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

[Anonymous]

There has been a lot of guessing on almost every aspect of this case in this thread. I don't know what happened either. I do know Karen Carr who delivered my son last year (my third, first home birth). He was not breathing when he was born because the cord had been wrapped so tightly around his neck. I was hysterical, but Karen was very calm and took charge of the situation and today I'm chasing that 15 month old around thinking sometimes I don't have time to breath.

Could Karen have made a mistake in this case's labor and birth? Of course. Could a doctor have made a mistake in a C-Section (or vaginal birth for that matter?) Of course. We like to think that those with advanced training, whether through medical school or midwifery program will not make mistakes. They are human like the rest of us, but the stakes are much higher than when I make a mistake at my job.

Did Karen do everything right at this delivery and it went wrong anyway? Of course she could have. Could the same thing have happened in hospital with a C-Section? Of course it could.

That's why this case is being decided in a courtroom where the facts can be discussed and not in the DC Urban Moms Forum. As much as we think we know about every situation under the sun in these forums, the truth is we don't have all the details. But we sure are good at spreading rumor and innuendo and passing judgment on people involved in situations when we really know nothing.

[Anonymous]

wait a minute. the birth assistant was hired for the mom's birthcare birth and mom got transferred out. the ba didn't abandon her client for her choices, she provided continuity of care. maybe she didn't know that karen wasn't licensed, as cpms are legal in VA.

and another thing - what about the risks to the mother for cesarean section. one could argue that mom chose her life over her baby's life as cesarean was more risky for her? did anybody on this thread stop to think that it was the mother who disliked hospitals and doctors as she chose home birth for her first birth in the first place?

this post is full of judgement without facts. the facts will make you wish you had kept quiet here.

this thread is a witch hunt in the "modern" age.

[Anonymous]

"Did Karen do everything right at this delivery and it went wrong anyway? Of course she could have. Could the same thing have happened in hospital with a C-Section? Of course it could."

But are the likelihoods of things going wrong in both scenarios equal -- as this formulation presents them?

[Anonymous]

"and another thing - what about the risks to the mother for cesarean section. one could argue that mom chose her life over her baby's life as cesarean was more risky for her?"

My understanding is that breech is also high risk for the mother -- not just for the baby.

[Anonymous]

I probably shouldn't jump in here, but.....

I have birthed 6 of my 10 children at home. The last one was in the hospital because of very low fluid. Because hindsight is always 20/20, I wish I had continued with my plans to have him at home, even at 45 years old.

I KNOW the risks of having a baby at home, that is MY responsibility. I have had one baby turn breech at 37 weeks and was able to turn her within a few days, even though she was 9 1/2 lbs at birth, so usually it is possible to turn a baby late in pregnancy, even a large one. I have had babies whose heartrates drop into the 80s and 90s, one that had the cord wrapped twice around his neck, and one that had a knot in it: all these things that make a doctor immediately decide on a c-section. Yet, they were birthed safely at home after 1-2 hours labor. But, in all those situations, I KNEW the risk.

Had my breech baby, I may have opted for a homebirth because I KNEW the risks involved and believed it to be safe. If I had researched and decided to go with a home birth despite the risks, and had found a provider who was comfortable attending my home birth, it would still have been my decision to go forward with a homebirth. I decided to home birth, then proceeded to procure an attendant whom I felt was most competent to handle my situation. I am not a victim in that decision, completely, blindly trusting my midwife, nor ignorant of the risks. Any parent who decides to birth at home, especially in a high risk situation, is just as negligent as the attendant. For me to go back, after a horrible result, and place total blame on my chosen attendant, is not right. I accept responsibility for the outcome when I decide to homebirth or hospital birth.

If, during labor, my midwife would ask whether or not I would like to transfer, I would probably decline at that point, unless the baby was in serious distress and/or I could tell my midwife was not comfortable continuing at home. One thing many women like about midwives over doctors is the fact that they allow us to decide rather than decide for us.

Most comments seem to portray Karen as someone for whom delivering babies is her career and she'll do whatever she can; that this is her business and she takes advantage of women desperate for a homebirth who trust her knowledge of the risks rather than their own. But, though I don't know her, I doubt this is the case. I KNOW my midwife would be devastated if my baby died after deciding not to transfer. I imagine Karen is heartbroken over this mother's loss.

Would it bother me that she were unlicensed? No, not with her track record. Not any more than it would bother me to get raw milk for my children when it is illegal to sell it. And, she shouldn't get 30 years just for being unlicensed.

IF it were true negligience on her part, then she should be found guilty and face jail time, though 30 years seems a bit harsh. But, the definition of negligience should be accurate, not just attending a high risk homebirth. If she gets jail time, should we not make doctors similarly criminal, if they have an elective c-section go wrong? Is not the doctot negligient in the same degree? He attended a birth, performed an unnecessary surgery because the patient wanted it. Will we assume the patient was not fully aware of the risks and trusted the doctor's willingness, interpreting that to mean the procedure was safe?

TammiK

[Anonymous]

Anonymous wrote: 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.

Depending on how you asked, they may not bristle. Homebirth is still very much frowned upon and you find those who adhere to it are sometimes defensive because they expect to be confronted rather than simply asked.

As to the midwife, she asked because that's what midwives do. Should she have directed a transfer? Would you want a doctor commanding a procedure you weren't completely sure you needed? We hear stories of that all the time. Sometimes, they turn out well. But, sometimes, not. Just recently, a couple had their newborn taken away because they refused the hospital's directive to place her in the NICU for jaundice. Another woman was arrested because she refused to be induced. She went on to deliver naturally at home. No, advise, don't direct. If my midwife asked me what I wanted, I would have responded by asking her what she thought. If she were ok with continuing, or not convinced of the need, I would have remained at home. But, if she were convinced that this baby was in danger and transfer was necessary, I would transfer. If Karen had homebirthed breech babies, she may not have been convinced transfer was necessary. She may have been comfortable with continuing, but was willing to transfer if the mother would be more comfortable in a hospital. That doesn't necessarily mean, either, that she had an inflated sense of her own capabilities. That situation turned out well, remember.

As an aside, it is a crying shame that malpractice insurance is highest for OB/GYN partly because emotions are so much higher and positive outcomes are the norm. Negative outcomes, therefore, so unexpected they are deemed to be someone's fault. And so, lawsuits become much more common. We have an inflated sense of the responsibility of the provider to ensure a positive outcome. Yet, there is a larger 'unknown' in this medicine than any other. Things can go horribly wrong at the last minute that neither mom nor doctor, or midwife, had any clue was coming. That realm of the unknown means that you can perform the same thing in similar cases, make the same decision in exact situations, yet the outcomes can be vastly different. As a result of the malpractice insurance rates, fewer and fewer med students are entering this field. What will we do then? We need to stop lawsuits simply because the outcome was bad and only allow them for true negligience.

TammiK

[Anonymous]

Karens track record speaks for itself. For those of you not familiar with her she is a professional who conducts herself at the highest level of integrity. She is highly skilled and respected among her peers. Yes, she is known to be willing to take on what the medical community designates high risk home birth clients but she will also turn down clients for a variety of reasons based on both the client and her experiences of truly risky situations. Anyone who considers themselves supporters of the home birth community please respect her track record. She is a midwife of the highest caliber.

[Anonymous]

Anonymous wrote:
IF it were true negligience on her part, then she should be found guilty and face jail time, though 30 years seems a bit harsh. But, the definition of negligience should be accurate, not just attending a high risk homebirth. If she gets jail time, should we not make doctors similarly criminal, if they have an elective c-section go wrong? Is not the doctot negligient in the same degree? He attended a birth, performed an unnecessary surgery because the patient wanted it. Will we assume the patient was not fully aware of the risks and trusted the doctor's willingness, interpreting that to mean the procedure was safe?

TammiK

The difference is with a licensed doctor that you have recourse -- lawsuit, medical board review, revoke license, prosecution, etc. There is already a system in place to deal with a doctor who is unlicensed or negligent. When you are dealing with an unlicensed care provider who has been hired by a person to provide an illegal service then the recourse isn't so clear. Considering the charges it looks like sort of threw everything at her thinking some of them would be dismissed or reduced to lesser charges. I do think that 30 years seems a bit harsh but that is probably what the charge carries rather than what she will actually get.

[Anonymous]

Seems there are two types of homebirthers -- one the type that accepts that there is additional risk and decides to proceed forward despite it, and the other (the kool-aid drinker) that believes homebirth is actually safer than hospital birth.

Sounds like the mother in this situation may have been lead down the primrose path by the advocate BA (with all the stats that show what she wants to believe rather than what is necessarily true) and may not have understood the risk that was at issue.

"Karens track record speaks for itself."

Quite frankly, the track record of an unlicensed midwife willing to take on a high risk set of pregnancies (where any assertion about the safety of home birth, questionable though those assertions are, is based on the assumption of a low risk pregnancy) does speak for itself.

[Anonymous]

Anonymous wrote:Seems there are two types of homebirthers -- one the type that accepts that there is additional risk and decides to proceed forward despite it, and the other (the kool-aid drinker) that believes homebirth is actually safer than hospital birth.

Sounds like the mother in this situation may have been lead down the primrose path by the advocate BA (with all the stats that show what she wants to believe rather than what is necessarily true) and may not have understood the risk that was at issue.

"Karens track record speaks for itself."

Quite frankly, the track record of an unlicensed midwife willing to take on a high risk set of pregnancies (where any assertion about the safety of home birth, questionable though those assertions are, is based on the assumption of a low risk pregnancy) does speak for itself.

Ouch, but possibly true. (the statement bolded above) No one has commented as to why Ms. Carr did not choose to be licensed in VA. That is important information, IMO.

[Anonymous]

Playing devil's advocate here...

So, if you visit a cardiologist and then find out later s/he had patients die, but didn't disclose when these deaths occurred, would you still trust his/her clinical judgement? Why should doctors and other medical professionals be required to receive education and training, maintain licensure and be required to continue earning continuing education credits to keep up with their profession but lay midwives no? That is the absurd notion here.

This is not Karen's first brush with the law. This is not her first patient to be transferred under abysmal circumstances. She knew perfectly well that she took on high risk clients that could possibly have a poor outcome and that choosing not to relicense in the state of VA could potentially mean prosecution at some point.

People keep saying "if a doctor loses a patient in the hospital, there is no recourse". That is also a completely absurd notion. Doctors can have their licenses revoked or suspended (as they do); doctors also must be deemed safe by their colleagues...they do not practice alone at home (on a virtual island) and must be considered safe to continue practicing in the hospital environment. Malpractice is a highly lucrative industry.

Most of the pro-lay midwife comments completely negate the entire medical community, which is again ridiculous. If you need a doctor for a medical condition, you'd be running to that doctor to save you or your baby's life. In this case, the verdict is not out on whether or not breech delivery is safe at home. If so, I want to see recent journal articles (i.e. within the last 5 years, which is what folks in the medical community deem as current) on the safety of breech delivery at home. Where are all of these studies and statistics all of you keep talking about? Cut and paste a few current abstracts for the rest of us to read. Blanket statements just make your arguments weak and shady.

[Anonymous]

I've read most of this thread, and I think it's interesting that no one has commented-- that OBs are, at times, absurdly conservative. And crying wolf means you don't listen when you need to. When doctors say things like VBACs are generally a bad idea (and many do say this, despite the evidence and guidance to the contrary) many people just stop listening b/c they know it's bunk. They loose trust in the medical community, which is so busy covering its liability that their credibility becomes shot. It's not the doctors faults, necessarily-- but the system is such that it's hard to tell whats true when a doctor says it and what's a doctor covering themselves.

[Anonymous]

Anonymous wrote:Playing devil's advocate here...


This is not Karen's first brush with the law. This is not her first patient to be transferred under abysmal circumstances. She knew perfectly well that she took on high risk clients that could possibly have a poor outcome and that choosing not to relicense in the state of VA could potentially mean prosecution at some point.



How do you know this? What articles can you cut and past to show your statement?

There is so much "being stated" in this thread, but no proof of anything. If anyone on this thread was at the birth, could they say so. I sure wasn't so I don't know what happened. And from reading the posts it seems that most of the posters weren't there either. They are just making judgments on comments in this thread which for all we know could be true or false.

A death of a baby is a horrible outcome but we have no clue what really happened. Jeff, are you reading? Could you take this down?

[Anonymous]

Taking down the thread would be absurd.

[Anonymous]

Anonymous wrote:I've read most of this thread, and I think it's interesting that no one has commented-- that OBs are, at times, absurdly conservative. And crying wolf means you don't listen when you need to. When doctors say things like VBACs are generally a bad idea (and many do say this, despite the evidence and guidance to the contrary) many people just stop listening b/c they know it's bunk. They loose trust in the medical community, which is so busy covering its liability that their credibility becomes shot. It's not the doctors faults, necessarily-- but the system is such that it's hard to tell whats true when a doctor says it and what's a doctor covering themselves.

Actually, this has been commented on multiple times...are we reading the same thread?