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

[Anonymous]

Anonymous wrote:

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.

I gave birth to my daughter at home (with a certified NURSE midwife - I'd never go with a CPM, ever) and I think the original poster here is spot on.

[Anonymous]

So if CPMs are all so dangerous, why are they perfectly OK in over 30 other states? She wasn't licensed in VA probably because if she was, she couldn't practice legally in MD. News flash anyway, CPM licensure in Virginia actually limits the practice to a point that it is LESS safe WITH licensure than without. They cannot legally carry oxygen and other lifesaving medication as a licensed CPM. But all of them do because it's good medicine to do so, so all of them are practicing illegally in VA, licensed or not. To attend births at home as a CNM, you have to find a physician to back you up. Which is next to impossible because of insurance concerns. So nobody wants to be a CNM either. And the hospitals make it even more dangerous by abusing transferring moms and babies and midwives instead of welcoming and working with them. So homebirth has its hands tied no matter how you slice it. Hospitals and doctors make it less safe because nobody works together. No doc wants to learn to use forceps, nobody wants to learn how to deliver breech, nobody wants to do VBAC. The real problem here is that the CPM licensing is screwed up. It's not Karen's fault she wasn't licensed in Maryland if there is no such license to be had!

[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."
[b]

No one can talk about details - it is a criminal proceeding and everyone has to remain silent until the trial. Nothing being hidden - all will be heard at the trial.

[Anonymous]

Anonymous wrote:So if CPMs are all so dangerous, why are they perfectly OK in over 30 other states? She wasn't licensed in VA probably because if she was, she couldn't practice legally in MD. News flash anyway, CPM licensure in Virginia actually limits the practice to a point that it is LESS safe WITH licensure than without. They cannot legally carry oxygen and other lifesaving medication as a licensed CPM. But all of them do because it's good medicine to do so, so all of them are practicing illegally in VA, licensed or not. To attend births at home as a CNM, you have to find a physician to back you up. Which is next to impossible because of insurance concerns. So nobody wants to be a CNM either. And the hospitals make it even more dangerous by abusing transferring moms and babies and midwives instead of welcoming and working with them. So homebirth has its hands tied no matter how you slice it. Hospitals and doctors make it less safe because nobody works together. No doc wants to learn to use forceps, nobody wants to learn how to deliver breech, nobody wants to do VBAC. The real problem here is that the CPM licensing is screwed up. It's not Karen's fault she wasn't licensed in Maryland if there is no such license to be had!

Midwives have been practicing for thousands of years. Over that time, wisdom has evolved. Midwives practiced illegally in VA before licensure, and most practice with herbs and homeopathics without access to medications. Statistics weren't any worse. Not all of the VA CPMs carry medications as what they use works, so not all are practicing illegally. If they were to have a complaint for using a life saving medication, it would be a much different discussion than a midwife who chose to violate the law by not getting a license. It just would be, whether or not both situations are illegal.

BTW - there are CNMs practicing illegally in VA - they may be using those lifesaving medications, but how many of them have a collaborating doctor for their prescription privilege? That is required of a Virginia CNM.... Birth Care has collaborating doctors - what of the other homebirth CNMs who have meds but don't mention that illegal part about needing a collaborating doctor for those meds......

[Anonymous]

Anonymous wrote: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.

Um, wow, PP. How do you know this stuff? I didn't.

[Anonymous]

Anonymous wrote:So if CPMs are all so dangerous, why are they perfectly OK in over 30 other states? She wasn't licensed in VA probably because if she was, she couldn't practice legally in MD. News flash anyway, CPM licensure in Virginia actually limits the practice to a point that it is LESS safe WITH licensure than without. They cannot legally carry oxygen and other lifesaving medication as a licensed CPM. But all of them do because it's good medicine to do so, so all of them are practicing illegally in VA, licensed or not. To attend births at home as a CNM, you have to find a physician to back you up. Which is next to impossible because of insurance concerns. So nobody wants to be a CNM either. And the hospitals make it even more dangerous by abusing transferring moms and babies and midwives instead of welcoming and working with them. So homebirth has its hands tied no matter how you slice it. Hospitals and doctors make it less safe because nobody works together. No doc wants to learn to use forceps, nobody wants to learn how to deliver breech, nobody wants to do VBAC. The real problem here is that the CPM licensing is screwed up. It's not Karen's fault she wasn't licensed in Maryland if there is no such license to be had!

A lot of what you are saying is true (lack of collaboration between MDs and midwives, hospitals not as welcoming to hb transfers)...BUT...that does not mean the system is entirely broken. There are plenty of CNMs who work within the system and are making great change from within. The hb community often refers to these midwives as "medwives" because they choose to practice in the hospital setting, but I look at it this way: over 90% of women and families CHOOSE to birth in the hospital setting and why should midwives only be available to those educated, affluent individuals who can afford out of hospital birth? Midwifery care should be available to ALL women, not a chosen few. Any woman can get Medicaid during pregnancy so ALL women have access to medical care and a free birth - not all women can afford $2000 or more dollars out-of-pocket for a homebirth (plus the materials, birth assistant costs and/or doula)...it's simply economically out of reach for many women. Most of the women I know choosing hb are well-educated AND affluent.

The other factor here is when you've worked in a hospital and you've seen the proverbial "train wrecks" brought in from the home, it might begin to influence your thoughts/beliefs regarding hb. Often times, women are transferred once the situation has become an emergency and the hospital staff is left to pick up the pieces (and liability) of a potentially poor outcome. Of course this would influence your thoughts on hb...especially when the woman's provider waited far too long to transfer.

[Anonymous]

Anonymous wrote:So if CPMs are all so dangerous, why are they perfectly OK in over 30 other states? She wasn't licensed in VA probably because if she was, she couldn't practice legally in MD. News flash anyway, CPM licensure in Virginia actually limits the practice to a point that it is LESS safe WITH licensure than without. They cannot legally carry oxygen and other lifesaving medication as a licensed CPM. But all of them do because it's good medicine to do so, so all of them are practicing illegally in VA, licensed or not. To attend births at home as a CNM, you have to find a physician to back you up. Which is next to impossible because of insurance concerns. So nobody wants to be a CNM either. And the hospitals make it even more dangerous by abusing transferring moms and babies and midwives instead of welcoming and working with them. So homebirth has its hands tied no matter how you slice it. Hospitals and doctors make it less safe because nobody works together. No doc wants to learn to use forceps, nobody wants to learn how to deliver breech, nobody wants to do VBAC. The real problem here is that the CPM licensing is screwed up. It's not Karen's fault she wasn't licensed in Maryland if there is no such license to be had!

What are you talking about? There are licensed midwives in MD and VA and DC. They are certified NURSE midwives. You can't just decided to make up a "medical" profession to fit your needs and then not think there may be ramifications when something goes wrong.

[Anonymous]

Anonymous wrote:So if CPMs are all so dangerous, why are they perfectly OK in over 30 other states? She wasn't licensed in VA probably because if she was, she couldn't practice legally in MD. News flash anyway, CPM licensure in Virginia actually limits the practice to a point that it is LESS safe WITH licensure than without. They cannot legally carry oxygen and other lifesaving medication as a licensed CPM. But all of them do because it's good medicine to do so, so all of them are practicing illegally in VA, licensed or not. To attend births at home as a CNM, you have to find a physician to back you up. Which is next to impossible because of insurance concerns. So nobody wants to be a CNM either. And the hospitals make it even more dangerous by abusing transferring moms and babies and midwives instead of welcoming and working with them. So homebirth has its hands tied no matter how you slice it. Hospitals and doctors make it less safe because nobody works together. No doc wants to learn to use forceps, nobody wants to learn how to deliver breech, nobody wants to do VBAC. The real problem here is that the CPM licensing is screwed up. It's not Karen's fault she wasn't licensed in Maryland if there is no such license to be had!

Well, CPMs do seem to be good at lobbying together (as we've seen here), so maybe that has something to do with it?

The rest of this doesn't make much sense to me. It's illegal for a CPM to carry oxygen and other medications, so instead of acting illegally by carrying the oxygen and other meds anyway, she chooses to act illegally by not being licensed and acting as a care provider anyway? With the license, she would have been reviewed by her licensing body. Without the license, she's criminally liable for practicing medicine without a license. Like I said, I'm not seeing the logic there.

And I really don't think that the big reason why CPMs aren't becoming CNMs is because it's next to impossible to find a physician to back you up. I'm guessing it has more to do with the huge difference in pre-clinical and clinical requirements and the level of time and commitment required to become a nurse midwife (Master's level degree).

Also, anyone who suffers abuse while transfering to a hospital needs to file a complaint about the doctors/nurses involved. What my anecdata say, however, is that by the time many homebirth moms are transferred, they're already in big trouble, and the CPM is either not there at all (the "dump and run"), or is there but not helping the doctors/nurses much (the "but you can't give her an IV!"). I'm sure that there are many great CPMs out there who transfer moms quickly when things start looking bad and who give the hospital staff a good, quick history, but there are enough of the other kind that in some places, the staff dreads what might be coming when they hear they have a homebirth transfer.

And in my city, all OB/GYN residents do learn to use forceps.

[Anonymous]

Karen Carr may have attended many births but that hardly qualifies her as a credible birth attendant. 90%-95% births don't really require any intervention whatsoever. The trained birth attendant is necessary to monitor for those complications that require intervention. So when you read all of the glowing testimonials, keep that in mind. Karen Carr has decided that she will attend any mom who asks her regardless of history or risk. Dandy! The parents assume the risk. Then why bother to have anyone at all. You might as well have your neighbor drop by. Anyone can "catch" a baby. Most people would require more accountability from their mechanic.

[Anonymous]

Karen Carr was qualified to become licensed in Virginia. She simple decided not to. No standard of care for Karen Carr. She can operate as a "midwife" anyway she chooses with zero accountability.

[Anonymous]

Anonymous wrote:Karen Carr was qualified to become licensed in Virginia. She simple decided not to. No standard of care for Karen Carr. She can operate as a "midwife" anyway she chooses with zero accountability.

She is held to the standards and accountability of the CPM credential, just like any other current CPM is.

[Anonymous]

I don't have much to add I just wanted to say that when I was at Birth Care today the Washington Post called asking for a statement on a "midwife where something went wrong." At least that is how the girl at the desk relayed it to the other assistant. I perked up (and of course butted in)...is that about Karen Carr? They replied probably ...but didn't tell me anything else. I am not sure if they offered a statement. My guess is probably no if they are involved in the case.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Karen Carr was qualified to become licensed in Virginia. She simple decided not to. No standard of care for Karen Carr. She can operate as a "midwife" anyway she chooses with zero accountability.

She is held to the standards and accountability of the CPM credential, just like any other current CPM is.

Really? By whom? NARM? They have listed 5 CPMs with revoked credentials. Five total. Very thorough indeed!

[Anonymous]

Anonymous wrote:
Also, anyone who suffers abuse while transfering to a hospital needs to file a complaint about the doctors/nurses involved. What my anecdata say, however, is that by the time many homebirth moms are transferred, they're already in big trouble, and the CPM is either not there at all (the "dump and run"), or is there but not helping the doctors/nurses much (the "but you can't give her an IV!"). I'm sure that there are many great CPMs out there who transfer moms quickly when things start looking bad and who give the hospital staff a good, quick history, but there are enough of the other kind that in some places, the staff dreads what might be coming when they hear they have a homebirth transfer.

And in my city, all OB/GYN residents do learn to use forceps.

Even with a licensed CPM attending a transfer of a non-emergent situation, some docs call that a "dump" and get all huffy about it. They don't like homebirth and they do not like transfers - emergencies or otherwise. They have created a very hostile environment in this area for even legally practicing CPMs to work within.

Transfers aren't all dumps (VA's licensed CPMs are required to be present for the transfer of care) and they aren't all emergencies. The receiving docs tend to make up the drama involved. Makes for a better story.

In other parts of Virginia, CPMs and their moms are actually received well. It's our litigious area.

[Anonymous]

Unless NARM knows about a midwife's practice (if she's reported) they cannot take action. In Karen Carr's case, she has no license. I suspect that if she had possessed a license with the same scenario, she would not have been prosecuted criminally. Instead, she would have been disciplined by her licensing board. That's what it means to be accountable. I wonder what NARM would think about this case if they knew the details? But even if her CPM was revoked, it wouldn't stop Karen Carr. She doesn't see herself as beholden to any law or regulation or rule.