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

[Anonymous]

Anonymous wrote:

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.

Yes, please enlighten us as to why this 43 year old woman, pregnant with her first child who was breech, would ignore the advice of Birthcare and insist on delivering at home, putting herself and her baby at risk.

[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 agree. I don't know to what extent the parents understood the risks involved... but the general fear mongering and condemning of hospitals, interventions, and c-sections by some people is not good for public health (in other words, you should be able to choose your setting, but please be reasonable and make a truly informed choice). Yes, the c-section rate in this country is higher than in several others, but this is because you guys (and me too btw) don't have ANY tolerance for deaths and disability, and despite it being major surgery, there is still more risk for hypoxia of the baby if there is protracted difficult vaginal birth with complications.

[Anonymous]

Anonymous wrote:

Anonymous wrote:


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.

.

I am the poster who had a breech delivery with Dr. Udwin. You really are only seeing things through your lens of trust and belief in a non medical model of birth. Have YOU ever been in a hospital with a breech baby or are you simply repeating what you might have heard culturally or perhaps through your homebirth assistant/midwife/doula? You were not there for the discussion. You were not there for any part of what went on with my hospital breech delivery so don't make assumptions based on what YOUR lens looks like.

[Anonymous]

My heart goes out to all involved - Ms. Carr included. I'm very much a believer that birth is natural, normal, and healthy and doesn't usually require the interventions often imposed by hospitals for convenience sake (e.g., the medically unnecessary c-section because a mom's labor is taking "too long").

That said, I cannot imagine making the decision to give birth at home given the high risk circumstances at play in this case. No one deserves to lose their baby and this is a terrible tragedy. But at some point, it's just plain foolishness and ego when parents and health care providers ignore those risks in pursuit of their "ideal birth scenario."

I want to have a completely unmedicated birth with no interventions, but if there are indicators of significant risk, then absolutely, I will not hesitate to pursue the availability of modern medicine to protect the life of my baby and my own well being. I'm not trying to prove a point; I'm trying to have a healthy baby.

[Anonymous]

I hardly think that Cuccinelli has anything to do this this. There are so many errors in the Post story, it's hardly a story but a one sided opinion piece on behalf of the Carr defense team. She might be "prominent" but that's because she will show up to "attend" a birth that all other providers reject because of the risk. Risk does not mean that 100% if the time something will go wrong. It means that delivering a 43 year old primigravida at home knowing that the baby is breech is fool-hardy. It's amazing that some people are so on board with Carr, who is unlicensed in any state (no licensing in Maryland and to to suggest that she has a Maryland Ceritfication is a plain lie), but yet they are probably appalled by the cancer cures from the snake oil salesman who routinely take advantage of the public. She's dangerous and has lost more than just this baby. The fact that criminal charges are pending is because there is no other way to make this woman accountable for her actions. I'm sure she can provide wonderful kind support. But in this case, as with all of her cases, she could phoned it in. What's the point of having an attendant who makes bad choices and lacks the judgment that the public is entitled to. I am a midwife and I am ashamed. I've performed hundreds, yes hundreds, of home births. And as far as Cesareans go for breech deliveries? Long before the "malpractice crisis" the overall belief was that unless you had evidence to support a safe breech delivery, a Cesarean section was the best option. And even so, the labor should take place in an environment where a Cesarean section is readily available just for the reason that exemplifies this case. Holding hands and singing Kumbaya while the baby is "caught" is wonderful but within the context of a high risk situation, it's a travesty.

I agree with this.

[Anonymous]

Anonymous wrote: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

Excellent video. Thanks. I hope that some of the people here who think that C-section is the only right answer for breech will watch this video.

[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.

The problem with that questionable logic is that in this case both the risks were much higher for a home birth, something the parents appear to have been forewarned about and something that anyone who calls herself a midwife should have known. They should all be prosecuted, and all those who engage in fear-mongering about birth in a hospital setting with the help of trained medical personnel should be ashamed of themselves.

[Anonymous]

This "argument" reminds me of debating abortion. People have their beliefs and there is little anyone can say to change anyone's mind.

What else is left to say at this point? Really. My wish is for this thread to turn to covering the FACTS of the case as they become available.

[Anonymous]

To all the PPs who are confused, or even wrongly enraged, about the training of OB/GYN doctors (and what they believe it entails or doesn't):
They ARE trained in all kinds of delivery, including breech vaginal, forceps etc etc in depth, and certainly infinitely more than a newly starting midwife (CPM) after 'attending 20 births' (and yes, I know that's not Carr).
Once they start to practice independently however, they will do less and less of them overall, *because* breech vaginal deliveries DO carry higher risks, and esp risk of hypoxia for the baby, this is simply a fact. Ob/Gyn's, despite paying exorbitant amounts of money to insure them, are professionals that are, like most people, not willing to accept this high risk for a horrible outcome (and I think 10% is a fairly high risk).
The anecdotes pps have written about here like 'my grandma still says the breech was her best delivery' do not negate the facts, nor what MOST REASONABLE PROVIDERS WOULD CHOOSE if faced with the same situation. And that is one of the definitions of malpractice.

[Anonymous]

Anonymous wrote: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.

That's true. But the maternal mortality rate from elective CS is ~58.5/1,000,000 CS performed (1999 British study, so numbers may be better now). The neonatal mortality for breech babies delivered vaginally is 6/1000 (6000/1,000,000) in a well-equipped hospital. (In this same study, there were no neonatal deaths in over 500 elective CS for breech.)

Just for comparison, in the US your annual chance of dying in a car accident is ~157/1,000,000. And remember, the risk of an elective CS isn't compared to zero- it's compared to the risk of a successful vaginal delivery times the rate of successful vaginal delivery plus the risk of unsuccessful vaginal delivery (ie, emergency CS, assisted delivery) times the rate of unsuccessful vaginal delivery.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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

Excellent video. Thanks. I hope that some of the people here who think that C-section is the only right answer for breech will watch this video.

And freak out the other ones who are worried they might need to have a C-section at some point.

[Anonymous]

...publication excerpts by Dr Richard Fischer, Prof of Fetal Maternal Medicine, Cooper Univerity Hospital, NJ, from April 2011.....

Three types of vaginal breech deliveries are described, as follows:
•Spontaneous breech delivery: No traction or manipulation of the infant is used. This occurs predominantly in very preterm, often previable, deliveries.
•Assisted breech delivery: This is the most common type of vaginal breech delivery. The infant is allowed to spontaneously deliver up to the umbilicus, and then maneuvers are initiated to assist in the delivery of the remainder of the body, arms, and head.
•Total breech extraction: The fetal feet are grasped, and the entire fetus is extracted. Total breech extraction should be used only for a noncephalic second twin; it should not be used for a singleton fetus because the cervix may not be adequately dilated to allow passage of the fetal head. Total breech extraction for the singleton breech is associated with a birth injury rate of 25% and a mortality rate of approximately 10%. ...
Risks...
Lower Apgar scores, especially at 1 minute, are more common with vaginal breech deliveries. Many advocate obtaining an umbilical cord artery and venous pH for all vaginal breech deliveries to document that neonatal depression is not due to perinatal acidosis. ... Fetal head entrapment may result from an incompletely dilated cervix and a head that lacks time to mold to the maternal pelvis. This occurs in up to 8.5% of vaginal breech deliveries. Dührssen incisions (ie, 1-3 cervical incisions made to facilitate delivery of the head) may be necessary to relieve cervical entrapment. However, extension of the incision can occur into the lower segment of the uterus, and the operator must be equipped to deal with this complication. The Zavanelli maneuver has been described, which involves replacement of the fetus into the abdominal cavity followed by cesarean delivery. ... Nuchal arms, in which one or both arms are wrapped around the back of the neck, are present in 0-5% of vaginal breech deliveries and in 9% of breech extractions. Nuchal arms may result in neonatal trauma (including brachial plexus injuries) in 25% of cases. ... Cervical spine injury is predominantly observed when the fetus has a hyperextended head prior to delivery. ....Cord prolapse may occur in 7.4% of all breech labors. This incidence varies with the type of breech. ...
Candidates
... After 37 weeks' gestation, parents should be informed of the results of a recent multicenter randomized clinical trial that demonstrated significantly increased perinatal mortality and short-term neonatal morbidity associated with vaginal breech delivery (see Comparative Studies). For those attempting vaginal delivery, if estimated fetal weight (EFW) is more than 4000 g, some recommend cesarean delivery because of concern for entrapment of the unmolded head in the maternal pelvis, although data to support this practice are limited.
A frank breech presentation is preferred when vaginal delivery is attempted. Complete breeches and footling breeches are still candidates, as long as the presenting part is well applied to the cervix and both obstetrical and anesthesia services are readily available in the event of a cord prolapse.
The fetus should show no neck hyperextension on antepartum ultrasound imaging (see the image below). Flexed or military position is acceptable. ...
It had been commonly believed that primigravidas with a breech presentation should have a cesarean delivery, although no data (prospective or retrospective) support this view. The only documented risk related to parity is cord prolapse, which is 2-fold higher in parous women than in primigravid women. ...

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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

Excellent video. Thanks. I hope that some of the people here who think that C-section is the only right answer for breech will watch this video.

And freak out the other ones who are worried they might need to have a C-section at some point.

Why would it freak anyone out? Everyone knows there is a slight risk of death from major surgery. I would hope anyone who has a C-section is aware of that risk. If anything I would think the video might help women recognize the signs and dangers of a blood clot after surgery. I recently had abdominal surgery and no one told me what to look for. The video is very informative and points out repeatedly that some C-sections are necessary.

[Anonymous]

Terrible tragedy for everyone involved.

The thing is, that this death could have been prevented with a C-section. The midwife, who knows better than the FTM, should NOT have agreed to a home birth for a breech baby, esp. for a FTM of advanced age.

http://www.washingtonpost.com/local/midwife-faces-involuntary-manslaughter-charges/2011/04/18/AFTsqs1D_story.html

[Anonymous]

The CPM in question was practicing in VA without the required license (CPMs are legally recognized in VA and the license is easy to get and the regulations are minimal).

The mother is a 43 year old, primigravida (first baby) with a BREECH baby. Her CNM midwives at BirthCare referred her for a C-Section. The mother went "midwife shopping" in VA for someone to do a vaginal breech at home. NONE of the NOVA licensed midwives she interviewed could or would accept her into care. She then sought help outside the state, finding Karen Carr, CPM of MD, who was willing to help her.

According to numerous reports, the breech delivery became complicated and 911 was called. The baby was transported, first to an Alexandria, VA hospital (which is where the charges have been filed) and was later moved to a hospital in D.C. were the baby later died.

Mrs. Carr has been indicted on a charge of involuntary manslaughter, as well as on charges of child abuse, child neglect, and acting without a license. She was indicted by a grand jury last week on an additional charge of negligently allowing a child’s life to be endangered.

There is speculation that this is not the only baby death and that another *may* be involved.

The larger matter is that this midwife *SHOULD* have obtained the VA license to practice, despite her long-standing political opposition to licensure. NOW, because she acted outside the laws of VA with regards to practicing midwifery (which does NOT prohibit CPMs from attending breech births at home and REQUIRES the CPM to provide evidence-base informed consent!), the state prosecutors can take this matter to the highest level the law allows. And, instead of facing a hearing at the VA Dept of Health Professionals Board of Medicine for the bad outcome and a peer review by other VA licensed midwives, Mrs. Carr faces 30 years in jail !!