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

[Anonymous]

It's perfectly okay for the homebirth community to come forward with support for their beloved midwife. She has touched many lives and has had some great outcomes. HOWEVER, what disturbs me about this case is that they are not willing to share any details. The website set up to take donations and the blog posts regarding her arrest make no mention of what really happened. Instead, they only state, "a disheartening investigation ensued after the tragic death of a client’s baby."

Well, duh, of course an investigation ensued after a baby died? What else would anyone expect AND why is it disheartening to investigate the negligent death of a child? When a child dies of SIDS the authorities come to the family's home and treat it as a crime scene - grieving family and all. Remind me again, why a lay midwife should be excused from a similiar investigation? When someone dies under suspicious circumstances, it is the job of the law to investigate.

Now I can understand if you had a wonderful birth experience with this midwife and trust in her judgement...but that was YOUR birth. No one knows what happened 9/11/2010 in Alexandria VA and frankly it is quite possible that she acted negligently. Why is that so hard to understand? Just as an OB might have an off day (resulting in a bad outcome, the revocation of his/her license and getting sued), so might a lay midwife. We are all human and as a healthcare provider you assume risk everyday on the job.

For the state to come forward with charges against her this means they had enough evidence to pursue a case. This is not a black and white issue, a witchunt, etc. Perhaps she acted with poor judgement and a baby died. Since she doesn't have a license or malpractice insurance, the only way to move forward with prosecution is through the criminal system. This is why she took her chances by practicing without a license and without malpractice insurance. This should be a lesson to other DEMs, LMs and CPMs that you are not immune from the law.

[Anonymous]

Anonymous wrote:

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.

Yes, thanks for posting this! I had no idea. I find the terminology VERY misleading!!! To a degree that it should be forbidden to stay like this.

Certified Professional Midwife sounds way more professional than Certified Midwife!!!

Yet it's exactly the opposite, Certified Midwife's per the document entering mainly through nursing and most often certified RNs, college degree, etc... vs. Certified Professional Midwife: NOTHING, not even a High School Diploma!!! (only an apprenticeship is required) This terminology is totally messed up!

[Anonymous]

Anonymous wrote:Is this the same case before a criminal judge in Alexandria, VA? That midwife is being charged with manslaughter because she did a home birth where the child did not survive. The parents didn't press charges, it was the DA's office that brought charges against the midwife. She did have a license to practice midwifery in Maryland, but not Virginia and the parents knew that from the beginning.

I think its a bit extreme to potentially put this woman in jail, with hardened criminals, because she practiced in a different state with the parents being fully aware of her situation. And of course, as a midwife with her own practice, she isn't covered under the corporate vail of a hospital's malpractice insurance so they are throwing the book at her.

Maryland does not license CPMs.

That is some of the protection given when getting licensed. This would have gone through they licensing board and not right to a criminal case, like with all other licensed providers.

[Anonymous]

Anonymous wrote:It is hardly a secret that Karen (and other lay midwives) do many births in the DC metro area. Why is it only after a bad outcome that the state is pursuing her? I think that it is clear that her practice was not lawful, but it is confusing (and gives lots of people the idea that it's OK) when the state looks the other way. Now there is a bad outcome and suddenly they decide to act. Does the state bear some responsibility for ignoring her practice and others like it for such a long time? You can see reviews and find Karen's contact info easily with a simple internet search. It is not as though she has been in hiding.

What do you want them to do? A sting on a homebirth? Fake a pregnancy to catch the unlicensed midwife breaking the law? The state can only act when the law is broken. Just because someone has a website and reviews doesn't mean you can prosecute them. There has to be evidence that the law was broken which sadly doesn't come from the internet.

[Anonymous]

In 2009, the American College of Nurse-Midwives (ACNM) -- a national group that represents more than 11,000 certified nurse midwives in all 50 states -- approved a statement that distanced themselves from lay midwives and NARM. ACNM agreed on the definition of a professional midwife as one who has graduated from a formal education program that is accredited by an agency recognized by the US Department of Education. ACNM’s definition of midwifery in the United States is congruent with the international definition of midwifery by the International Confederation of Midwives. The definition is as follows.

"A professional midwife in the United States is a person who has graduated from a formal education program in midwifery that is accredited by an agency recognized by the US Department of Education. The professional midwife has evidence of meeting established midwifery competencies that accord with a defined scope of practice corresponding to the components and extent of coursework and supervised clinical education completed. In addition, this person has successfully completed a national certification examination in midwifery and is legally authorized to practice midwifery or nurse-midwifery in one of the 50 states, District of Columbia, or US jurisdictions."

This was a group of nurses' attempt to distance themselves from a group that hopes to confuse people. Most people talk about midwives in a generic sense, but there are obvious and vast differences between a Certified NURSE Midwife with a graduate degree and a Certified PROFESSIONAL Midwife with her high school education.

http://www.midwife.org/siteFiles/position/MidwiferyCertification_in_the_United_States_3_31_09.pdf

[Anonymous]

NP, Group marriage link
http://en.wikipedia.org/wiki/The_Farm_(Tennessee)

Hard to believe this stuff. I consulted Dr. Tchabo about a breech birth but risked out due to the size of the baby. Had we been able to go forward and attempt it I don't know if I would have. It sounded like things could get pretty grisly if they went south, basically at a certain point he recommended a light epidural being placed in case they had to pry open your pelvis with forecepts. Not something I was altogether comfortable with doing at a hospital, never mind home. My child has had some neuro soft signs and I am glad that he went footling and we had the c-section. I think I would have always questioned whether it was my birth preferences that could have caused the problem.

When you are pregnant, all this is presented as safer. I had not done research on Ina May. I am shocked that you can become a midwife with so little training. I did VBAC in the hospital with the FHBC midwives. I believe that GW has midwives with privileges as well now, haven't seen them mentioned. Once the babies were here my emotional investment in their birth was so diminished in my joy about their safety. I think that people are more easily swayed due to pregnancy hormones too. You have to be careful with taking the advice of a birth educator. In my class the educator suggested indirectly that staying at home until labor was well established after your water breaking might keep you "off the clock". One of the moms in the class did so, "outlaw" without calling her midwife who probably would have instructed her to take her temp regularly (mine did with my VBAC birth). She developed an infection by the time she went in and the baby was then in the NICU. There really needs to be an eye on safety and not zealotry from either side.

One point that I haven't seen mentioned explicitly - if a midwife is unlicensed and has no arranged backup, wouldn't it make sense that there might be more hesitation to transfer?

[Anonymous]

Anonymous wrote:You're right. My information about the NARM Applications Center being based in a mobile home on a commune came from a questionable source. I read it in the 2010 Summer issue of NARM's newsletter (Volume XIIi, Issue 1, Summer 2010). Read it yourself:

http://www.narm.org/pdffiles/2010-summer-CPM-News.pdf

Give you the trailor -- but it isn't a run down shack as you imply with your language. Sorry I missed the article in their newsletter about the wife swapping. Maybe you can show where you got that information.

I've read hundrds of stories where women have gotten the birth they wanted with a midwife.

I don't think the group sex angle is what sinks Ina May. That's common knowledge, everybody knows it. As I sometimes tell people, one person's sin is another person's Saturday night. Whatever. I think what sinks Ina May is her general quackery. She is self-taught and generally respected in homebirth circles, but to get there how many children had to needlessly die? She learned what she knows from trial and error (how many babies were unfortunately errors) and a loose reading of the Mexican Midwives Birth Guide. (She and her friends didn't read the part about complications because reading about dead babies is bad luck.) Her own child was born prematurely on her bus. It needed medical attention, but she let it die 12 hours later.

[Anonymous]

Anonymous wrote:NP, Group marriage link
http://en.wikipedia.org/wiki/The_Farm_(Tennessee)

Hard to believe this stuff. I consulted Dr. Tchabo about a breech birth but risked out due to the size of the baby. Had we been able to go forward and attempt it I don't know if I would have. It sounded like things could get pretty grisly if they went south, basically at a certain point he recommended a light epidural being placed in case they had to pry open your pelvis with forecepts. Not something I was altogether comfortable with doing at a hospital, never mind home. My child has had some neuro soft signs and I am glad that he went footling and we had the c-section. I think I would have always questioned whether it was my birth preferences that could have caused the problem.

When you are pregnant, all this is presented as safer. I had not done research on Ina May. I am shocked that you can become a midwife with so little training. I did VBAC in the hospital with the FHBC midwives. I believe that GW has midwives with privileges as well now, haven't seen them mentioned. Once the babies were here my emotional investment in their birth was so diminished in my joy about their safety. I think that people are more easily swayed due to pregnancy hormones too. You have to be careful with taking the advice of a birth educator. In my class the educator suggested indirectly that staying at home until labor was well established after your water breaking might keep you "off the clock". One of the moms in the class did so, "outlaw" without calling her midwife who probably would have instructed her to take her temp regularly (mine did with my VBAC birth). She developed an infection by the time she went in and the baby was then in the NICU. There really needs to be an eye on safety and not zealotry from either side.

One point that I haven't seen mentioned explicitly - if a midwife is unlicensed and has no arranged backup, wouldn't it make sense that there might be more hesitation to transfer?

To answer that, yes, there is hesitation. In Indiana, it is illegal for a person to practice lay midwifery. This includes CPMs who are basically lay midwives with a fancy sounding title. There was an NPR interview in 2008 with a Certified NURSE Midwife in Indiana who practices at a very woman-friendly clinic where they do water births and vaginal deliveries. She said that when a lay midwife (a CPM) is practicing in a state like Indiana, that midwife and the mother will often put off going to the hospital for as long as possible because they know they will have a hard time at the hospital. So they procrastinate on getting the skilled medical care.

“What we see a lot of times is the situation where the patient needs to be transferred to the hospital, but they try to hold out a little longer at home because they know it’s not going to be a friendly environment when they get there. (The mother) knows her lay midwife is going to have to leave them at the door of the hospital because (the lay midwife) could have charges filed against her because it’s not legal. And that’s why we see the bad situations.” -- Beth Bary, CNM, Jeffersonville, Indiana

Here is the link. It's an hourlong radio segment:
http://archive.wfpl.org/soa/20080813SOA.mp3

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

OMG, the requirements are ridiculously low. 10 births within 3 years? Total of 20? There is a certification for that?? That is called 'Certified Professional Midwife'??

I've attended about 50 births and would only feel right to offer help in a 'good samaritan setting' like if we were stuck in the wilderness.
That people are able charge money with this experience for their role as 'Certified Solo Professionals' is crazy.
Anyone who feels that 20 births and the space in between - 10 in 3 years- is adequate to practice solo as a midwife, is just in total dark about the realities of human physiology and doesn't have a clue at all that can go wrong.... or feels that it is acceptable for mom and/or baby to die...

[Anonymous]

Are we debating CPM certification requirements or the expertise of Karen Carr? If we are talking about Karen, let's consider these numbers from the In Service to Women site:

To date Karen has served more than 700 families in the greater metro area including PA and WV, delivering approximately 1,200 babies.

She is far from inexperienced.

[Anonymous]

Anonymous wrote:Are we debating CPM certification requirements or the expertise of Karen Carr? If we are talking about Karen, let's consider these numbers from the In Service to Women site:

To date Karen has served more than 700 families in the greater metro area including PA and WV, delivering approximately 1,200 babies.

She is far from inexperienced.

Does anyone know her maternal and perinatal morbidity/mortality rates?

[Anonymous]

Again from the site:

"Her practice boasts a VBAC success rate greater than 70%. To date Karen has served more than 700 families in the greater metro area including PA and WV, delivering approximately 1,200 babies. Karen has helped more than 96% of her mothers achieve a vaginal birth, greatly reducing the cesarean rate amongst her clients."

I'm assuming that any greater level of detail on her stats will be revealed during the trial.

[Anonymous]

Anonymous wrote:Are we debating CPM certification requirements or the expertise of Karen Carr? If we are talking about Karen, let's consider these numbers from the In Service to Women site:

To date Karen has served more than 700 families in the greater metro area including PA and WV, delivering approximately 1,200 babies.

She is far from inexperienced.

Over what period of time? When you look at a rate, you need it to be time factored.
So, 1,200 babies over 10 years is 120/yr.
1,200 babies over 20 years is 60/yr.
What is her actual rate?
That is a more important number, than total volume, IMO.

[Anonymous]

Anonymous wrote:It's perfectly okay for the homebirth community to come forward with support for their beloved midwife. She has touched many lives and has had some great outcomes. HOWEVER, what disturbs me about this case is that they are not willing to share any details. The website set up to take donations and the blog posts regarding her arrest make no mention of what really happened. Instead, they only state, "a disheartening investigation ensued after the tragic death of a client’s baby."

Well, duh, of course an investigation ensued after a baby died? What else would anyone expect AND why is it disheartening to investigate the negligent death of a child? When a child dies of SIDS the authorities come to the family's home and treat it as a crime scene - grieving family and all. Remind me again, why a lay midwife should be excused from a similiar investigation? When someone dies under suspicious circumstances, it is the job of the law to investigate.

Now I can understand if you had a wonderful birth experience with this midwife and trust in her judgement...but that was YOUR birth. No one knows what happened 9/11/2010 in Alexandria VA and frankly it is quite possible that she acted negligently. Why is that so hard to understand? Just as an OB might have an off day (resulting in a bad outcome, the revocation of his/her license and getting sued), so might a lay midwife. We are all human and as a healthcare provider you assume risk everyday on the job.

For the state to come forward with charges against her this means they had enough evidence to pursue a case. This is not a black and white issue, a witchunt, etc. Perhaps she acted with poor judgement and a baby died. Since she doesn't have a license or malpractice insurance, the only way to move forward with prosecution is through the criminal system. This is why she took her chances by practicing without a license and without malpractice insurance. This should be a lesson to other DEMs, LMs and CPMs that you are not immune from the law.

They probably aren't posting more because unlike DCUM they care about the truth, not so much how many rumors can be started with a thread. If you haven't read this whole thread, you should. I can see why they aren't posting more. You are 100% correct saying we don't know what happened at that birth and why this thread is kind of ridiculous given the statments being made about a person with no knowledge of the situation being discussed. But again, that is DCUM at its core.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Are we debating CPM certification requirements or the expertise of Karen Carr? If we are talking about Karen, let's consider these numbers from the In Service to Women site:

To date Karen has served more than 700 families in the greater metro area including PA and WV, delivering approximately 1,200 babies.

She is far from inexperienced.

Does anyone know her maternal and perinatal morbidity/mortality rates?

I know for a fact that she has lost at least one other baby - but she might have lost more, I don't know.

I cannot speak to her maternal morbidity rate, because I don't know it.