if needed. People shouldn't think that because it is against the law, at least in some places, for them to have these things, that they don't have them and use them.

[Anonymous]

Anonymous wrote:I think I this earlier, but just because it was mentioned by the CNM above. I had a homebirth with a CPM and she had oxygen, pitocin and an IV. So maybe they're not allowed to have them, but they frequently do.

Just to clarify---it was an NP who made the remarks above, not a CNM

[Anonymous]

Yeah breech birth happened, babies were injured or killed, and we as a country had a lower trust level in birth. The fact that a woman can give WRITTEN and signed consent to a procedure such as vaginal breech birth and then turn around and sue the provider when somerhing goes wrong because "she didn't understand" that the paper that she signed saying she knew something could go wrong really meant just that---well hell if I were a provider I'd go with mainstream medical thought too.

[Anonymous]

I had a footling breech baby and took my OBs advice for a c-section. I had a great experience. I never considered a vaginal birth with a breech child because the research I did said a c-section had the best outcome for us. My daughter has not had any issues from the c-section- does not have hip joint issues, we are well-bonded and she is in good health. She was brought into the world in a hospital and we chose this option because my husband and I believe in modern medicine- there is nothing wrong with this thinking.

Some may equate homebirths to using a cell phone from the early 1990's vs. the current iPhone. If both parties are happy with the instrument they are using to communicate why berate the other for their choice? We like the most current technology.

Not everyone has an awful c-section story and I don't feel maimed in any way. For my husband and I, a healthy child was more important than a natural birth.