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

[Anonymous]

Anonymous wrote: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.

Good luck in your move...I hope you don't try to collect social security when you're 65. Growing up in a border state, you'd be amazed at all the people coming over to the States for medical care!

[Anonymous]

This is my first post on DCUM but damn, what a bunch of rude posts out there. People cussing and just general mean-spiritedness. Whether you are pro-homebirth or want an elective c-section, there's got to be a more cordial, respectful manner to discuss these issues. Bravo to the idiots out there using the b word and saying STFU...you are so mature!!

Now I work in the medical field (precisely this field) and I don't have all of the facts of this case (not even close), but a couple of things here.

1) It was established that the baby was born breech and had poor APGAR scores at delivery, which required immediate transport to the hospital
2) Life-saving care was provided but in all likelihood the baby was HYPOXIC from lack of oxygen during/after a difficult birth and was later declared brain dead. If it is true that the family waited 3 days to terminate life support it is most likely because they were hoping there would be brain activity or the baby would recover from the poor prognosis
3) If this baby were born in the hospital it PROBABLY would not have died. Why? Mom would have been on continuous fetal monitoring. She would have had a c-section and the baby would be extracted in less than 3 minutes from the time of the first skin incision to the delivery of the baby. Baby would have immediately been handed to the awaiting NICU team for full evaluation. Cord blood gases would be drawn from the umbilical cord to test for fetal oxygenation status.
4) If the baby was born in a hospital with positive APGAR scores, the parents could have done skin-to-skin with the baby immediately after delivery and mom could have established breastfeeding immediately postpartum. Not her ideal birth experience but in all honesty (and for this particular case) it was probably the safest option.
Now I myself am a proponent of homebirth and would like to have one, but there are reasons why some women "risk out" of homebirth...because it has been deemed that this person is not a good candidate for HB. Yes, hospitals are far too intervention-prone and not necessarily the best option for a low-risk pregnancy; however, there has to be some standard as to what is too risky for the home. People keep citing Europe and other countries where HB is more prevalant...but these countries ALSO have standards of care in which they follow. I read the mother's review of BirthCare (a few pages back) and she is clearly devestated by the outcome of her pregnancy and the loss of her baby. It makes me question whether she truly understood the risks she was taking? Informed consent is a two-way street. The provider had an obligation to talk about the risks rather than romanticize the beauty of a home birth. No one shared thier prenatal visits and have no idea what was discusssed. Similarly, OBs should be held more accountable for providing true informed consent. The thing is - many OBs truly believe that c-section IS the safest option...as opposed to a potentailly deadly vaginal birth. They feel comfortable in the OR - a well-controlled environment. Think what you will, but when you have the possibility to control for the unknown, this is comforting to them, regardless of the postpartum pain and stress on the mother. Now some of the comments on here just make me laugh and make me think people have no clue what REALLY goes on in the hospital. There are plenty of hospitals that will allow a preeclamptic woman to be induced for 3 or 4 days as opposed to rushing back for a c-section. Where are they sectioning women just for having asthma and for being 35? Come on...where is this happening. - certainly not at my hospital. The problem is that people often see black and white - home v. hospital and there are plently of hospitals and birth centers where you can have an ideal birth experience provided you choose the right birth team. Now the true loss here is if the mother who lost her baby didn't understand the risks she was taking while birthing a breech baby at home (even with an awesome midwife). Sad as it may be, I have to put some of the "blame" on her for taking that risk. Birthing at home means trading some comfort with risk...and you have to be able to live with the outcome if there is a potentially poor outcome.

[Anonymous]

I had a hospital birth that ended up as a c/s probably because of too many interventions (fetal distress due to epidural, epidural needed because labor was induced with pitocin, labor induced because of low amniotic fluid, low amniotic fluid detected because of weekly ultrasounds due to GD...) so I fully understand the appeal of a home birth.

But then, I read about places that DON'T have access to medical care, where women routinely die from childbirth. It's so heartbreaking. Remember this special from the Washington Post a few years ago?
http://www.washingtonpost.com/wp-dyn/content/story/2008/10/12/ST2008101201887.html?sid=ST2008101201887

And obviously, what we're talking about here is a completely different thing (birthing at home with a midwife and access to a hospital). But it just made me a little grateful to be where we are, even with all its many flaws.

[Anonymous]

3) Mom would have been on continuous fetal monitoring.

As you stated, you do not have any information about this case. You make some assumptions; however the fact is that continuous fetal monitoring would not have changed the outcome of this birth.

I read the mother's review of BirthCare (a few pages back) and she is clearly devestated by the outcome of her pregnancy and the loss of her baby. It makes me question whether she truly understood the risks she was taking? Informed consent is a two-way street. The provider had an obligation to talk about the risks rather than romanticize the beauty of a home birth.

I believe that homebirth midwives are some of the last people to romanticize homebirth. Women usually bring their own ideas, feelings, research and histories to these relationships, and oftentimes it is the midwife who spends time counseling the couple to have realistic expectations. In this particular case, I think it is fair to say that the grief of the mother would completely eclipse anything that she thought or knew prior to the birth. In other words, I'm not sure her post is particularly indicative of anything except her deep grief.

Birthing at home means trading some comfort with risk...and you have to be able to live with the outcome if there is a potentially poor outcome.

Alternatively, one could argue that birthing in the hospital also means accepting certain risks which are unique to the hospital setting. Remember, a woman in North Carolina died last Fall as a result of a planned cesarean. She chose a cesarean to deliver her breech baby, and died shortly thereafter as a result surgical complications. I wonder if anyone is lecturing her family on the importance of living with the outcome of what they surely knew was a dangerous procedure? Or, perhaps more relevant, is the state of North Carolina charging that doctor with manslaughter?

[Anonymous]

Anonymous wrote:

3) Mom would have been on continuous fetal monitoring.

As you stated, you do not have any information about this case. You make some assumptions; however the fact is that continuous fetal monitoring would not have changed the outcome of this birth.

I read the mother's review of BirthCare (a few pages back) and she is clearly devestated by the outcome of her pregnancy and the loss of her baby. It makes me question whether she truly understood the risks she was taking? Informed consent is a two-way street. The provider had an obligation to talk about the risks rather than romanticize the beauty of a home birth.

I believe that homebirth midwives are some of the last people to romanticize homebirth. Women usually bring their own ideas, feelings, research and histories to these relationships, and oftentimes it is the midwife who spends time counseling the couple to have realistic expectations. In this particular case, I think it is fair to say that the grief of the mother would completely eclipse anything that she thought or knew prior to the birth. In other words, I'm not sure her post is particularly indicative of anything except her deep grief.

Birthing at home means trading some comfort with risk...and you have to be able to live with the outcome if there is a potentially poor outcome.

Alternatively, one could argue that birthing in the hospital also means accepting certain risks which are unique to the hospital setting. Remember, a woman in North Carolina died last Fall as a result of a planned cesarean. She chose a cesarean to deliver her breech baby, and died shortly thereafter as a result surgical complications. I wonder if anyone is lecturing her family on the importance of living with the outcome of what they surely knew was a dangerous procedure? Or, perhaps more relevant, is the state of North Carolina charging that doctor with manslaughter?

I disagree with alot of what you said and especially the quote bolded above. You have absolutely NO way of know if continuous fetal monitoring would have changed the outcome. May have, may not have.

[Anonymous]

http://www.inservicetowomen.org/

"Karen Carr

* Created by: Nicole Jolley of In Service To Women

Today, Karen’s safety and future are on the line. A disheartening investigation ensued after the tragic death of a client’s baby. Karen is being charged with involuntary manslaughter and other felonies for her role as a homebirth midwife. She will be on trial for these charges beginning June 7th and is facing up to 30 years in jail.

Please help us support Karen and the greater midwife community by making a donation today"

[Anonymous]

Why is the investigation disheartening? Every suspicious death or death due to unknown causes is investigated, and midwives aren't immune to that. Also, why is it a service to women to have unlicensed care providers? Every professional must act within the bounds of her training and licensure or face consequences. Again, why would midwives be immune to that? Just because Karen is nice does not mean that in this case she was a safe provider who exercised good judgment.

[Anonymous]

Anonymous wrote:OK, now this is just ridiculous. Unless the doula was somehow representing herself as a doctor or midwife, anyone who knows enough about the birth process to research and choose a homebirth, and take an 8 week long Bradley class, would understand a) what the role of a doula is, and b.) that the doula's opinion is not a MEDICAL or "clinical" opinion. Anyone can have an opinion or make "suggestions", but ultimately it's my responsibility to figure out which opinions are valid, do the research, and make the decision myself.

I don't say this to pile on a grieving mother. But the PP's assertion that now the DOULA needs to be put on trial, too? Absurd.

Again, every suspicious death or death due to unknown causes is investigated, so if the doula was there, she is part of the investigation. If she was acting within her scope of practice (ie, emotional and physical support and comfort, NOT clinical suggestions), then the investigation into her role should be perfunctory. Yes, anybody can have an opinion, but a doula who offers clinical opinions while acting as a doula is acting outside her scope of practice and needs to have her certification revoked. That's why people have licenses and certifications- so that they will have clear guidelines as to what is and is not appropriate for them to do while working as a professional.

[Anonymous]

as a bradley teacher she provided options at moms request
birthcare ba followed mom to next provider once risked out
ba did not give medical advice during labor

[Anonymous]

What a convoluted nightmare.

I don't understand the apparent lack of communication between the birth assistant and unlicensed midwife. Wouldn't the midwife have ultimate responsibility for the outcome? Wouldn't it be her responsibility to assess the situation and provide feedback to the parents about the risks?

Of course we do not know all the particulars, but this situation sounds like a recipe for disaster.

[Anonymous]

Anonymous wrote:as a bradley teacher she provided options at moms request
birthcare ba followed mom to next provider once risked out
ba did not give medical advice during labor

Maybe not, but it sounds like the mom believes the birth assistant was instrumental in encouraging her to go with Karen at home.

It doesn't sound like birth care ever made it clear enough to the mother that a birth assistant is NOT a true medical professional.

If this woman was teaching classes at birth care and birth care had the birth assistant on their approved list, I can easily see how that could have been misconstrued by the mom.

[Anonymous]

I am a Birth Care mom. I would very much like to know who the birth assistant was. Does anyone know?

[Anonymous]

Don't know if anyone would say if they did know.

You can searh Karen Carr through the court records and see if any of the BC assistants are being called as witnesses. You'd have to know their names.

http://ajis.alexandriava.gov/ajis/System/cf030_dcsn.cfm

[Anonymous]

Anonymous wrote:Don't know if anyone would say if they did know.

You can searh Karen Carr through the court records and see if any of the BC assistants are being called as witnesses. You'd have to know their names.

http://ajis.alexandriava.gov/ajis/System/cf030_dcsn.cfm

Thank you for posting. I don't see any names that I recognize as a birth assistant.

Does anyone here know which Birth Care birth assistant teaches classes at Birth Care?

[Anonymous]

Come on, is this really so hard to understand? I'm sure the BA was not going out of her way to convince the woman into having a home birth or overstepping her authority.

I'm sure what happened is the mom (unsure of what to do) probably called up the birth assistant and said, "what have you seen happen in circumstances like this?" or "who would you suggest I see?" And the birth assistant (who only attends home births) likely said, "well, I've seen many breech births go well at home and a good number of these were with Karen Carr". And so the mom factored this in to her decision, especially since it sounds like Birthcare didn't come right out and say "You need a c/s" or conversely, "you absolutely should give vaginal birth a try" but rather, "we are not comfortable with delivering a breach at home and/or we are not allowed to (based on our back-up physician agreement).

And then it sounds like there was nothing that Karen Carr wouldn't attempt.