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

[Anonymous]

I don't blame the midwife.

I do blame the mother.

How the hell could she take a chance with her child's life like that?

[Anonymous]

In the spinoff thread talking about whether you can refuse a c-section in labor or not, the Angela Carder case from the early 1990s came up. I think the rulings and findings referred to in that case are equally valid here. Not sure if any of these rulings have been overturned since then (I hope not,) but this paragraph stuck out to me:

"To tolerate compelled invasive medical treatment of pregnant women would vest the fetus with rights superior not only to those of the woman whose medical choice is subordinated, but also to those of existing children who have no right to compel parents to undergo surgery or to donate organs for their benefit 19 This ruling is consistent with other trial and appellate court decisions which have similarily rejected the argument that a pregnant woman has a legal duty to guarantee the health and well-being of her fetus.20"

The woman in this recent case would have been compelled to undergo a c-section (invasive medical treatment) for her breech, against her wishes. According to this, the mother is also not liable for the death. Angela Carder's case is very applicable to this case.

http://www.advocatesforpregnantwomen.org/articles/angela.htm

A pregnant patient's refusal~~ of treatment should not pose any risk of liability for the physician.

Consistent with the ACOG guidelines, the policies adopted by GWUMC recognize that, as a corollary to its obligations to a pregnant patient, the physician is ethically obligated to consider the health of the fetus, as well as that of the pregnant patient, in assessing the range of medically reasonable treatment options.38 This is fully consistent with the longstanding doctrine of informed consent, which requires the physician to advise the patient of the risks and benefits of the full range of reasonable treatment options. However, once so informed, the policy explicitly emphasizes that treatment choices are left to the patient.

When a pregnant woman refuses recommended medical treatment, the feelings of frustration and perplexity by physicians are perhaps understandable. Nevertheless, those feelings, even by beneficient medical staff~ do not justify involving lawyers and courts to compel compliance with medical recommendations. Even less justifiable are hospital petitions to "test" the abstract acceptability of medical decisions. Recognizing the range of emotional responses to treatment decisions, GWUMC policies permit the treating physician or institution to withdraw from the doctor-patient relationship under certain limited, highly unusual circumstances, rather than to impose their views on the patient through court-compelled treatment. This possibility, if communicated early in the doctor-patient~ relationship, will encourage the physician and patient to discuss refusals of treatment before a medical emergency arises. It also provides an essential and important fact upon which a patient may decide whether to continue treatment with that physician or institution in light of her values and the willingness of health care providers to abide by them.

Adopting the recommended ACOG and In refusal A.C. standards, the policies emphasize that resort to the courts is virtually never justified, and decisions concerning health care should be resolved in the doctor-patient relationship. If the physician satisfies the obligation to provide adequate information relative to the treatment decision at hand, a pregnant patient's refusal of treatment should not pose any risk of liability for the physician. Although a hospital or physician could be liable for negligently informing or disregarding the medical decisions of a patient,41 there has never been a case subjecting either to liability for respecting an informed refusal of treatment by a pregnant patient. Thus, in pregnancy, as in other areas of health care, the doctrine of informed consent properly governs the decision-making process. Policies which expressly reaf~ the applicability of these principles for pregnant women will reassure medical and administrative staff that it is proper and desirable to respect informed refusals of treatment by pregnant patients and discourage unnecessary and detrimental use of the courts.

Risk Management and Patient Choices

[Anonymous]

http://ecmama.blogspot.com/2009/12/aquilas-birth-story.html

To me, this epitomized the focus on the trappings of home birth and the lack of ability to respond effectively if a crisis occurs. Hair braiding, tubs, etc are all groovy, and helpful in the case of the tub, but the goal is a live baby and mom.

Also, the kids should not have been in the house being exposed to all of that screaming, blood and tragedy. It is not fair to them to be all focused on your braided hair and they are trying to tune it all out in front of the tv. How did that meet the emotional needs of the kids you already had? How scary it must have been for them, even if the outcome had been different.

I had a friend suffer from this same complication, in the hospital while VBACing and she barely survived, with a hysterectomy. Her baby daughter lived but almost died herself. The mom in this link was lucky she did not die. Her instinct was to go to the hospital, at that point it was too late. Just tragic. The whole focus on birth being empowering for the mom rather than safe for baby and moms scares me. Animals die in birth, so do people. Historically it was one of the most dangerous events in a woman's life, we now have the illusion that it is safe due in large part to improved medical care. Now medical care if portrayed as the biggest risk to the baby and even unassisted breech births (with no midwife or attendant) and encouraged by some on the fringe.

I hope that the pendulum keeps swinging back so that women can get good birth experiences in the hospital, I'd love to see more hospital based birth centers. We are lucky that GW and WHC both offer midwife deliveries. Hopefully one day Gtown will get back to having a midwife practice, their tubs were great back in the day.

[Anonymous]

I too am familiar with Liz Paparella and Aquila's story. She is a champion and courageous woman.

On a different note, I checked the online review of BirthCare, which was believed to be the online review written by the mother of the dead child. I read that review days ago and it scolded the company for their advice and counsel which led to tragedy. I checked again today and the review had disappeared and been replaced with at least four reviews that flattered and praised the company.

http://washingtondc.citysearch.com/review/10493926?reviewId=201120661

[Anonymous]

Anonymous wrote:In the spinoff thread talking about whether you can refuse a c-section in labor or not, the Angela Carder case from the early 1990s came up. I think the rulings and findings referred to in that case are equally valid here. Not sure if any of these rulings have been overturned since then (I hope not,) but this paragraph stuck out to me:

"To tolerate compelled invasive medical treatment of pregnant women would vest the fetus with rights superior not only to those of the woman whose medical choice is subordinated, but also to those of existing children who have no right to compel parents to undergo surgery or to donate organs for their benefit 19 This ruling is consistent with other trial and appellate court decisions which have similarily rejected the argument that a pregnant woman has a legal duty to guarantee the health and well-being of her fetus.20"

The woman in this recent case would have been compelled to undergo a c-section (invasive medical treatment) for her breech, against her wishes. According to this, the mother is also not liable for the death. Angela Carder's case is very applicable to this case.

http://www.advocatesforpregnantwomen.org/articles/angela.htm

A pregnant patient's refusal~~ of treatment should not pose any risk of liability for the physician.

Consistent with the ACOG guidelines, the policies adopted by GWUMC recognize that, as a corollary to its obligations to a pregnant patient, the physician is ethically obligated to consider the health of the fetus, as well as that of the pregnant patient, in assessing the range of medically reasonable treatment options.38 This is fully consistent with the longstanding doctrine of informed consent, which requires the physician to advise the patient of the risks and benefits of the full range of reasonable treatment options. However, once so informed, the policy explicitly emphasizes that treatment choices are left to the patient.

When a pregnant woman refuses recommended medical treatment, the feelings of frustration and perplexity by physicians are perhaps understandable. Nevertheless, those feelings, even by beneficient medical staff~ do not justify involving lawyers and courts to compel compliance with medical recommendations. Even less justifiable are hospital petitions to "test" the abstract acceptability of medical decisions. Recognizing the range of emotional responses to treatment decisions, GWUMC policies permit the treating physician or institution to withdraw from the doctor-patient relationship under certain limited, highly unusual circumstances, rather than to impose their views on the patient through court-compelled treatment. This possibility, if communicated early in the doctor-patient~ relationship, will encourage the physician and patient to discuss refusals of treatment before a medical emergency arises. It also provides an essential and important fact upon which a patient may decide whether to continue treatment with that physician or institution in light of her values and the willingness of health care providers to abide by them.

Adopting the recommended ACOG and In refusal A.C. standards, the policies emphasize that resort to the courts is virtually never justified, and decisions concerning health care should be resolved in the doctor-patient relationship. If the physician satisfies the obligation to provide adequate information relative to the treatment decision at hand, a pregnant patient's refusal of treatment should not pose any risk of liability for the physician. Although a hospital or physician could be liable for negligently informing or disregarding the medical decisions of a patient,41 there has never been a case subjecting either to liability for respecting an informed refusal of treatment by a pregnant patient. Thus, in pregnancy, as in other areas of health care, the doctrine of informed consent properly governs the decision-making process. Policies which expressly reaf~ the applicability of these principles for pregnant women will reassure medical and administrative staff that it is proper and desirable to respect informed refusals of treatment by pregnant patients and discourage unnecessary and detrimental use of the courts.

Risk Management and Patient Choices

Thanks for posting! Very informative on informed consent and the birthing process.

[Anonymous]

However, none of that means that the health professional a duty has to provide services that go beyond his or her scope of care, or provide unreasonable treatment options.

You may prefer to have your wisdom teeth removed in your living room -- the dentist, however, doesn't have to do it.

[Anonymous]

NP here. Great discussion.

I totally agree with PPs who said that home birth advocates are doing women a disservice by saying how evil hospitals and OBs are for women. We used Birthcare for our first baby and all the reading that we did, our birth assistant, and especially our Bradley instructor scared us half to death with stories about how bad hospitals and OBs are for birth. This was not helpful when we ended up risking out of BC at 41+ weeks and transferring to an OB for induction, which ended in a c-section. We were terrified the entire time and had no support from BC after the transfer.

But you know what? The hospital and OB were great, the L&D nurses were fantastic. Baby was on my chest minutes after the surgery and nursed right away and never left our side except when DH went with him to the nursery a couple of times for tests. I was home two days later. Even the c-section recovery was fast. The thing that took the longest to recover from was my emotional expectations surrounding the birth. I felt betrayed by BC for a long time and am still angry at our Bradley instructor for flat out lying to us in telling us how terrible the whole thing would be. I can definitely understand the mother in this article wanting to avoid hospitals at all costs, especially if this was likely to be her only baby. They pretty much tell you you’re a bad mother if you go to an OB or have medical interventions of any kind.

It’s one thing to say that home birth gives women choices, but deliberately lying about the facts and trying to scare people into adopting your point of view, doesn’t help women make informed decisions. I’m sure some of the information we got from our Bradley class was good, but now that I know how much they lied about, it’s hard to know what to believe.

[Anonymous]

Anonymous wrote:I too am familiar with Liz Paparella and Aquila's story. She is a champion and courageous woman.

On a different note, I checked the online review of BirthCare, which was believed to be the online review written by the mother of the dead child. I read that review days ago and it scolded the company for their advice and counsel which led to tragedy. I checked again today and the review had disappeared and been replaced with at least four reviews that flattered and praised the company.

http://washingtondc.citysearch.com/review/10493926?reviewId=201120661

Interesting that the original bad review has been totally scrubbed from that site. It can still be found on others that picked it up from Citysearch - Yellowpages and Judysbook are a couple of places I found it.

[Anonymous]

13:19 - Can you provide examples of what they lied about?

[Anonymous]

13:19 here.

Sure. Our Bradley instructor told us that the nurses would be hostile and treat us with contempt. That our baby would be taken from us immediately after birth and not returned for hours. That you couldn’t walk around or eat and drink during labor. That they’d try to wash your vagina out with soap (yes, she actually said that) and shave your pubic hair. That you’d have to have an epidural and immediately be hooked up to an IV and a catheter. None of that happened. The OB okayed eating and drinking and walking around so I did. I walked into the OR and had a spinal and rolled out with my baby on my chest. I’m sure there’s more, but the gist of it was that hospitals and c-sections were to be avoided at all costs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I too am familiar with Liz Paparella and Aquila's story. She is a champion and courageous woman.

On a different note, I checked the online review of BirthCare, which was believed to be the online review written by the mother of the dead child. I read that review days ago and it scolded the company for their advice and counsel which led to tragedy. I checked again today and the review had disappeared and been replaced with at least four reviews that flattered and praised the company.

http://washingtondc.citysearch.com/review/10493926?reviewId=201120661

Interesting that the original bad review has been totally scrubbed from that site. It can still be found on others that picked it up from Citysearch - Yellowpages and Judysbook are a couple of places I found it.

Here it is:

The founders of this organization have some integrity issues
Provided by Citysearch Posted by by MDawn at… on 01/09/2011

The founders of this organization have some integrity issues they need to resolve.

When I asked about birthing my breech baby vaginally, they gave me the names of 5 midwives who were experienced birthing breech babies. And she went on to tell me how she had only delivered one, because they, BC, hadn't realized it was breech until delivery. Note: when she learned the baby was breech, she chose to birth the baby (at home or in the birth center) instead of transferring the mother to the hospital.

It was the birth assistant I hired from Birth Care’s list of approved birth assistants, who suggested I birth my baby vaginally. During labor, after the midwife learned that the baby had changed position and was no longer in the optimal breech position for vaginal delivery, my husband asked her, the birth assistant, what we should do and she refused to answer. (This is someone we thought we had a good relationship with because we took her Bradley class at Birth Care.)

After my baby died, I kept going back to Birth Care for postpartum checkups because I felt comfortable with them. Yet, each time I saw the midwife she seemed to be blaming me for my child’s death. When I confronted her about this she denied ever condoning birthing my baby vaginally.

She probably did tell me to go to have a hospital birth but the conversation that day was overwhelmingly pro vaginal breech birth. These ladies are both grandmothers and they’re still operating under do as I say not as I do. How am I to figure that out when I’m a scared first time mother staring down abdominal surgery? They never asked why I wanted to birth my baby vaginally. Nor did they counsel against it. Furthermore, they did not explain or discuss the benefits of a c-section in my circumstance.

Everyone I paid to help bring my baby safely into this world failed me - including the founders of Birth Care. I'm devastated by the loss of my child. My pain is compounded by callous display of BC’s tremendous lack of responsibility toward my care.

Now that they’ve destroyed a life and are being investigated by the local authorities they will probably be more careful with you.

[Anonymous]

It sounds like a bunch of these birthing classes need disclaimers that they are approaching the issue from a certain philosophical perspective.

I never imagined that birth could become as ideological as it apparently is (in fact, I didn't realize it until after I became a Mom myself). Luckily, I got to miss out on all NCB advocates telling me I was crazy to have an elective c-section for my identical twins...

[Anonymous]

Anonymous wrote:NP here. Great discussion.

I totally agree with PPs who said that home birth advocates are doing women a disservice by saying how evil hospitals and OBs are for women. We used Birthcare for our first baby and all the reading that we did, our birth assistant, and especially our Bradley instructor scared us half to death with stories about how bad hospitals and OBs are for birth. This was not helpful when we ended up risking out of BC at 41+ weeks and transferring to an OB for induction, which ended in a c-section. We were terrified the entire time and had no support from BC after the transfer.

But you know what? The hospital and OB were great, the L&D nurses were fantastic. Baby was on my chest minutes after the surgery and nursed right away and never left our side except when DH went with him to the nursery a couple of times for tests. I was home two days later. Even the c-section recovery was fast. The thing that took the longest to recover from was my emotional expectations surrounding the birth. I felt betrayed by BC for a long time and am still angry at our Bradley instructor for flat out lying to us in telling us how terrible the whole thing would be. I can definitely understand the mother in this article wanting to avoid hospitals at all costs, especially if this was likely to be her only baby. They pretty much tell you you’re a bad mother if you go to an OB or have medical interventions of any kind.

It’s one thing to say that home birth gives women choices, but deliberately lying about the facts and trying to scare people into adopting your point of view, doesn’t help women make informed decisions. I’m sure some of the information we got from our Bradley class was good, but now that I know how much they lied about, it’s hard to know what to believe.

Yeah, but then you ended up with a c-section after getting an induction, which I'm sure they also warned you about and turned out to be true! I have seen everything you listed actually happen more than once, nay-more than ten times each in the many, many, many hospital births I have attended. This instructor probably should have used the phrases "You may encounter" and "You might want to be aware that this is what often happens..." instead of "You WILL" but...maybe she did and you don't remember.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP here. Great discussion.

I totally agree with PPs who said that home birth advocates are doing women a disservice by saying how evil hospitals and OBs are for women. We used Birthcare for our first baby and all the reading that we did, our birth assistant, and especially our Bradley instructor scared us half to death with stories about how bad hospitals and OBs are for birth. This was not helpful when we ended up risking out of BC at 41+ weeks and transferring to an OB for induction, which ended in a c-section. We were terrified the entire time and had no support from BC after the transfer.

But you know what? The hospital and OB were great, the L&D nurses were fantastic. Baby was on my chest minutes after the surgery and nursed right away and never left our side except when DH went with him to the nursery a couple of times for tests. I was home two days later. Even the c-section recovery was fast. The thing that took the longest to recover from was my emotional expectations surrounding the birth. I felt betrayed by BC for a long time and am still angry at our Bradley instructor for flat out lying to us in telling us how terrible the whole thing would be. I can definitely understand the mother in this article wanting to avoid hospitals at all costs, especially if this was likely to be her only baby. They pretty much tell you you’re a bad mother if you go to an OB or have medical interventions of any kind.

It’s one thing to say that home birth gives women choices, but deliberately lying about the facts and trying to scare people into adopting your point of view, doesn’t help women make informed decisions. I’m sure some of the information we got from our Bradley class was good, but now that I know how much they lied about, it’s hard to know what to believe.

Yeah, but then you ended up with a c-section after getting an induction, which I'm sure they also warned you about and turned out to be true! I have seen everything you listed actually happen more than once, nay-more than ten times each in the many, many, many hospital births I have attended. This instructor probably should have used the phrases "You may encounter" and "You might want to be aware that this is what often happens..." instead of "You WILL" but...maybe she did and you don't remember.

Seriously? Can't you just realize that she may have had the birth she wanted and isn't upset by that? I have had a vaginal, c-section for breech (given the option of a breech deliver I chose the section all by myself) and two VBACs. No enema, no shaving, no washing with soap, no pressure to do anything I didn't want to do, no continual fetal monitoring if I felt like I had to get up, OB even encouraged me to deliver the first on hands and knees due to positioning of baby, no taking baby from me, no strapping me down during section or delivery, no mean nurses (though the lactation consultant I saw outside the hospital was the devil).

Perhaps if you were an attendant (being paid I assume) then you should have stepped in and said something. Or perhaps you should have your clients (again, paying you right?) deliver in a different location where these practices aren't done. Though I will tell you that of the many, many, many friends and family (I am one of 8 children with 30+ nieces and nephews) I have who have delivered in hospitals I haven't heard of one having done what was listed above which you seem to see all the time. Weird.

[Anonymous]

Anonymous wrote:13:19 here.

Sure. Our Bradley instructor told us that the nurses would be hostile and treat us with contempt. That our baby would be taken from us immediately after birth and not returned for hours. That you couldn’t walk around or eat and drink during labor. That they’d try to wash your vagina out with soap (yes, she actually said that) and shave your pubic hair. That you’d have to have an epidural and immediately be hooked up to an IV and a catheter. None of that happened. The OB okayed eating and drinking and walking around so I did. I walked into the OR and had a spinal and rolled out with my baby on my chest. I’m sure there’s more, but the gist of it was that hospitals and c-sections were to be avoided at all costs.

Your Bradley instructor sounds a lot like the one who was the souls at this birth.