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

[Anonymous]

Anonymous wrote:Here is the clinical training requirements to become a CPM per NARM's website:

I. As an active participant, the applicant must attend a
minimum of 20 births.

II. Functioning in the role of primary midwife under
supervision, the applicant must attend a minimum of an
additional 20 births:

A. A minimum of ten of the 20 births attended as
primary under supervision must be in homes or other
out-of-hospital settings; and

B. A minimum of three of the 20 births attended as
primary under supervision must be with women for
whom the applicant has provided primary care during
at least four prenatal visits, birth, newborn exam and
one postpartum exam.

C. At least ten of the 20 primary births must have
occurred within three years of application submission.

III. Functioning in the role of primary midwife under
supervision, the applicant must document:
A. 75 prenatal exams, including 20 initial exams;
B. 20 newborn exams; and
C. 40 postpartum exams.

At least 10 out of the 20 births in the past 3 years! Yup, just like a CNM.

Do people realize that, most of the time, labor and birth go fine out of sheer dumb luck? To identify when things are not fine, you have to have seen the complication before, and if that complication happens in 1/250 births, what are the chances that a CPM has seen it and knows how to deal with it? Someone who's going to practice all by herself with no OBs, nurses, or support staff (ie, in someone's home) needs to have seen MORE births than a CNM, and possibly more than the typical OB, not orders of magnitude fewer births.

Ridiculous.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Here is the clinical training requirements to become a CPM per NARM's website:

I. As an active participant, the applicant must attend a
minimum of 20 births.

II. Functioning in the role of primary midwife under
supervision, the applicant must attend a minimum of an
additional 20 births:

A. A minimum of ten of the 20 births attended as
primary under supervision must be in homes or other
out-of-hospital settings; and

B. A minimum of three of the 20 births attended as
primary under supervision must be with women for
whom the applicant has provided primary care during
at least four prenatal visits, birth, newborn exam and
one postpartum exam.

C. At least ten of the 20 primary births must have
occurred within three years of application submission.

III. Functioning in the role of primary midwife under
supervision, the applicant must document:
A. 75 prenatal exams, including 20 initial exams;
B. 20 newborn exams; and
C. 40 postpartum exams.

At least 10 out of the 20 births in the past 3 years! Yup, just like a CNM.

Do people realize that, most of the time, labor and birth go fine out of sheer dumb luck? To identify when things are not fine, you have to have seen the complication before, and if that complication happens in 1/250 births, what are the chances that a CPM has seen it and knows how to deal with it? Someone who's going to practice all by herself with no OBs, nurses, or support staff (ie, in someone's home) needs to have seen MORE births than a CNM, and possibly more than the typical OB, not orders of magnitude fewer births.

Ridiculous.

Why do you HAVE to have seen something before? I have had several (I think more than three) experiences with various doctors for different issues where they had not personally seen my problem before but they had studied it and could recognize it, sometimes only after consulting their books and doing some research. And all the doctors elsewhere who admit they had "never seen anything like this before." Everyone has a story like that. Isn't that what that TV show "Mystery Diagnosis" is all about?

So I bet, because the OBs are no longer trained in it, the homebirth midwives have actually seen way, way way more vaginal breech and twin births than any OB/GYN has.

[Anonymous]

The link below takes you to a comparison of CMs CNMs and CPMs. It is a recent document - March 2011. The paper is published on the American College of Nurse-Midwives website.

http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000762/CNM-CM-CPM%20comparison%20FINAL.pdf

[Anonymous]

Anonymous wrote:Why do you HAVE to have seen something before? I have had several (I think more than three) experiences with various doctors for different issues where they had not personally seen my problem before but they had studied it and could recognize it, sometimes only after consulting their books and doing some research. And all the doctors elsewhere who admit they had "never seen anything like this before." Everyone has a story like that. Isn't that what that TV show "Mystery Diagnosis" is all about?

So I bet, because the OBs are no longer trained in it, the homebirth midwives have actually seen way, way way more vaginal breech and twin births than any OB/GYN has.

So while you're alone in your living room, you want your midwife to be googling "vaginal breech signs of fetal distress" instead of watching you?

If a doctor in an office setting hasn't seen a particular illness or problem before but vaguely remembers something about it, there's nothing to keep her from looking it up. It's generally not going to hurt you to wait the few minutes/hours/days while she calls a colleague or looks up some relevent literature. If a surgeon is operating on your heart and sees some strange anatomy that's only present in 1/250 patients, it's in your best interest that that surgeon has seen that complication before and immediately knows how to handle it, instead of having to call someone else in from home or go look at a textbook. The difference is the acuity of the problem. In labor a baby can lose brain cells after a very short period of low oxygen (much like the heart surgery patient can go south really fast), so in those settings the practitioner needs to recognize a problem and react quickly, not just wait and see what happens.

[Anonymous]

Anonymous wrote:The link below takes you to a comparison of CMs CNMs and CPMs. It is a recent document - March 2011. The paper is published on the American College of Nurse-Midwives website.

http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000762/CNM-CM-CPM%20comparison%20FINAL.pdf

That's a great comparison. Thanks for posting.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Why do you HAVE to have seen something before? I have had several (I think more than three) experiences with various doctors for different issues where they had not personally seen my problem before but they had studied it and could recognize it, sometimes only after consulting their books and doing some research. And all the doctors elsewhere who admit they had "never seen anything like this before." Everyone has a story like that. Isn't that what that TV show "Mystery Diagnosis" is all about?

So I bet, because the OBs are no longer trained in it, the homebirth midwives have actually seen way, way way more vaginal breech and twin births than any OB/GYN has.

So while you're alone in your living room, you want your midwife to be googling "vaginal breech signs of fetal distress" instead of watching you?

If a doctor in an office setting hasn't seen a particular illness or problem before but vaguely remembers something about it, there's nothing to keep her from looking it up. It's generally not going to hurt you to wait the few minutes/hours/days while she calls a colleague or looks up some relevent literature. If a surgeon is operating on your heart and sees some strange anatomy that's only present in 1/250 patients, it's in your best interest that that surgeon has seen that complication before and immediately knows how to handle it, instead of having to call someone else in from home or go look at a textbook. The difference is the acuity of the problem. In labor a baby can lose brain cells after a very short period of low oxygen (much like the heart surgery patient can go south really fast), so in those settings the practitioner needs to recognize a problem and react quickly, not just wait and see what happens.

There are finite ways to fix the finite number of things that go wrong during a birth. Labor will not progress, baby will get stuck, baby will not breathe, mom/baby can't maintain blood pressure or heart rate, mom will hemorrhage, mom will stroke out, mom/baby will be infected. That is about it. Also, many many times doctors will open someone up and find something unexpected and will USE CREATIVE TECHNIQUES and MAKE SHIT UP to fix the problem BASED ON WHAT THEY ALREADY KNOW. Problem solving skills. Right? If you have a deep understanding of anatomy and physiology and WHY things happen, you can come up with some creative and appropriate things to do to free a stuck baby, etc. Right?

[Anonymous]

Hello. This is the PP from 10:59 who asked the question about CPMs. I appreciate the comparison between CNMs and CPMs that someone posted since then. Very informative. I do know how to use search devices, but I don't have a week to research how a lay midwife goes about getting certification. I'll accept it is a fact, perhaps an embarrassing one, that a Certified Professional Midwife like Karen Carr received her certificate to practice from a mobile home on a Tennessee commune with a history of marijuana cultivation and wife swapping. I read a recent post on mothering.com that said someone's Christian homebirth midwife sat in a corner and prayed while her baby plummeted into distress. But maybe the midwife was just googling her inner crystal. I'm so sorry for this poor mother that she bought into this baloney and ended up with a dead child. And yes, if I'm having heart surgery, I would prefer an expert, preferably from an accredited school and who doesn't practice illegally!

[Anonymous]

Anonymous wrote:There are finite ways to fix the finite number of things that go wrong during a birth. Labor will not progress, baby will get stuck, baby will not breathe, mom/baby can't maintain blood pressure or heart rate, mom will hemorrhage, mom will stroke out, mom/baby will be infected. That is about it. Also, many many times doctors will open someone up and find something unexpected and will USE CREATIVE TECHNIQUES and MAKE SHIT UP to fix the problem BASED ON WHAT THEY ALREADY KNOW. Problem solving skills. Right? If you have a deep understanding of anatomy and physiology and WHY things happen, you can come up with some creative and appropriate things to do to free a stuck baby, etc. Right?

We can agree on that. I just don't agree that after presiding over 20 births, a CPM on her own will necessarily recognize the signs of infection in the mother in a timely manner. They don't get a sign on their foreheads that says "infection," and if the midwife has never seen it, it could take her hours to recognize that it's not just labor, it's labor + other problem. I also don't agree that most CPMs have "a deep understanding of anatomy and physiology."

Also, to "USE CREATIVE TECHNIQUES and MAKE SHIT UP to fix the problem BASED ON WHAT THEY ALREADY KNOW," a person has to have a pretty deep fund of knowledge to call from. If you're attending the newborn who's taking a minute to pink up and don't immediately recognize that the mom has suddenly gone pale and quiet, I'm guessing that the CPM isn't going to suddenly invent a new and better way to give the woman a hysterectomy and rig up a blood transfusion from pureed steak.

[Anonymous]

Anonymous wrote:Hello. This is the PP from 10:59 who asked the question about CPMs. I appreciate the comparison between CNMs and CPMs that someone posted since then. Very informative. I do know how to use search devices, but I don't have a week to research how a lay midwife goes about getting certification. I'll accept it is a fact, perhaps an embarrassing one, that a Certified Professional Midwife like Karen Carr received her certificate to practice from a mobile home on a Tennessee commune with a history of marijuana cultivation and wife swapping. I read a recent post on mothering.com that said someone's Christian homebirth midwife sat in a corner and prayed while her baby plummeted into distress. But maybe the midwife was just googling her inner crystal. I'm so sorry for this poor mother that she bought into this baloney and ended up with a dead child. And yes, if I'm having heart surgery, I would prefer an expert, preferably from an accredited school and who doesn't practice illegally!

Aaaand here we go comparing childbirth to heart surgery. Birth is not an illness. It is not a problem to be solved. Heart surgery is never a normal process. Sex, eating and bowel movements are also vigorous natural processes that can go very, very wrong as well, but (not yet at least) we don't require monitoring and hospitalization to do so. The only difference is that there is a cute little baby at stake and lots of money to be made. Does sex and pooping and swallowing food go right most of the time just because of "dumb luck"? Hardly.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Hello. This is the PP from 10:59 who asked the question about CPMs. I appreciate the comparison between CNMs and CPMs that someone posted since then. Very informative. I do know how to use search devices, but I don't have a week to research how a lay midwife goes about getting certification. I'll accept it is a fact, perhaps an embarrassing one, that a Certified Professional Midwife like Karen Carr received her certificate to practice from a mobile home on a Tennessee commune with a history of marijuana cultivation and wife swapping. I read a recent post on mothering.com that said someone's Christian homebirth midwife sat in a corner and prayed while her baby plummeted into distress. But maybe the midwife was just googling her inner crystal. I'm so sorry for this poor mother that she bought into this baloney and ended up with a dead child. And yes, if I'm having heart surgery, I would prefer an expert, preferably from an accredited school and who doesn't practice illegally!

Aaaand here we go comparing childbirth to heart surgery. Birth is not an illness. It is not a problem to be solved. Heart surgery is never a normal process. Sex, eating and bowel movements are also vigorous natural processes that can go very, very wrong as well, but (not yet at least) we don't require monitoring and hospitalization to do so. The only difference is that there is a cute little baby at stake and lots of money to be made. Does sex and pooping and swallowing food go right most of the time just because of "dumb luck"? Hardly.

I think you missed my larger point. A poster above reference heart surgery, which I also referenced in my post above. My point was about going with a person who promises the most expertise, clinical knowledge, resources, and a legal license. I was making a larger point about undergoing something as sensitive as birth with someone who doesn't know how to handle unexpected phenomenon.

[Anonymous]

Anonymous wrote:

Anonymous wrote:There are finite ways to fix the finite number of things that go wrong during a birth. Labor will not progress, baby will get stuck, baby will not breathe, mom/baby can't maintain blood pressure or heart rate, mom will hemorrhage, mom will stroke out, mom/baby will be infected. That is about it. Also, many many times doctors will open someone up and find something unexpected and will USE CREATIVE TECHNIQUES and MAKE SHIT UP to fix the problem BASED ON WHAT THEY ALREADY KNOW. Problem solving skills. Right? If you have a deep understanding of anatomy and physiology and WHY things happen, you can come up with some creative and appropriate things to do to free a stuck baby, etc. Right?

We can agree on that. I just don't agree that after presiding over 20 births, a CPM on her own will necessarily recognize the signs of infection in the mother in a timely manner. They don't get a sign on their foreheads that says "infection," and if the midwife has never seen it, it could take her hours to recognize that it's not just labor, it's labor + other problem. I also don't agree that most CPMs have "a deep understanding of anatomy and physiology."

Also, to "USE CREATIVE TECHNIQUES and MAKE SHIT UP to fix the problem BASED ON WHAT THEY ALREADY KNOW," a person has to have a pretty deep fund of knowledge to call from. If you're attending the newborn who's taking a minute to pink up and don't immediately recognize that the mom has suddenly gone pale and quiet, I'm guessing that the CPM isn't going to suddenly invent a new and better way to give the woman a hysterectomy and rig up a blood transfusion from pureed steak.

How many CPMs do you know or have worked with? I'd like to know where you are getting these preconceived notions of all CPMs and their knowledge and skills. And don't forget that CPMs work with birth attendants that have seen plenty of births themselves if not CPMs themselves, so one is attending to baby, one to mom. Are nurses trained to catch babies? NO, yet guess who is with these women in the hospital for 99 percent of their labor? Sometimes not even a nurse, a freaking fetal monitor is the only one watching the mom!!! Haven't you heard of nurses pushing babies back into vaginas because the doctor isn't there yet?

[Anonymous]

Anonymous wrote:Aaaand here we go comparing childbirth to heart surgery. Birth is not an illness. It is not a problem to be solved. Heart surgery is never a normal process. Sex, eating and bowel movements are also vigorous natural processes that can go very, very wrong as well, but (not yet at least) we don't require monitoring and hospitalization to do so. The only difference is that there is a cute little baby at stake and lots of money to be made. Does sex and pooping and swallowing food go right most of the time just because of "dumb luck"? Hardly.

Yup, it's not a problem until it is one, and recognizing that point isn't so easy.

I think that losing ~7 women per 1000 live births and ~100 infants per 1000 live births is pretty bad, whereas my chances of choking to death are much, much lower, but I guess since the ideology says that "birth is natural and not an illness," that birth must be super safe!

[Anonymous]

I would not hire a CPM who had just completed certification but I would hire someone like Karen Carr who has been practicing midwifery for 15 years (I believe) and who obviously has extensive experience. I would not attempt a breech birth at home but I appreciate the fact that there are experienced professionals who are willing to offer women these choices at great personal risk. I don't know enough details on this case to have an opinion on whether or not the midwife made a mistake. If she did everything she could possibly do correctly and the baby died because they couldn't do an emergency C-section fast enough, then I don't think the midwife should be prosecuted for anything other than practicing without a license.

[Anonymous]

Anonymous wrote:How many CPMs do you know or have worked with? I'd like to know where you are getting these preconceived notions of all CPMs and their knowledge and skills. And don't forget that CPMs work with birth attendants that have seen plenty of births themselves if not CPMs themselves, so one is attending to baby, one to mom. Are nurses trained to catch babies? NO, yet guess who is with these women in the hospital for 99 percent of their labor? Sometimes not even a nurse, a freaking fetal monitor is the only one watching the mom!!! Haven't you heard of nurses pushing babies back into vaginas because the doctor isn't there yet?

I think what's being addressed is the fact that the minimum requirement to become a CPM is having attended 40 births. If some/most CPMs have much more training and education than that, that's great, but why on earth would the standards be so low for a situation that's so potentially risky? And didn't someone say earlier that a birth attendant can't act legally in a medical capacity?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Hello. This is the PP from 10:59 who asked the question about CPMs. I appreciate the comparison between CNMs and CPMs that someone posted since then. Very informative. I do know how to use search devices, but I don't have a week to research how a lay midwife goes about getting certification. I'll accept it is a fact, perhaps an embarrassing one, that a Certified Professional Midwife like Karen Carr received her certificate to practice from a mobile home on a Tennessee commune with a history of marijuana cultivation and wife swapping. I read a recent post on mothering.com that said someone's Christian homebirth midwife sat in a corner and prayed while her baby plummeted into distress. But maybe the midwife was just googling her inner crystal. I'm so sorry for this poor mother that she bought into this baloney and ended up with a dead child. And yes, if I'm having heart surgery, I would prefer an expert, preferably from an accredited school and who doesn't practice illegally!

Aaaand here we go comparing childbirth to heart surgery. Birth is not an illness. It is not a problem to be solved. Heart surgery is never a normal process. Sex, eating and bowel movements are also vigorous natural processes that can go very, very wrong as well, but (not yet at least) we don't require monitoring and hospitalization to do so. The only difference is that there is a cute little baby at stake and lots of money to be made. Does sex and pooping and swallowing food go right most of the time just because of "dumb luck"? Hardly.

It's funny that all the vitriol directed at me contains no correction about CPMs being certified from a commune trailer park. You can get mad personally, but I'm still right.