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

[Anonymous]

Primip?

[Anonymous]

Primip?

From a quick Google search:

pri·mip·a·ra (pr-mpr-)
n. pl. pri·mip·a·ras or pri·mip·a·rae (--r)
1. A woman who is pregnant for the first time.
2. A woman who has given birth for the first time to an infant or infants, alive or stillborn.

[Anonymous]

First time mother, first pregnancy

[Anonymous]

Anonymous wrote:If this Post article is correct, Carr deserves to be prosecuted for gross negligence. I support a woman's right to choose a birth setting of her preference so long as it does not endanger the life of a child, but choosing to conduct a vaginal breech delivery at home is gross negligence. The risks to the child - and mother - are simply too great.

A lot of women claim that the natural birth movement is about rejecting the fear associated with child birth. I just don't think that's true anymore. Instead, I think it's become a movement that relies on fear of cesarians and hospitals and, as a result, drives women to make decisions that are not in our own best interest or that of our children. It's sad that this mother was so afraid of cesarian delivery that she sought a desperate alternative and now has a dead child.

Perhaps the parents didn't understand the gravity of the situation, I don't know. But Carr did. She deserves to be prosecuted for making a negligent decision to participate in this birth. Just because she's provided loving care to so many Washington families doesn't make this lapse of judgment any less wrong.

I've posted this before, but I think people are getting too hung up on individual decisions/choices while not seeing the bigger systemic picture. If more doctors were trained to do vaginal breech births and/or midwives were allowed to attend breech births in the hospital, then more women would have the option to have a breech birth in the hospital where there is the availability of emergency services should something go wrong. By not having the hospital option, women who do not want a c-section/want to attempt a vaginal birth first are forced to have a home birth where in the event of a problem access to care is more limited. The fact that there is only 1 doctor in the entire DC metro area who will perform a vaginal breech birth is ridiculous and sad.

[Anonymous]

Anonymous wrote: She traded a birth experience for motherhood, it's horrifying.

Totally agree with this poster. First-time pregnancy, advanced maternal age, AND breech presentation. According to today's Washington Post article, "BirthCare advised the mother that the case was too complicated for a home delivery, but she preferred to deliver at home."

She PREFERRED to deliver at home. Her preference resulted in tragedy. This birth should never have been attempted at home.

[Anonymous]

The "fear mongering" about hospitals is not crazy. Many, many women who ultimately home birth are drawn to that after a negative hospital experience. Many/most interventions are grossly overused, with resulting maternal and neonatal morbidities that would not be present in the home environment or in a hospital environment that practiced evidence-based medicine and gave mothers an appropriate range of choices and didn't try to coerce them into procedures they don't need to turn beds over faster (not every hospital, not every time, but it happens A LOT). There are many and complex reasons why things have gotten to this point, but enough women have had enough of overmedicalized birth that there is a groundswell for change, which is good. I hope that the coming years see reforms in maternity care in all settings.

Comma however ... some women have become so radicalized around birth issues that they don't see clearly that in some cases, medical interventions might be in the best interest of the mother and/or baby. Breech is one of the gray areas, but personally I would opt for a c-section for a breech baby because even before this happened I was uncomfortable with the risk of head entrapment in the home setting. I also would not VBAC at home -- the level of risk is low, but still beyond my comfort level. I'm very pro-natural birth, but at the same time am reasonable enough to recognize that in some cases medical interventions are necessary to facilitate a good outcome.

Still, regardless of what my personal decisions would be in such cases, I do think women should still have choices (informed choices, and they should live with the consequences of those choices ... just like people who ride motorcycles, etc.) about where and with whom to birth. But as several PPs have pointed out, one doctor in the metro area who does vaginal breech in the hospital does not give women a sufficient level of choice. And that leads directly to tragedies like this one.

[Anonymous]

Even had there been someone capable of doing this breech, it is highly possible she still would've been risked out. And chosen to ignore it anyway. You can't cure stupid, either on her part or the midwife's.

[Anonymous]

And that discussion needs to take place in the larger context -- that a number of studies, culminating with the Hanna study, had lead most OBs to conclude that they could not pursue vaginal breech delivery due to the higher risks to infants demonstrated in these studies. So you have a large pool who either let their skill set for breech delivery go or never obtained the skill set to begin with since breech vaginal delivery was considered "dead".

That appears to be no longer the case -- though I admit am suspicious that the NCB movement and consumer choice are the pressure points behind this change in policy, rather than hard evidence re: safety -- there is obviously some time lag between the change in policy and the ability of doctors to obtain the necessary skill set.

In my mind, the best course of action for vaginal breech would be similar to the set up my hospital uses for CVS tests during pregnancy. Studies have shown that the best outcome for CVS tests is if the practioner has done lots of them -- so this large university hospital has 1 doctor who does all the CVS tests.

Essentially, if vaginal breech is going to be done at all, I think there should be OB specialists in vaginal breech delivery, where that is all that they handle, and you are referred to them by your regular OB if breech delivery seems likely.

[Anonymous]

Anonymous wrote:

Essentially, if vaginal breech is going to be done at all, I think there should be OB specialists in vaginal breech delivery, where that is all that they handle, and you are referred to them by your regular OB if breech delivery seems likely.

Has anyone else ever proposed this idea, or or is it just something that sounds good to you? How likely is it to solve the problems described, by encouraging the availability of a sufficient number of doctors who are happy to be in this role?

[Anonymous]

Yeah, does anyone know who the doula was?

[Anonymous]

Anonymous wrote:And that discussion needs to take place in the larger context -- that a number of studies, culminating with the Hanna study, had lead most OBs to conclude that they could not pursue vaginal breech delivery due to the higher risks to infants demonstrated in these studies. So you have a large pool who either let their skill set for breech delivery go or never obtained the skill set to begin with since breech vaginal delivery was considered "dead".

That appears to be no longer the case -- though I admit am suspicious that the NCB movement and consumer choice are the pressure points behind this change in policy, rather than hard evidence re: safety -- there is obviously some time lag between the change in policy and the ability of doctors to obtain the necessary skill set.

In my mind, the best course of action for vaginal breech would be similar to the set up my hospital uses for CVS tests during pregnancy. Studies have shown that the best outcome for CVS tests is if the practioner has done lots of them -- so this large university hospital has 1 doctor who does all the CVS tests.

Essentially, if vaginal breech is going to be done at all, I think there should be OB specialists in vaginal breech delivery, where that is all that they handle, and you are referred to them by your regular OB if breech delivery seems likely.

The interesting thing is that this is essentially what happened for this birth. Karen Carr has studied breech birth, worked under other traditional midwives who attend breech birth, and has personally been responsible for the safe delivery of more breech babies than many doctors have. Her certification legally allows her to attend breech birth, in a home setting. You can throw jabs at NARM, at homebirth, or at women who make different choices than you personally would, but the fact is that none of what happened with regard to this birth was illegal, except for Karen's lack of the VA license. Practicing midwifery without a license is a misdemeanor, which she rightfully should be prosecuted for.

Many of you talk about the great risk involved with a breech birth; yet not only have you never seen a breech birth, you probably have not even done any in-depth research on it and are merely repeating what you might have heard culturally (or perhaps through your medical training). Yes, breech birth does carry a higher and unique risk when compared to a vertex birth, yet overall it is not such an enormous risk that it cannot potentially be carried out safely at home. Indeed, women all over the world as well as a small number of women in the US have safely delivered breech babies at home. When all of you argue that it "should have" been in the hospital, or that the parents "should have" made different choices, you are seeing the situation through your lens of trust and belief in a medical model of childbirth, and a belief that the medical community has the best answers for all people. Not everyone sees life that way, and thankfully we still have the freedom in this country to disagree about these things.

My questions are -- what gives us the right to think we know better than the parents themselves did? What makes anyone here think that you care more for that baby than the parents did? What makes anyone here think that you wanted a better outcome for that birth than Karen Carr did? It is not difficult for me to imagine that there might have been circumstances much bigger than what any DCUMers know about, which led this couple to make the choices they did.

[Anonymous]

It is not difficult for me to imagine that there might have been circumstances much bigger than what any DCUMers know about, which led this couple to make the choices they did.

Please, enlighten us all. I can't imagine any circumstances that would persuade anyone to make the choices that this mother and this "midwife" did.

[Anonymous]

My questions are -- what gives us the right to think we know better than the parents themselves did? What makes anyone here think that you care more for that baby than the parents did? What makes anyone here think that you wanted a better outcome for that birth than Karen Carr did? It is not difficult for me to imagine that there might have been circumstances much bigger than what any DCUMers know about, which led this couple to make the choices they did.

NP here. I am sure no one cared for the baby more than the parents. My heart breaks for them.

Carr has been indicted, however, which requires both a prosecutor and a grand jury to decide to pursue the claim after hearing the facts, more facts than we know. That doesn't mean she's guilty of breaking the law. But the grand jury voted to indict her on much more serious charges than practicing without a license.

[Anonymous]

Um, maybe she thought that she would die during a cesarean. She might have chosen the risk of her baby dying over her risksof dying on the operating table, which would leave her child motherless? Just a thought.

Only the mom can decide which risks she is willing to take.

It seems as if this community is only talking about the tragic loss of a baby's life. What if the mother had died, just like the mother that died in the youtube video previously posted (C for breech)? It's fine then, because she did everything she could for her baby's sake - right? She died but gosh darn it the baby lived...This could have gone this way very easily.

[Anonymous]

Anonymous wrote:Yes, breech birth does carry a higher and unique risk when compared to a vertex birth, yet overall it is not such an enormous risk that it cannot potentially be carried out safely at home. Indeed, women all over the world as well as a small number of women in the US have safely delivered breech babies at home. When all of you argue that it "should have" been in the hospital, or that the parents "should have" made different choices, you are seeing the situation through your lens of trust and belief in a medical model of childbirth, and a belief that the medical community has the best answers for all people. Not everyone sees life that way, and thankfully we still have the freedom in this country to disagree about these things.

Yes, it can "potentially" be carried out safely at home. What are the known risk factors for worse vaginal breech outcomes? Two big ones are primiparity and advanced maternal age. If this midwife had studied breech births as extensively as you claim, she should have known that there's a big difference between delivering a 43-year-old primip with breech presentation at home and delivering the 3rd child of a 27-year-old woman with a proven pelvis at home. Karen might be a very nice person, but I can't believe that she was a safe provider with good judgment in this case.

When you say that women all over the world delivery breech babies at home, are you referring to 1st world countries or developing nations? I don't know of any 1st world nation that condones breech delivery at home (especially a primip), and it's not quite fair to say that women in developing nations deliver breech babies at home when their choices are so limited in many cases, and when so many developing nations have horrible maternal mortality rates.

And what is this "medical model" of childbirth? Is it the one where you give birth in a hospital? Or does there have to be an OB for it to be the "medical model?" And what's the "midwife model?" Can you tell me why a "midwife model" is better/safer?