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

[Anonymous]

Anonymous wrote:...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.

...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.

Very well said, PPs. I agree 100%. Healthy baby and healthy mom are the ultimate goal and when all is said and done, nothing else matters. I am 35 weeks and 3 days and considered high risk due to 2 losses, incompetent cervix and cerclage. My planned C-section is scheduled for 4 weeks from today. My perinatologist's office actually has a sign informing patients that they don't participate in birth plans. Frankly, I don't give a s**t about my birth experience and I'm not trying to make a statement. What I want is a healthy baby, no matter how she gets here. After what I've been through, I'm just happy to have gotten this far. Modern medicine is not the devil and it is irresponsible for the natural birth/homebirth movement to demonize medical intervention and mislead people like this couple into making ill-informed decisions that can result in tragedy. This woman was simply not a candidate for home birth. She was advised of this by Birthcare, a group of certified nurse midwives, but she chose to ignore their advice because she "preferred" to give birth at home. At some point, preferences and birth plans and "ideal birth scenarios" must be sacrificed in the interest of the safe delivery of a healthy baby.

[Anonymous]

http://www.homebirth.net.au/2008/04/breech-birth.html (love that plump cord!)

http://www.homebirth.net.au/2010/01/frank-breech-video.html

[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.

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.

I know for an absolute fact that there have been multiple deaths with Karen Carr. I work at a local hospital and we have had several in the past 9 months come in who have died and should not have had their been someone competent present.

[Anonymous]

"The thing is, that this death could have been prevented with a C-section."

Please remember that surgery carries its own risk and unfortunately there are no do-overs when it comes to birth so we don't know this would be true either.

I had a high-risk pregnancy. No doctor ever told me what could happen to my baby. I vaginally delivered him at 37 weeks, with the help of a vacuum likely because of the epidural. He seemed fine and healthy until about 18 hours later. They suspected GBS pneumonia, since I was positive for it though I was loaded up on antibiotics and the neonatologist said antibiotics only help about 50% of the time. It wasn't pneumonia, it was a brain bleed that is very rare in full term infants. I was told it was because of his traumatic birth, though I don't believe it was traumatic. But if it was traumatic why didn't the doctors do anything. I had a room full of nurses and doctors when I delivered and yet my son still has brain damage. So, doctors and hospitals are the best thing since slice bread either. How did the human race survive without doctors and modern medicine. I didn't get the birth experience I desired nor a healthy baby.

Everything involves risk and it is probably more risky to drive to the hospital than anything. (Just for the record, I am not suing anyone, it wouldn't do any good IMHO.)

While I get that Ms. Carr practiced medicine without a license, though how something natural like birth is tied to "medicine" drives me nuts, I don't think she caused this baby's death. It is sad all around. However, I would prefer the state to spend their time going after harden criminals. And yes I agree with who ever said it and will add that pedophiles get less time than she could possibly face.

[Anonymous]

Anonymous wrote:

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?

Google is your friend but here are a couple of links to start with.
Midwife model of care:
http://www.americanpregnancy.org/labornbirth/midwives.html

http://www.medscape.com/viewarticle/501464_2
http://onlinelibrary.wiley.com/doi/10.1016/S0091-2182(99)00060-9/abstract

[Anonymous]

Anonymous wrote:

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.

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.

I know for an absolute fact that there have been multiple deaths with Karen Carr. I work at a local hospital and we have had several in the past 9 months come in who have died and should not have had their been someone competent present.

Sorry, not buying that a local midwife has several deaths in the past 9 months until you provide some evidence to back up your claim. Give us the hospital, dates and circumstances or something that can be substantiated.

[Anonymous]

Anonymous wrote:...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. ...

Wow, right out of your own post. For all of you who are so completely positive that cesarean was the best and "only rational" choice to make, what are you basing that opinion on? Where is that substantial risk that everyone is talking about and where is the data to prove it? Doctors in this country recommend cesarean for breech, primarily because it reduces their liability. There is little evidence that breech is overwhelmingly risky when compared to cesarean section, which has an entirely other set of risk factors, especially for the mother. Either way, it is not YOUR choice. I have no idea what I would do in the same situation, but I fully support this woman's right to have made the choice she did.

[Anonymous]

Anonymous wrote:

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.

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.

I know for an absolute fact that there have been multiple deaths with Karen Carr. I work at a local hospital and we have had several in the past 9 months come in who have died and should not have had their been someone competent present.

You are spreading rumors and misinformation; hopefully you are not doing it on purpose.

As a side question, in the past 9 months, how many babies have died in your hospital who were born under the care of an OB? Perhaps some of them would not have died had they been under the care of a competent homebirth midwife.

[Anonymous]

Anonymous wrote:

Anonymous wrote:...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. ...

Wow, right out of your own post. For all of you who are so completely positive that cesarean was the best and "only rational" choice to make, what are you basing that opinion on? Where is that substantial risk that everyone is talking about and where is the data to prove it? Doctors in this country recommend cesarean for breech, primarily because it reduces their liability. There is little evidence that breech is overwhelmingly risky when compared to cesarean section, which has an entirely other set of risk factors, especially for the mother. Either way, it is not YOUR choice. I have no idea what I would do in the same situation, but I fully support this woman's right to have made the choice she did.

Please read more carefully. The document is saying that a primip should not automatically be given a CS, not that she should automatically have a vaginal birth. The same risk factors still apply, and maternal age is a big one. The part that says that "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" also still applies to primips, and the neonatal mortality rate for vaginal breech births in well-equipped hospitals is ~6/1000. Maybe we can look at Karen's record to see what the neonatal mortality rate for breech deliveries outside the hospital is, but I somehow doubt that it's better.

The maternal mortality rate from elective CS is ~58.5/1,000,000 CS performed, but you have to remember that 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. And the rate of unsuccessful vaginal breech delivery in large studies is on the order of 30%.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:...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. ...

Wow, right out of your own post. For all of you who are so completely positive that cesarean was the best and "only rational" choice to make, what are you basing that opinion on? Where is that substantial risk that everyone is talking about and where is the data to prove it? Doctors in this country recommend cesarean for breech, primarily because it reduces their liability. There is little evidence that breech is overwhelmingly risky when compared to cesarean section, which has an entirely other set of risk factors, especially for the mother. Either way, it is not YOUR choice. I have no idea what I would do in the same situation, but I fully support this woman's right to have made the choice she did.

Please read more carefully. The document is saying that a primip should not automatically be given a CS, not that she should automatically have a vaginal birth. The same risk factors still apply, and maternal age is a big one. The part that says that "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" also still applies to primips, and the neonatal mortality rate for vaginal breech births in well-equipped hospitals is ~6/1000. Maybe we can look at Karen's record to see what the neonatal mortality rate for breech deliveries outside the hospital is, but I somehow doubt that it's better.

The maternal mortality rate from elective CS is ~58.5/1,000,000 CS performed, but you have to remember that 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. And the rate of unsuccessful vaginal breech delivery in large studies is on the order of 30%.

I never claimed that women should automatically have either type of birth. My whole point is that the evidence is inconclusive enough, that it is fair for women to decide what they want for themselves. I think we stand on very thin ice when we start thinking about this in terms of what must be "done to" a woman at all. No one can decide better than the woman herself what is best for her particular family given the information she has at hand. If this woman had died during an elective cesarean (which, according to most OBs, would have technically been elective even though they refuse to deliver breech vaginally), no one would be discussing this in terms of how stupid she was to choose the c/s.

And yes, I believe it is possible that Karen's statistics for breech may indeed be better than some OBs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

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.

I know for an absolute fact that there have been multiple deaths with Karen Carr. I work at a local hospital and we have had several in the past 9 months come in who have died and should not have had their been someone competent present.

Sorry, not buying that a local midwife has several deaths in the past 9 months until you provide some evidence to back up your claim. Give us the hospital, dates and circumstances or something that can be substantiated.

Does anyone know how many breech deliveries she's attended? Just curious...the other "camp" isn't exactly providing her statistics either. Are we talking 10, 20, 100? out of the 1200 births? Also, how many of those successful breeches were primips? Lastly, while I am not obliged to discuss other people's hospital dumps, I do know of other healthcare providers out there who have received a number of Ms. Carr's homebirth transfers , hence her name being well known throughout the region as a homebirth midwife.

[Anonymous]

Bingo - Give this poster a spa-vacation. This is a human rights issue.

[Anonymous]

Anonymous wrote:Bingo - Give this poster a spa-vacation. This is a human rights issue.

Human rights? The mom had the right to give birth however she wanted to, and the FBI wasn't going to burst in and force her to a hospital. As was mentioned above, if Karen had been licensed, she would be facing her licensing board. Since she was taking money for a medical service she wasn't licensed to provide, and in the course of providing that medical service a baby died, she's now in criminal court.

The wisdom of delivering a 43-year-old primip with breech presentation at home is a different discussion. The mom has the right to do what she wants with her body, but she does NOT have the right to have a professional put her own career on the line by attempting something risky. That's why many OBs won't do vaginal breech deliveries, and also why many OBs won't do elective CS. It all depends on the current knowledge about safety and risk, as well as the professional's level of comfort with a given scenario.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Bingo - Give this poster a spa-vacation. This is a human rights issue.

Human rights? The mom had the right to give birth however she wanted to, and the FBI wasn't going to burst in and force her to a hospital. As was mentioned above, if Karen had been licensed, she would be facing her licensing board. Since she was taking money for a medical service she wasn't licensed to provide, and in the course of providing that medical service a baby died, she's now in criminal court.

The wisdom of delivering a 43-year-old primip with breech presentation at home is a different discussion. The mom has the right to do what she wants with her body, but she does NOT have the right to have a professional put her own career on the line by attempting something risky. That's why many OBs won't do vaginal breech deliveries, and also why many OBs won't do elective CS. It all depends on the current knowledge about safety and risk, as well as the professional's level of comfort with a given scenario.

Look, this is true. This is why many women with preeclampsia or HELLP syndrome are encouraged to have their babies vaginally rather than opting for an immediate c-section. Less risks to mom and baby to birth vaginally as opposed to surgery on a mom who could have a potentially very low platelet count. Some of my patients would prefer to be given a c-section, but the evidence says a vaginal delivery is safer. Not saying all OBs operate under the most recent, best evidence, but why are we admonishing all OBs without realizing that many midwives (like Carr) aren't necessarily taking the time to read/practice the most up-to-date evidence either? She's not affiliated with a hospital, making it far more expensive to have access to current journal articles on these topics. She works out of her home and is not practicing side-by-side with other professionals on a daily basis. Someone mentioned that this shouldn't be investigated by the law, rather Ms. Carr should undergo "peer review" with her fellow midwives. How would that resolve the ego of a midwife who thinks that every client (regardless of risk) is fair game. Studies show that women with multiple cesareans have a much higher risk of placenta accreta, increta and percreta yet some of these midwives are all too happy to take on a homebirth client who has undergone 3+ cesarean sections. Without access to ultrasound, the potential for an undiagnosed complication such as this (and subsequent maternal death) is great.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Bingo - Give this poster a spa-vacation. This is a human rights issue.

Human rights? The mom had the right to give birth however she wanted to, and the FBI wasn't going to burst in and force her to a hospital. As was mentioned above, if Karen had been licensed, she would be facing her licensing board. Since she was taking money for a medical service she wasn't licensed to provide, and in the course of providing that medical service a baby died, she's now in criminal court.

The wisdom of delivering a 43-year-old primip with breech presentation at home is a different discussion. The mom has the right to do what she wants with her body, but she does NOT have the right to have a professional put her own career on the line by attempting something risky. That's why many OBs won't do vaginal breech deliveries, and also why many OBs won't do elective CS. It all depends on the current knowledge about safety and risk, as well as the professional's level of comfort with a given scenario.

Why exactly would she be facing her licensing board? I think you are lacking a fundamental understanding about the midwifery model of care.