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

[Anonymous]

Anonymous wrote:

Anonymous wrote: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 But even if her CPM was revoked, it wouldn't stop Karen Carr.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.

Karen is licensed, not in Virginia as has been discussed ad nauseam in this thread.

in what state(s) is she currently licensed?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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 But even if her CPM was revoked, it wouldn't stop Karen Carr.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.

Karen is licensed, not in Virginia as has been discussed ad nauseam in this thread.

And as we have discussed, ad nauseam, this happened in Virginia, where she was unlicensed, and Virginia is prosecuting her. Not so hard to follow.

People keep bringing up the fact that she was UNLICENSED and UNTRAINED and LACKING SKILL, etc. etc. CPMs with her exact training are recognized and legal in the majority of this country. She was simply not licensed in Virginia. Because she lives in Maryland. Okay, so, she has earned the practicing without a license charge. Fair enough. But I think everyone is shocked and wanting to protest the outrageous manslaughter charge and that is the biggest issue here. Everyone is so hung up on requiring licensing and certification and degrees and time served reading books and writing stupid pointless papers and kissing professor ass. Well guess what, guys, EMTs and paramedics have as much or less training than the CPMs. No college degree required there, either. I was a freaking EMT IN HIGH SCHOOL and I was able to save lives without even a high school degree. But everyone trusts EMTs and paramedics with lives, it's their sole job and core training to save lives, right? You know how EMTs know how to deliver babies in emergency situations? They read a card with the steps on it. (This card includes how to deliver a breech, by the way). And then they give out bad and dangerous advice like tie off the umbilical cord with a shoelace. But everyone's like "Call an ambulance!!! OMG!" if a baby is being born in a Mc Donalds bathroom. The paramedics generally have no idea how to catch a baby and they generally have never seen it before. So ironic. It really ought to be "Call the town midwife!"
You know who else we entrust with our lives who don't require anything but some extra training? Licensed practical nurses, yep, the people you trust and hire to care for your dying grandma in hospice.

I am pretty sure that no one hires an EMT to be their birth attendant. She was hired to provide a service which she legally wasn't licensed to provide. Doctors are licensed in certain states also. Just because a doctor lives in Bethesda doesn't mean they can practice in Alexandria. Really, it isn't that hard to follow. She chose to be unlicensed. This is the risk she assumed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"You know who else we entrust with our lives who don't require anything but some extra training? Licensed practical nurses, yep, the people you trust and hire to care for your dying grandma in hospice.

You clearly have little or no knowledge regarding the education/training and licensure of LPNs, Ms. Know-it-All!

And you don't know anything about CPMs if you think that it comes anywhere close to the amount of training a LPN requires!!!! Really I have read the requirements and know several LPNs and it is not even comparable to the amount of training a CPM requires.

That's because LPNs do not deliver babies. They dispense medications under the LICENSE of an RN. They do not practice independently. They provide wound care and trach care and do many other things, but they are not in the home practicing without supervision. Many LPNs go to school for 2+ years and sit for a rigorous exam similiar to the NCLEX (the licensure exam for RNs).

Anyone can say they are a midwife (with or without the CPM credential) and still only have a basic high school education and have read a few anatomy books and/or Spiritual Midwifery, etc. Anyone can be a preceptor, but that does not make them a good one...and a lay midwife is often only good as her one preceptor. This conversation is far greater than Karen Carr. It's discussing an entire cadre of individuals who presume themselves "beyond" the educational system and fit to practice without rules or scope...it's about patient safety.

[Anonymous]

Anonymous wrote:And you don't know anything about CPMs if you think that it comes anywhere close to the amount of training a LPN requires!!!! Really I have read the requirements and know several LPNs and it is not even comparable to the amount of training a CPM requires.

And the training that CPMs receive doesn't come anywhere close to the training that CNMs receive, and midwives in Canada, and Australia, and England. And yet they're trusted to work all by themselves in someone's home (not like EMTs, who try to keep people from getting worse while in transit but then hand off care to doctors and nurses). If CPMs had more rigorous training than CNMs, it might make more sense, but a person can see 40 births, be the main caregiver at 20 of those, and as long as 10/20 have been in the last 3 years she's deemed experienced enough to be the sole care provider for a woman in labor. I really think that women and babies deserve better than that.

[Anonymous]

Anonymous wrote:

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.

It's worth the $3.95 on the Ny Times:

http://select.nytimes.com/gst/abstract.html?res=F10E1FFE3D5D117B93C7A9178FD85F458785F9&scp=12&sq=ina%20may%20gaskin&st=cse

Superstition about poisoning the karma from the Mexican Midwives Rural Handbook. Read all of Chapter Four, especially page 25:

http://www.gutenberg-e.org/hodgdon/pdfs/hodgdon_chapter4.pdf

Ina May's child born on a bus dies 12 hours after birth:

http://www.salon.com/people/bc/1999/06/01/gaskin/

Ina May learning about labor through her experience with LSD:

http://www.thefarm.org/general/hightime.html

[Anonymous]

Anonymous wrote: 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!

This is no longer true in Maryland - a law was passed last year that allows CNMs to practice without an OB agreement. There are several well-respected CNMs who attend home births in MD (one of whom attended my homebirth). Agree with you about the lack of support from hospitals - if there wasn't so much politicizing of this issue and "turf battles" births in general would be a lot safer - the real victims in the battle between doctors/hospitals/ and midwives are the mothers and babies.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:"You know who else we entrust with our lives who don't require anything but some extra training? Licensed practical nurses, yep, the people you trust and hire to care for your dying grandma in hospice.

You clearly have little or no knowledge regarding the education/training and licensure of LPNs, Ms. Know-it-All!

And you don't know anything about CPMs if you think that it comes anywhere close to the amount of training a LPN requires!!!! Really I have read the requirements and know several LPNs and it is not even comparable to the amount of training a CPM requires.

That's because LPNs do not deliver babies. They dispense medications under the LICENSE of an RN. They do not practice independently. They provide wound care and trach care and do many other things, but they are not in the home practicing without supervision. Many LPNs go to school for 2+ years and sit for a rigorous exam similiar to the NCLEX (the licensure exam for RNs).

Anyone can say they are a midwife (with or without the CPM credential) and still only have a basic high school education and have read a few anatomy books and/or Spiritual Midwifery, etc. Anyone can be a preceptor, but that does not make them a good one...and a lay midwife is often only good as her one preceptor. This conversation is far greater than Karen Carr. It's discussing an entire cadre of individuals who presume themselves "beyond" the educational system and fit to practice without rules or scope...it's about patient safety.

CPMs work legally in many states. In several states, Medicaid even reimburses them! Holy crap! So it must be Maryland's problem, not Karen's. She deserves a charge of "practicing without a license." This I think nobody disputes. But manslaughter is just way over the top. This "cadre" of individuals is no different than any of these other professions that get qualified based on some classes, some OJT, and a test. The problem lies with the individual states that legislate against them for no reason at all.

[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.

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.

Really? Why? Genuinely curious.

[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.

Exagerate much? If she operates with zero accountability, why is she standing trial for manslaughter?

[Anonymous]

Anonymous wrote:

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.

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.

Really? Why? Genuinely curious.

I'm guessing that the concern is keeping skills up. If she's attending at least several births per month she's more likely to be sharp than if she's only seeing several per year.

[Anonymous]

Anonymous wrote:And the training that CPMs receive doesn't come anywhere close to the training that CNMs receive, and midwives in Canada, and Australia, and England. And yet they're trusted to work all by themselves in someone's home (not like EMTs, who try to keep people from getting worse while in transit but then hand off care to doctors and nurses). If CPMs had more rigorous training than CNMs, it might make more sense, but a person can see 40 births, be the main caregiver at 20 of those, and as long as 10/20 have been in the last 3 years she's deemed experienced enough to be the sole care provider for a woman in labor. I really think that women and babies deserve better than that.

Where are the stats that show more training makes for better outcomes?

CPM 2000 speaks for itself:
http://www.bmj.com/content/330/7505/1416.full.pdf

[Anonymous]

Hold on: Your study lists the cause of death as SIDS in a surprising number of newborn deaths. I would state that 15-28 hours postpartum is a little soon to diagnose something as SIDS and not as a birth complication, even if you are trying really really hard to make CPMs look all spiffy.

WNL on a systems assessment translates as We Never Looked, and the overwhelming sepsis, just for one example, caused by Group B strep can easily go undiagnosed until the baby crashes.

[Anonymous]

Anonymous wrote:CPM 2000 speaks for itself:
http://www.bmj.com/content/330/7505/1416.full.pdf

It sure does speak for itself. Take a look at Table 4, where the authors list all of those low risk births attended by physicians or obstetricians in hospitals. Note that the in-hospital studies have data going back as far as 1969, and that some of the institutions jump out as being not particularly known for low-risk births (Parkland, anyone?). And this data is supposed to be the in-hospital control for homebirths that took place in 2000? When you have to use 30-year-old data from a higher risk group to make your data look good, something is wrong.

[Anonymous]

This just posted by the Washington Post.
http://www.washingtonpost.com/local/midwife-faces-involuntary-manslaughter-charges/2011/04/18/AFTsqs1D_story.html

[Anonymous]

And, hot-off-the press youtube video. It's very well done. One sad story is of a mother who died after complications from cesarean. She had the cesarean for breech.

http://www.youtube.com/watch?v=Gkga6GP6SWY