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

[Anonymous]

I think that some experienced CPM's use women that they are training to be midwives as assistants. They may be with the laboring woman or monitoring her prior to the midwife arriving. This muddies the waters a bit as the mother (in the situation where the assistant/doula is actually a midwife-in-training) would not see the assistant as a purely non-clinical support person because the role would be beyond emotional support and coping techniques. Now, if the mother in this particular case had a birth assistant that she brought with her through multiple providers, it is unlikely that was the case here.

[Anonymous]

Anonymous wrote:I think that some experienced CPM's use women that they are training to be midwives as assistants. They may be with the laboring woman or monitoring her prior to the midwife arriving. This muddies the waters a bit as the mother (in the situation where the assistant/doula is actually a midwife-in-training) would not see the assistant as a purely non-clinical support person because the role would be beyond emotional support and coping techniques. Now, if the mother in this particular case had a birth assistant that she brought with her through multiple providers, it is unlikely that was the case here.

19:04 here.

How does that make it unlikely that that is the case with this incident?

I am a birth care mom and I do know that many of the birth assistants are studying to be midwives. I can see how it could muddy the waters, in a situation like this. Just from what I know in my experience at birth care, it is hugely likely that this birth assistant was/is a student midwife.

I'm very interested in knowing who the birth assistant is.

[Anonymous]

Check the Bradley page for classes offered at BirthCare. There are only 2 and possibly a third. At least one of those is also a BC birth assistant and training to be a CNM. Anyone who has taken her Bradley class could tell you she is passionate about home birth and has very negative feelings about OBs and hospitals. If you are also still on her class reading list, you saw that she just sent out a link to the FB page in support of Karen.

I do not know for sure that it was this person but those facts add up.

[Anonymous]

Ok, I just posted above 20:05 but have come back to ask a few things, because this situation has been something that I have been thinking about a lot lately. I have friends (well educated, not what you would expect) that adore the midwife in question, and this is something that I can not discuss with them and have a true open exchange of ideas because it is so emotionally loaded.

Some had no risk factors whatsoever, another had way more risk than seemed prudent to me. They have all said that they felt they were safer at home. Some information or relationship caused them to feel that way. They have asked if I know about the statistics of increased mortality with a c-section in the hospital. They say the 1% risk of rupture with a VBAC1 is less than the mortality rate being 2-4 times higher with a c-section. What is the rupture risk after 2, 3, or 4 + c-sections? Every group seems to have data that supports their claims about what is the best course of action and honestly the whole thing befuddles me.

One thing that I know for sure is that that relationship component is a very strong driving force. Someone that spends time talking, visits you in your home, and with whom you have a deeply personal connection is a huge pull especially for people who felt they were shuffled through a less personal medical practice where they did not understand the reason for various policies and procedures.

The main thing that bothers me is that its seems there isn't much that Karen wouldn't take on. On the website started to support her, a woman writes about her breach birth where Karen was unsure the presenting part and she asked her, the mother, what she wanted to do, which was stay at home. This made me upset. Why did she ask? I felt strongly that this was a situation where the care provider should direct a transfer. If I were to share my unease about this with those who have had a birth with her, I think that they would bristle and tell me about the dangers of the hospital and that Karen does transfer people when something isn't right. I have been told that her her injury/death stats are better than many MD's.

What are the real stats about these things? What are some ways that an actual dialogue can be engaged in? I don't know the stats, so can be mowed down in a few moments. It seems that each side can have blinders on, but that by being able to have frank and open exchanges that maternity care could be improved.

[Anonymous]

Not directly related, because PPs have stated that this case was NOT a footling breech, but this website shows the most incredible vaginal delivery of a footling breech that I thought might be educational in this discussion:

http://www.homebirth.net.au/2011/03/mechanism-of-breech.html

[Anonymous]

Many assumptions are being made about everyone involved (the birthcare midwives, the birth assistant, Tchabo, the breech baby, the birth mother). We really don't know who did what, until the trial. Most of the time, speculation is more grandiose than the real story that comes out in the end.

[Anonymous]

This thread makes my heart ache. I had a breech baby, and I was GBS+. Reading of two women in these situations whose babies died brought me to tears. That could have been me. I went with the conventional recommendations of a c section for breech baby and antibiotics for GBS, and my baby is fine. But following those recommendations does not guarantee anything, just (arguably) improves your odds. Life is so precarious. My heart goes out to these families.

It is probably hard for many to understand why this family chose a homebirth for a breech presentation. As I read through this thread that was my reaction too. But then I went back to my own experience and remembered that it was NOT an easy decision for me. When I found out the baby was breech, and did not move, I never seriously considered anything other than a c section - but that does not mean it was an easy decision. I agonized over it. I really worried about the risks of a c section, both to me and to the baby.

Finding out that the baby is breech happens late in pregnancy, when you don't have much time left. You've spent your entire pregnancy planning for the birth, and then all of a sudden a wrench is thrown in the works.

I had a doula, and a childbirth class instructor, and I went to both for help. At the time I found the doula pretty worthless and I was frustrated. Now, reading this, I thank my lucky stars that she was so helpless. Because it scares me to think, if she had pushed options other than a c section, what if I had listened to her?

My heart goes out to the family. I cannot imagine the pain they are in.

[Anonymous]

Anonymous wrote:Many assumptions are being made about everyone involved (the birthcare midwives, the birth assistant, Tchabo, the breech baby, the birth mother). We really don't know who did what, until the trial. Most of the time, speculation is more grandiose than the real story that comes out in the end.

My thoughts exactly. Our culture teaches us that there must always be someone or something to blame. But in this case, the research shows that breech birth, while slightly more risky than vertex birth, is still overwhelmingly safe. What if this were truly just a freak accident? It is not fair to be blaming anyone involved with this until we see what evidence arises at the trial.

[Anonymous]

"But in this case, the research shows that breech birth, while slightly more risky than vertex birth, is still overwhelmingly safe."

But from all I have read, this has only been researched and show to be true, where there is easy access to a c-section. For example, the RCOG statement on breech agrees with the statement above but also indicates that: "Ready access to caesarean section is considered important, particularly in the event of poor progress in the second stage of labour. No systemic evidence exists on the complications of breech birth outside the hospital setting."

So any statement about the relative "risky-ness" of breech birth versus vertex birth only applies to a hospital breech birth. One question might be -- is having a breech homebirth by definition malpractice?

[Anonymous]

Anonymous wrote:"But in this case, the research shows that breech birth, while slightly more risky than vertex birth, is still overwhelmingly safe."

But from all I have read, this has only been researched and show to be true, where there is easy access to a c-section. For example, the RCOG statement on breech agrees with the statement above but also indicates that: "Ready access to caesarean section is considered important, particularly in the event of poor progress in the second stage of labour. No systemic evidence exists on the complications of breech birth outside the hospital setting."

So any statement about the relative "risky-ness" of breech birth versus vertex birth only applies to a hospital breech birth. One question might be -- is having a breech homebirth by definition malpractice?

And here-in lies the real problem - most women do not have the choice to have a vaginal breech birth in the hospital. My guess is if they did, more women would choose this option. In the DC area, as far as I know, Dr. Tchabo is the only doctor who will attempt a vaginal breech birth. As was referenced earlier in this thread, in this case Dr. Tchabo was consulted but was possibly going to be out of town for the delivery. And clearly one doctor in the entire DC metropolitan area cannot handle the entire caseload of breech births. So the options become either get a c-section in the hospital or attempt a breech birth at home. This happens, though not to the same extent, with VBACs as well. Defensive medicine has led to a reduction in birth options for women and training for medical professionals, leading women to have to make less than ideal choices.

[Anonymous]

Anonymous wrote:One question might be -- is having a breech homebirth by definition malpractice?

As much as hiring a skilled midwife to attend your breech birth is child endangerment on the part of the parents.

[Anonymous]

Anonymous wrote:Because it scares me to think, if she had pushed options other than a c section, what if I had listened to her?

And this is the problem - why would a woman listen to a doula, midwife, BA, childbirth educator, etc. and not do the research herself? Women have got to be proactive in their decision making , and that demands asking tough questions, knowing the evidence to support decisions, etc. beforehand. Before life or death situations arise.

[Anonymous]

Anonymous wrote:
Finding out that the baby is breech happens late in pregnancy, when you don't have much time left. You've spent your entire pregnancy planning for the birth, and then all of a sudden a wrench is thrown in the works.

The thing is there ARE some options out there to help turn a breech baby - an external version being one of them. There is acupuncture, moxibustion, chiropractors and Spinning Babies (check out the website), which provides ways to help get one's baby to turn. If mom exhausted all of those options and then chose the road of homebirth (over c-section) and the birth assistant, BirthCare and a midwife who is known for taking "any" patient are all telling her, "ahhhh, forget what's offered in the hospital setting, homebirth is totally safe and this woman has delivered dozens of breeches at home", I'm sure this sounded more appealing than a c-section. Honestly, nothing can replace the intimacy and beauty of a homebirth, but I'm sure if this mom could go back and change her decision-making,an uncomfortable c-section and a live baby would have been her choice. This story also breaks my heart because I am pregnant and always wanted a homebirth, but am in a risky situation that risks me out of it unless I plan to go with an unlicensed CPM. This bad outcome certainly weighs on my decision-making. It's not the 100 good outcomes that worry me, but the one bad one. Most term infants born in a hospital setting via c-section do okay generally speaking. Of course mom is at risk from major surgery, but so many of us struggle to get pregnant and maintain our pregnancies I would/will weigh the risks and find out what's best for me and my child (as I'm sure this mom tried to do).

[Anonymous]

"And, her "high risk" birth was a VBAC. Many women do those at home. I wouldn't discredit her for that. That is not radical anymore in the homebirth population."

The scary thing is -- I'm not sure anything is "radical" anymore in the homebirth population.

Maybe an unattended childbirth of a GBS+ mother giving birth to premature triplets. Maybe, just maybe, that would be radical.

[Anonymous]

"And this is the problem - why would a woman listen to a doula, midwife, BA, childbirth educator, etc. and not do the research herself? Women have got to be proactive in their decision making , and that demands asking tough questions, knowing the evidence to support decisions, etc. beforehand. Before life or death situations arise."

How many women have the time to identify what are considered the most important and reliable studies for each particular area of concern, find them (many only have the abstract on line), read them, analyze the data for accuracy and determine whether the statistical analysis was correctly performed, etc., etc.

I have a graduate degree from one of our finer institutions of higher learning, had statistics in college, etc. and KNOW that I would not be able to do that.

My "research" necessarily consisted of finding an OB that I trusted (who I expected to have performed that research) together with some independent reading of others whose opinions I also believed to be credible (preferably someone who was not an ideologue or philosophically fixated on any one position).