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

[Anonymous]

Anonymous wrote:It doesn't matter whether or not OBs want criminal liability. The reality is that it is the prosecutor's discretion whether to proceed with criminal charges.

As has been said time and again -- how else do you restrain someone who is repeatedly illegally practicing medicine in your state and is (in all likelihood) judgement proof (due to having limited assets and being uninsured).

1 - she was practicing midwifery without a license; not medicine without a license and 2 - I do not believe it should be job of the state to restrain anyone in this particular situation. It's not like the midwife is foisting herself upon laboring women. Educated women seek out her care. To say that I need or want the state to babysit me in this matter is insulting.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I had my first baby in a birth center with midwives. I chose the out of hospital birth setting because studies have shown that even midwives in hospital settings use more interventions and have higher c-section rates than midwives attending home and birthcenter births. I am pretty sure I would have gotten several interventions had I given birth in the hospital because my birth was not easy and I pushed for a very long time. In hospitals both doctors and midwives are much more likely to use interventions rather than allow women to push as long as I did. This is because hospitals allow limited time for the stages of labor before intervention is required. I was able to have the birth I wanted and I am grateful for that.

I also have two children whom I adopted at birth and I was present at both hospital births. It was pretty horrific to see how many things were done to the women and the babies without explanation or consent. The nurses and doctors just did things to them, often without even saying what they were going to do. I was traumatized just watching these sweet young women give birth and both of them chose to give birth with minimal medication, no epidurals. I am sure that some hospital births are not
like the ones that I witnessed but I think the birthcenter should be given some credit for trying to teach women about some of the things that might happen in the hospital and also for offering a safe alternative.

I am the pp who birthed on all fours (at Georgetown). I pushed for over 5 hours and that is how I ended up in that position. There was no time limit believe me. Where did you get the idea there was one?

You are extremely naive to think that most women have a similar experience as yours. The vast majority of OBs and hospitals do indeed place fairly strict limits on 2nd stage labor, and rarely allow women to birth in a hands and knees position. I've attended over 200 births in the hospital as a doula, and the only times I've seen a woman push for more than three hours are times when the floor is extremely busy with emergencies which take precedence over the women who is pushing. In a couple of those cases, the woman herself had no idea why her birth turned out as it did, because whenever a doctor checked on her the woman was told "keep going", but again the only reason the doc told her that was because he needed to run back to a c/s. I have also personally witnessed nurses and doctors physically shove a woman onto her back - situations where there were no complications whatsoever, mother was unmedicated, yet the doctor refused to allow her push her baby out on her hands and knees.

[Anonymous]

NARM requires its CPMs to create their customized informed consent form, which the mother signs to acknowledge that yes she has heard all the risks (as explained by the lay midwife) and that she is OK with it. Here is an example from NARM's Web site, coincidentally from Virginia.

http://narm.org/wp-content/uploads/2011/02/MVM-Midwifery-and-HIPAA-Disclosure.pdf

[Anonymous]

It is correct to prosecute Karen Carr for practicing without a license. There are licensing requirements for many things driving, fishing, hunting, boating, practicing law, RNs, medicine etc. This is a misdemeanor though and but I do not think involuntary manslaughter is appropriate at all here. Unless the prosecutor can show that the lack of the VA license is what led to the fetal demise then I don't think they have a case without trying to prove that any natural breech birth conducted by a mid wife is reckless. Karen's educational status, experience, and standing on other states would refute that she lacked training or that her lack of a license led to the demise. She would still be guilty of the misdemeanor but her defense could break the connection to mansalughter.

My guess is that the prosecutors do try to make a case about crossing over the line of the medical definition of standard of care within this situation and with the full support of ob/gyns ready to pounce on the existence of midwives. It will be interesting to see how they deal with the issue of patient consent. I would assume that they would try to keep any mothers off the jury since there is such polarization between natural vs medical invention birth based on what a women experienced herself. I hate to say it but after reading comments on this board on both sides I just don't see how any woman who has given birth could make a rational unbiased judgement in this case.

It is hypocritical that ob/gyns are never prosecuted criminally for gross neglience leading to poor patient outcomes. The only cases that come forward with doctors are ones involving financial fraud or financial motive.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had my first baby in a birth center with midwives. I chose the out of hospital birth setting because studies have shown that even midwives in hospital settings use more interventions and have higher c-section rates than midwives attending home and birthcenter births. I am pretty sure I would have gotten several interventions had I given birth in the hospital because my birth was not easy and I pushed for a very long time. In hospitals both doctors and midwives are much more likely to use interventions rather than allow women to push as long as I did. This is because hospitals allow limited time for the stages of labor before intervention is required. I was able to have the birth I wanted and I am grateful for that.

I also have two children whom I adopted at birth and I was present at both hospital births. It was pretty horrific to see how many things were done to the women and the babies without explanation or consent. The nurses and doctors just did things to them, often without even saying what they were going to do. I was traumatized just watching these sweet young women give birth and both of them chose to give birth with minimal medication, no epidurals. I am sure that some hospital births are not
like the ones that I witnessed but I think the birthcenter should be given some credit for trying to teach women about some of the things that might happen in the hospital and also for offering a safe alternative.

I am the pp who birthed on all fours (at Georgetown). I pushed for over 5 hours and that is how I ended up in that position. There was no time limit believe me. Where did you get the idea there was one?

You are extremely naive to think that most women have a similar experience as yours. The vast majority of OBs and hospitals do indeed place fairly strict limits on 2nd stage labor, and rarely allow women to birth in a hands and knees position. I've attended over 200 births in the hospital as a doula, and the only times I've seen a woman push for more than three hours are times when the floor is extremely busy with emergencies which take precedence over the women who is pushing. In a couple of those cases, the woman herself had no idea why her birth turned out as it did, because whenever a doctor checked on her the woman was told "keep going", but again the only reason the doc told her that was because he needed to run back to a c/s. I have also personally witnessed nurses and doctors physically shove a woman onto her back - situations where there were no complications whatsoever, mother was unmedicated, yet the doctor refused to allow her push her baby out on her hands and knees.

no need to call the OP naive. Let's have a nice, mature discussion.

But I have to concur. I was an OB and have done enough L and D throughout DC and MD to tell you that there is pretty a 3 hour limit (in general). The only doctor who didn't mind pushing going beyond three hours was a doc that was sleeping in the middle of the night. I was pretty new then and the older nurses insisted I call him again to have him intervene. Had I knew then what I know now, I would've continued pushing with the mother.

As for positions, I know L and D nurses who have worked in the field for more than 20 years and looked at me crazy when I suggested another position other than lithomy. Side lying position was stretching it for them.

[Anonymous]

Anonymous wrote:It is correct to prosecute Karen Carr for practicing without a license. There are licensing requirements for many things driving, fishing, hunting, boating, practicing law, RNs, medicine etc. This is a misdemeanor though and but I do not think involuntary manslaughter is appropriate at all here. Unless the prosecutor can show that the lack of the VA license is what led to the fetal demise then I don't think they have a case without trying to prove that any natural breech birth conducted by a mid wife is reckless. Karen's educational status, experience, and standing on other states would refute that she lacked training or that her lack of a license led to the demise. She would still be guilty of the misdemeanor but her defense could break the connection to mansalughter.

My guess is that the prosecutors do try to make a case about crossing over the line of the medical definition of standard of care within this situation and with the full support of ob/gyns ready to pounce on the existence of midwives. It will be interesting to see how they deal with the issue of patient consent. I would assume that they would try to keep any mothers off the jury since there is such polarization between natural vs medical invention birth based on what a women experienced herself. I hate to say it but after reading comments on this board on both sides I just don't see how any woman who has given birth could make a rational unbiased judgement in this case.

It is hypocritical that ob/gyns are never prosecuted criminally for gross neglience leading to poor patient outcomes. The only cases that come forward with doctors are ones involving financial fraud or financial motive.

That just isn't true. It happens. Criminal prosecution for malpractice is rare but a reality.

[Anonymous]

PP here. Some info on criminal prosecution for malpractice: http://www.obgmanagement.com/pdf/2008/2008OBGM_Article3.pdf

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had my first baby in a birth center with midwives. I chose the out of hospital birth setting because studies have shown that even midwives in hospital settings use more interventions and have higher c-section rates than midwives attending home and birthcenter births. I am pretty sure I would have gotten several interventions had I given birth in the hospital because my birth was not easy and I pushed for a very long time. In hospitals both doctors and midwives are much more likely to use interventions rather than allow women to push as long as I did. This is because hospitals allow limited time for the stages of labor before intervention is required. I was able to have the birth I wanted and I am grateful for that.

I also have two children whom I adopted at birth and I was present at both hospital births. It was pretty horrific to see how many things were done to the women and the babies without explanation or consent. The nurses and doctors just did things to them, often without even saying what they were going to do. I was traumatized just watching these sweet young women give birth and both of them chose to give birth with minimal medication, no epidurals. I am sure that some hospital births are not
like the ones that I witnessed but I think the birthcenter should be given some credit for trying to teach women about some of the things that might happen in the hospital and also for offering a safe alternative.

I am the pp who birthed on all fours (at Georgetown). I pushed for over 5 hours and that is how I ended up in that position. There was no time limit believe me. Where did you get the idea there was one?

You are extremely naive to think that most women have a similar experience as yours. The vast majority of OBs and hospitals do indeed place fairly strict limits on 2nd stage labor, and rarely allow women to birth in a hands and knees position. I've attended over 200 births in the hospital as a doula, and the only times I've seen a woman push for more than three hours are times when the floor is extremely busy with emergencies which take precedence over the women who is pushing. In a couple of those cases, the woman herself had no idea why her birth turned out as it did, because whenever a doctor checked on her the woman was told "keep going", but again the only reason the doc told her that was because he needed to run back to a c/s. I have also personally witnessed nurses and doctors physically shove a woman onto her back - situations where there were no complications whatsoever, mother was unmedicated, yet the doctor refused to allow her push her baby out on her hands and knees.

I think I took a Bradley class from you. You scare me.

[Anonymous]

This is just a sad, sad story. I don't think there is a more respected midwife in the Baltimore/DC area than Karen. Every day our children face risks, possible dangerous situations... we as the parents have to choose what's best for them. Time after time home birth has been shown to have the same infant mortality rate as hospital births, but a much lower rate of complications. Overall, it's far superior for the mother and baby. Countless babies are born in this area every month who are in some way touched by Karen's excellent skill as a midwife. My own midwife learned from Karen.

The government has no business whatsoever in licensing midwives. If a woman thinks she's making the best decision by having her baby at home, then as the one who made the informed choice, she should stand by her decision. My heart aches for the family who lost this baby but it's important to remember 1: the family knew the risks associated with the birth 2: tragically sometimes things like this happen. Hospitals aren't exempt and anyone who thinks they are needs to check their facts. Licensing does not stop a baby from dying, nor does it make things "safer". What would these parents have done if the mother had gone to the hospital for c-section and the mother died from operation complications, or what if the baby contracted MRSA and died? No thank you, I don't need the government to be my nanny and walk me from birth through death.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had my first baby in a birth center with midwives. I chose the out of hospital birth setting because studies have shown that even midwives in hospital settings use more interventions and have higher c-section rates than midwives attending home and birthcenter births. I am pretty sure I would have gotten several interventions had I given birth in the hospital because my birth was not easy and I pushed for a very long time. In hospitals both doctors and midwives are much more likely to use interventions rather than allow women to push as long as I did. This is because hospitals allow limited time for the stages of labor before intervention is required. I was able to have the birth I wanted and I am grateful for that.

I also have two children whom I adopted at birth and I was present at both hospital births. It was pretty horrific to see how many things were done to the women and the babies without explanation or consent. The nurses and doctors just did things to them, often without even saying what they were going to do. I was traumatized just watching these sweet young women give birth and both of them chose to give birth with minimal medication, no epidurals. I am sure that some hospital births are not
like the ones that I witnessed but I think the birthcenter should be given some credit for trying to teach women about some of the things that might happen in the hospital and also for offering a safe alternative.

I am the pp who birthed on all fours (at Georgetown). I pushed for over 5 hours and that is how I ended up in that position. There was no time limit believe me. Where did you get the idea there was one?

You are extremely naive to think that most women have a similar experience as yours. The vast majority of OBs and hospitals do indeed place fairly strict limits on 2nd stage labor, and rarely allow women to birth in a hands and knees position. I've attended over 200 births in the hospital as a doula, and the only times I've seen a woman push for more than three hours are times when the floor is extremely busy with emergencies which take precedence over the women who is pushing. In a couple of those cases, the woman herself had no idea why her birth turned out as it did, because whenever a doctor checked on her the woman was told "keep going", but again the only reason the doc told her that was because he needed to run back to a c/s. I have also personally witnessed nurses and doctors physically shove a woman onto her back - situations where there were no complications whatsoever, mother was unmedicated, yet the doctor refused to allow her push her baby out on her hands and knees.

I think I took a Bradley class from you. You scare me.

Why? Because she has witnessed things that you would prefer not to acknowledge? I have read hundreds, maybe thousands, of anecdotes about hospital births, and from what I can tell it is a crapshoot. Some women have great experiences, even those who want to do things differently from the standard medicated birth, and then there are many others who have been treated like complete crap. I have read stories of doctors maliciously performing unnecessary procedures like episiotomies and manual placenta removals to "punish" women (for being a home birth transfer, or just wanting a natural birth), or just because they want to get back to their offices faster. I've read many, many stories about bullying and coercion. I had a maternity tour guide (an employee of the hospital I was touring) tell me flat out that unnecessary sections are performed every single day because of time pressure on doctors. These things are not universal, but they happen. A lot. I don't blame women for being wary of hospitals.

[Anonymous]

Anonymous wrote:This is just a sad, sad story. I don't think there is a more respected midwife in the Baltimore/DC area than Karen. Every day our children face risks, possible dangerous situations... we as the parents have to choose what's best for them. Time after time home birth has been shown to have the same infant mortality rate as hospital births, but a much lower rate of complications. Overall, it's far superior for the mother and baby. Countless babies are born in this area every month who are in some way touched by Karen's excellent skill as a midwife. My own midwife learned from Karen.

The government has no business whatsoever in licensing midwives. If a woman thinks she's making the best decision by having her baby at home, then as the one who made the informed choice, she should stand by her decision. My heart aches for the family who lost this baby but it's important to remember 1: the family knew the risks associated with the birth 2: tragically sometimes things like this happen. Hospitals aren't exempt and anyone who thinks they are needs to check their facts. Licensing does not stop a baby from dying, nor does it make things "safer". What would these parents have done if the mother had gone to the hospital for c-section and the mother died from operation complications, or what if the baby contracted MRSA and died? No thank you, I don't need the government to be my nanny and walk me from birth through death.

I think the issue here is that it appears the family did NOT feel they knew the risks of this particular situation, hence the gutwrenchingly hard to read review the mom left regarding Birth Care. It seems as though they believe someone failed them when it came to informing them of the risks associated with certain choices, namely the midwife and birth assistant. Very sad to hear, but then again, they're grieving and it's natural to look for someone to blame. Still, it does beg the question regarding the standard of care for a homebirth midwife when it comes to their responsibility to inform their clients about risk.

[Anonymous]

I have also attended hundreds of hospital births and the truth of the matter is that MOST women (even first time mom's) will push a baby out within the 3 hour time span. Generally speaking, women who often reach the 3 hour mark without success in bringing the baby down either a) started pushing too soon before the baby was in a more conducive station or b) are exhausted and unable to push effectively or c) - the biggest cause - have chosen epidural anesthesia which prevents them from feeling how to push effectively.

If the baby is tolerating labor well, there are doctors that will allow a mom to keep going after 3 hours. I have seen doctors manually rotate the fetus' head (from OP to OA position,etc.) to allow for more effective pushing. A vacuum or forceps can sometimes be used. We do a lot of "laboring down" in the hospital before allowing a mom to push - more specifically mom's with epidural anesthesia.

I agree - having a home birth decreases your risks of agreeing to an epidural by 100%, but the truth of the matter is that many, many women and families WANT to give birth in the hospital. Many more want an epidural. It's not a choice I would be happy making, but most of my friends made that choice and are happy with their decision-making process. For many, birthing in the hospital setting is within their level of comfort and may be completely covered by insurance. People continue to gloss over the fact that a homebirth can cost thousands of dollars in out of pocket expenses to the family (especially when you factor in the cost of the midwife, birth assistant, doula and aforementioned Bradley class). Why should affluent women be the only one's privvy to good, evidence-based care? There are many, many midwives working in the hospital setting who offer NCB to women who desire it and come prepared for it. I have been there to assist with a number of these deliveries. No one has EVER been forced to have an epidural that I am aware of. Sure, I think doctors come in an say, "we want to start Pitocin" or "we want to break your bag of waters" and most patients say, "ok" without a second thought. An educated, empowered patient will know the difference and advocate for themselves not only durng the hosptial experience, but prior to labor by asking questions in the office. An empowered patient has chosen her birth team far in advance.

The sad truth of modern-day obstetrics is not that there are thousands of empowered, educated patients out there advocating for their needs and unable to have them met. Instead, it's a largely uneducated group of consumers who care more about what car they drive or what new iPhone model they buy over educating themselves about the birth process. When you have teen girls having thier 3rd or 4th baby by age 20 you can't exactly blame the doctors and nurses because she didn't go to her Bradley class and get all empowered about birth. I'm sure she and her children are merely trying to survive. Or is it the doctors fault too because she has no interest in birth spacing or using family planning? Where does the buck stop? And why are hosptials the proverbial "dumping ground" for all negative outcomes and/or failed homebirths? Just something for people to chew on...

[Anonymous]

Anonymous wrote:This is just a sad, sad story. I don't think there is a more respected midwife in the Baltimore/DC area than Karen. Every day our children face risks, possible dangerous situations... we as the parents have to choose what's best for them. Time after time home birth has been shown to have the same infant mortality rate as hospital births, but a much lower rate of complications. Overall, it's far superior for the mother and baby. Countless babies are born in this area every month who are in some way touched by Karen's excellent skill as a midwife. My own midwife learned from Karen.

The government has no business whatsoever in licensing midwives. If a woman thinks she's making the best decision by having her baby at home, then as the one who made the informed choice, she should stand by her decision. My heart aches for the family who lost this baby but it's important to remember 1: the family knew the risks associated with the birth 2: tragically sometimes things like this happen. Hospitals aren't exempt and anyone who thinks they are needs to check their facts. Licensing does not stop a baby from dying, nor does it make things "safer". What would these parents have done if the mother had gone to the hospital for c-section and the mother died from operation complications, or what if the baby contracted MRSA and died? No thank you, I don't need the government to be my nanny and walk me from birth through death.

Are you insane, PP? Seriously? Nail technicians and tattoo artists must be licensed, why should a midwife be exempt? And yes, you can pick up MRSA, staph, Hepatitis and other fun communicable diseases at your local nail salon too...

[Anonymous]

The government has no business whatsoever in licensing midwives. If a woman thinks she's making the best decision by having her baby at home, then as the one who made the informed choice, she should stand by her decision. My heart aches for the family who lost this baby but it's important to remember 1: the family knew the risks associated with the birth 2: tragically sometimes things like this happen. Hospitals aren't exempt and anyone who thinks they are needs to check their facts. Licensing does not stop a baby from dying, nor does it make things "safer". What would these parents have done if the mother had gone to the hospital for c-section and the mother died from operation complications, or what if the baby contracted MRSA and died? No thank you, I don't need the government to be my nanny and walk me from birth through death.

If you believe the bolded above, do you think that the parents should also be charged with manslaughter, or be charged instead of the midwife?

[Anonymous]

Anonymous wrote:

The government has no business whatsoever in licensing midwives. If a woman thinks she's making the best decision by having her baby at home, then as the one who made the informed choice, she should stand by her decision. My heart aches for the family who lost this baby but it's important to remember 1: the family knew the risks associated with the birth 2: tragically sometimes things like this happen. Hospitals aren't exempt and anyone who thinks they are needs to check their facts. Licensing does not stop a baby from dying, nor does it make things "safer". What would these parents have done if the mother had gone to the hospital for c-section and the mother died from operation complications, or what if the baby contracted MRSA and died? No thank you, I don't need the government to be my nanny and walk me from birth through death.

If you believe the bolded above, do you think that the parents should also be charged with manslaughter, or be charged instead of the midwife?

They do in other states. I read about one recently where the baby got stuck, head down, and the collar bone was broken to get the baby out. The parents brought baby in to get it looked at and CPS were called and they were arrested for child neglect or something like that.