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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Not the poster you're responding to, but I'm not really sure what makes you think it's okay to say to this woman "Your actual experience is wrong and did not happen." She said that she witnessed things done to the birth mothers of her adopted children. She was THERE. It's not like she was talking about something she heard from her brother's girlfriend's cousin's cashier at the grocery store.

I'm glad your experiences have been good in the years and years you've been practicing. But recognize that your experiences are not the only experiences a person can have, ever.

You are right, I didn't mean to say 'it did not happen at all', nor 'this could never ever ever happen'. She did believe it happened that way that she remembers it as a bad experience. All I tried to say is that it is really really unusual and I cannot imagine any doctors or nurses or other attendants 'doing all these horrible things to the mothers and babies without explanation or consent'. She did not give a specific example of what was allegedly done to the babies at that hospital that was 'horrible and not explained'. As I said, in years of practicing: there is constant explaining going on (unless there is no time because the situation is so dire) ... it's the right thing to do, and it's human to do so.

One of the mothers (I will call her A) was induced two weeks early because the baby was due on Christmas which was inconvenient for the doctor. They started her at midnight after she waited 3 hours for the doctor. She was not ready to give birth so a series of interventions were used to get the baby out after they broke her water (without explaining) and gave her increasingly high doses of pitocin and it still wasn't happening. They used the internal monitor without explaining and A was so upset about the fact that the baby had a scab on her head from the screw they put in her scalp that she cried. No one had told her. This was A's 4th baby. The last two had come quickly and with almost no pain. She told me that for her previous births, "I could feel the contractions but they weren't exactly painful." Well, this induced labor was entirely different. It was excruciating and long. The nurses were mean to her, probably because she was placing the baby for adoption. At one point they gave her an injection in her perineum with no warning and she screamed and asked what it was. She was given some type of medication even though she didn't really want it. They automatically gave her an unnecessary episiotomy when the second stage didn't go as quickly as they wanted it to and then they got out the vacuum extractor. She had been pushing for about an hour and a half. I have blocked out the rest of the gory details but it was horrible. And the baby was two pounds smaller than A's other 3 babies had been at birth and was covered with vernix so I believe she was more than 2 weeks early. She was very sleepy and out of it from the medication. I barely saw her eyes open for the first week.

I won't go into details about my DS's birth but it was equally ugly and the doctor left part of the placenta in which caused a later infection. It's very nice that you have only experienced beautiful birth stories in all your years of practice and that you have never seen time limits imposed but this is not consistent with the experiences of countless women who have had hospital births. And I never said that all hospitals or doctors or nurses are the same. I only said that these things are possible and they do happen and that's why a lot of women are more comfortable outside the hospital where they can control a large part of what goes on. Also, I can only compare these two births to my own during which there were no interventions at all, no medications whatsoever, and my baby was posterior. I pushed for 4 hours while the midwife and assistant sat by my side encouraging me to keep going. When the baby was born, she was strong and pink and alert and she didn't cry. It couldn't have been more different.

One more small detail which I think is relevant. My Godmother, who is a CNM practicing strictly in a hospital setting, was shocked and horrified when she found out they let me push for 4 hours. As were my in-laws who are both doctors. My Godmother loves that vacuum extractor. She rarely tells a birth story where it wasn't used. My in-laws and Godmother all agreed that the CNM never should have let me go that long without intervening. Obviously I disagree.

[Anonymous]

OP here...

Just wondering if anyone knows the answer to my original question- how do DC hospitals and the DC government handle home birth transfers to the hospital with CPMs?

One poster mentioned that Karen had received a cease and desist order from the DC gov, does anyone know which hospital reported Karen that prompted the cease and desist?

Or why- if there were birth complications that prompted the report, or if DC hospitals are making it a practice to report CPMs since they are technically illegal in DC regardless of their years of experience and success (e.g. birthing over 1,000 healthy babies like Karen Carr) without complications in the majority of births?

Anyone know which DC hospitals are friendly to midwives, either attending in the hospital or with home birth transfers?

Any help is appreciated...

[Anonymous]

Anonymous wrote:
Anyone know which DC hospitals are friendly to midwives, either attending in the hospital or with home birth transfers?

Any help is appreciated...

As has been mentioned elsewhere in this thread . . . CNMs practice at WHC and GWU in DC.

[Anonymous]

Anonymous wrote:

Anonymous wrote:
Anyone know which DC hospitals are friendly to midwives, either attending in the hospital or with home birth transfers?

Any help is appreciated...

As has been mentioned elsewhere in this thread . . . CNMs practice at WHC and GWU in DC.

And Washington Hospital Center (both an in-house midwife team and the DC Family Health & Birth Center midwives).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
Anyone know which DC hospitals are friendly to midwives, either attending in the hospital or with home birth transfers?

Any help is appreciated...

As has been mentioned elsewhere in this thread . . . CNMs practice at WHC and GWU in DC.

And Washington Hospital Center (both an in-house midwife team and the DC Family Health & Birth Center midwives).

But those are all CNMs, yes?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
Anyone know which DC hospitals are friendly to midwives, either attending in the hospital or with home birth transfers?

Any help is appreciated...

As has been mentioned elsewhere in this thread . . . CNMs practice at WHC and GWU in DC.

And Washington Hospital Center (both an in-house midwife team and the DC Family Health & Birth Center midwives).

15:39 here--sorry, PP, I just reread your question and realized that you were asking about CPMs rather than CNMs. I would be surprised if any hospitals allowed CPMs to deliver on-site (but there's a ton I don't know). No knowledge of DC hospital attitudes toward transfers by CPMs, either.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
Anyone know which DC hospitals are friendly to midwives, either attending in the hospital or with home birth transfers?

Any help is appreciated...

As has been mentioned elsewhere in this thread . . . CNMs practice at WHC and GWU in DC.

And Washington Hospital Center (both an in-house midwife team and the DC Family Health & Birth Center midwives).

WHC= Washington Hospital Center

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
Anyone know which DC hospitals are friendly to midwives, either attending in the hospital or with home birth transfers?

Any help is appreciated...

As has been mentioned elsewhere in this thread . . . CNMs practice at WHC and GWU in DC.

And Washington Hospital Center (both an in-house midwife team and the DC Family Health & Birth Center midwives).

15:39 here--sorry, PP, I just reread your question and realized that you were asking about CPMs rather than CNMs. I would be surprised if any hospitals allowed CPMs to deliver on-site (but there's a ton I don't know). No knowledge of DC hospital attitudes toward transfers by CPMs, either.

15:35 here -- No, CPMs cannot practice in hospitals in DC. For one thing, CPMs are "illegal" in DC. But more importantly, CPMs are trained to only do home births. That is what they specialize in. I cannot imagine a CPM wanting to work in a hospital even if it were theoretically possible for them to do so. CNMs are trained to work in hospitals and birth centers, although some also do home births.

[Anonymous]

Anonymous wrote:OP here...

Just wondering if anyone knows the answer to my original question- how do DC hospitals and the DC government handle home birth transfers to the hospital with CPMs?

One poster mentioned that Karen had received a cease and desist order from the DC gov, does anyone know which hospital reported Karen that prompted the cease and desist?

Or why- if there were birth complications that prompted the report, or if DC hospitals are making it a practice to report CPMs since they are technically illegal in DC regardless of their years of experience and success (e.g. birthing over 1,000 healthy babies like Karen Carr) without complications in the majority of births?

Anyone know which DC hospitals are friendly to midwives, either attending in the hospital or with home birth transfers?

Any help is appreciated...

anyone know answers to the OP's other questions?

[Anonymous]

I'm a CNM (certified nurse midwife) and have practiced in the greater VA/DC/MD/PA area. I had my children at home with a CNM.

In terms of hospital transfers by a CPM, each hospital generally has a staff OB doctor in house at all times to cover OB emergencies. This doctor will deliver women who deliver before their own physician arrives, women who might be traveling from out-of-area and have complications, women who never establish prenatal care with any provider and just show up in labor, home birth transfers, etc. Some hospitals pay a physician to take care of these patients, others share the responsibility between everyone who delivers at the hospital (all the OBs and midwives). In several of my previous positions I took this sort of ER call as a condition of my ability to deliver my patients at the hospital.

I can say as someone who has handled home birth transfers from CPMs that they're pretty much a nightmare for all involved in the hospital and it's NOT because we are anti-home birth. It's because 8/10 it's an emergency situation that necessitates immediate intervention (often a stat c/s). And many, many times the patient should have been transfered hours before she is. CPMs are known for transferring at the last possible minute. And the minute the patient crosses the threshold of the hospital, she is now my LIABILITY, even though I had nothing to do with the condition I received her in.

In contrast, the CNMs I know (including myself) have a back-up physician identified and on-call (and tied to my license). When I ran into problems with out-of-hospital delivery I didn't just show up at the nearest hospital and dump the crashing patient onto whomever happened to be covering OB that day. I called my back-up physician personally and had him/her waiting for me at the hospital with the OR ready.

And that is yet another HUGE difference between a CNM home birth and a CPM home birth.

[Anonymous]

Anonymous wrote:WHY are people going on about this "disheartening" investigation and rushing in to blindly support Karen?

My guess? Self interest. There are not that many homebirth midwives. People who are very invested in opting out of OBs and "medwife" care need someone unless they are the "UC" unassisted childbirth fringe. So if they got their good birth from Karen, or want one, they don't want you to take away their chance to have it. Many in the homebirth community blame bad outcomes on the mom rather than the midwife. It's eye opening if you do some searches, some homebirth moms who have suffered losses claim that their posts are taken down on message boards. Some say that people have said that their "fear" contributed to the baby's death rather than substandard care.

I considered a homebirth but had a breech baby. It seems that if there is a sudden emergency you are SOL, there is no time to transfer. But there are often signs of an emergency coming (I VBAC'd in a hospital with midwives and had complications so I know what they are the OBs were looking for in terms of signs of abruption, etc). If the midwife lacks the experience to see them, has the hubris to think she can handle anything, or fears legal consequences or "mean" treatment of herself or the client if there is a transfer, it seems likely that the window for transfer may close before anyone heads for the door. In some cases I read about they transported by car rather than ambulance, which seems crazy to me. It really seems like everyone might get caught up in emotion based decision making. The client doesn't really have a basis to judge and the midwife may be trying to be "empowering" and hands off or gain a sense of power from heroics. Seems like things could go south pretty easily if there are complications.

So ironic that moms/babies with bad birth outcomes are rushed to the hospital or EMTs are called to save the day but midwives in hospitals or natural birth friendly OBs are shunned.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Birth has gone on since the dawn of the race and women have died birthing babies who may have died or been I juried since then. We have found ways to lessen or manage the risk, but don't blather on to mean out how womens bodies know how to birth. They know how to die, too.

And if they get very ill, and do not want to be treated, then they have a right to do so without going to the hospital or hiring medical professionals.

Ah, but what about the choice of the baby? To live rather than to suffocate to death? How terrifying it must have been for him. And it didn't turn out that "empowerment" was so great for his mom either. She wanted to have her cake and eat it too, a "safe" high risk birth on her terms. Birth is a means to an end.

That a woman on the spin off thread said that she would rather die and take herr baby with her rather than have another c-section is either prone to exaggeration, hysterical or someone who should not be risking getting pregnant again.

[Anonymous]

Anonymous wrote:I'm a CNM (certified nurse midwife) and have practiced in the greater VA/DC/MD/PA area. I had my children at home with a CNM.

In terms of hospital transfers by a CPM, each hospital generally has a staff OB doctor in house at all times to cover OB emergencies. This doctor will deliver women who deliver before their own physician arrives, women who might be traveling from out-of-area and have complications, women who never establish prenatal care with any provider and just show up in labor, home birth transfers, etc. Some hospitals pay a physician to take care of these patients, others share the responsibility between everyone who delivers at the hospital (all the OBs and midwives). In several of my previous positions I took this sort of ER call as a condition of my ability to deliver my patients at the hospital.

I can say as someone who has handled home birth transfers from CPMs that they're pretty much a nightmare for all involved in the hospital and it's NOT because we are anti-home birth. It's because 8/10 it's an emergency situation that necessitates immediate intervention (often a stat c/s). And many, many times the patient should have been transfered hours before she is. CPMs are known for transferring at the last possible minute. And the minute the patient crosses the threshold of the hospital, she is now my LIABILITY, even though I had nothing to do with the condition I received her in.

In contrast, the CNMs I know (including myself) have a back-up physician identified and on-call (and tied to my license). When I ran into problems with out-of-hospital delivery I didn't just show up at the nearest hospital and dump the crashing patient onto whomever happened to be covering OB that day. I called my back-up physician personally and had him/her waiting for me at the hospital with the OR ready.

And that is yet another HUGE difference between a CNM home birth and a CPM home birth.

You sound more perturbed by being required to have a backup physician when CPMs (depending on the state, this varies) are not required to. BTW - not all CNMs across the country are required to have physician backup.
So, really, where would you prefer CPM moms to transfer to? Stay home with a situation that needs hospital attention because you don't want to receive them? Come on.
Is this how moms without prenatal care are treated? A go somewhere else attitude, when it comes time for them to walk in and have their baby? And are they treated poorly, too?

[Anonymous]

Anonymous wrote:

Anonymous wrote:WHY are people going on about this "disheartening" investigation and rushing in to blindly support Karen?

My guess? Self interest. There are not that many homebirth midwives. People who are very invested in opting out of OBs and "medwife" care need someone unless they are the "UC" unassisted childbirth fringe. So if they got their good birth from Karen, or want one, they don't want you to take away their chance to have it. Many in the homebirth community blame bad outcomes on the mom rather than the midwife. It's eye opening if you do some searches, some homebirth moms who have suffered losses claim that their posts are taken down on message boards. Some say that people have said that their "fear" contributed to the baby's death rather than substandard care.

I considered a homebirth but had a breech baby. It seems that if there is a sudden emergency you are SOL, there is no time to transfer. But there are often signs of an emergency coming (I VBAC'd in a hospital with midwives and had complications so I know what they are the OBs were looking for in terms of signs of abruption, etc). If the midwife lacks the experience to see them, has the hubris to think she can handle anything, or fears legal consequences or "mean" treatment of herself or the client if there is a transfer, it seems likely that the window for transfer may close before anyone heads for the door. In some cases I read about they transported by car rather than ambulance, which seems crazy to me. It really seems like everyone might get caught up in emotion based decision making. The client doesn't really have a basis to judge and the midwife may be trying to be "empowering" and hands off or gain a sense of power from heroics. Seems like things could go south pretty easily if there are complications.

So ironic that moms/babies with bad birth outcomes are rushed to the hospital or EMTs are called to save the day but midwives in hospitals or natural birth friendly OBs are shunned.

I can only speak for myself and explain I am supporting this midwife (at least in theory since I don't have all the facts). First of all, I am finished having babies as far as I know and if I did have a baby, it would have to be a c-section for specific medical reasons. My reason is that I believe that women have the right to birth the way they want to, no matter what. It is not my business to tell women that they are taking too much risk or that they have chosen an unqualified birth attendant. If a woman wants to hire her own grandma to help her deliver her breech quintuplets, then that's her own business. In a perfect world, it would be possible to hire a doctor or CNM to attempt a higher risk vaginal birth in a safe hospital setting but our laws make it almost impossible to do that in some cases. So my bottom line is that women get to make these choices for themselves even if I think they are foolish choices and if lay midwives are willing to attend these births then more power to them. It might be stupid, that's a matter of opinion, but it isn't manslaughter and I don't think it should be illegal.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm a CNM (certified nurse midwife) and have practiced in the greater VA/DC/MD/PA area. I had my children at home with a CNM.

In terms of hospital transfers by a CPM, each hospital generally has a staff OB doctor in house at all times to cover OB emergencies. This doctor will deliver women who deliver before their own physician arrives, women who might be traveling from out-of-area and have complications, women who never establish prenatal care with any provider and just show up in labor, home birth transfers, etc. Some hospitals pay a physician to take care of these patients, others share the responsibility between everyone who delivers at the hospital (all the OBs and midwives). In several of my previous positions I took this sort of ER call as a condition of my ability to deliver my patients at the hospital.

I can say as someone who has handled home birth transfers from CPMs that they're pretty much a nightmare for all involved in the hospital and it's NOT because we are anti-home birth. It's because 8/10 it's an emergency situation that necessitates immediate intervention (often a stat c/s). And many, many times the patient should have been transfered hours before she is. CPMs are known for transferring at the last possible minute. And the minute the patient crosses the threshold of the hospital, she is now my LIABILITY, even though I had nothing to do with the condition I received her in.

In contrast, the CNMs I know (including myself) have a back-up physician identified and on-call (and tied to my license). When I ran into problems with out-of-hospital delivery I didn't just show up at the nearest hospital and dump the crashing patient onto whomever happened to be covering OB that day. I called my back-up physician personally and had him/her waiting for me at the hospital with the OR ready.

And that is yet another HUGE difference between a CNM home birth and a CPM home birth.

You sound more perturbed by being required to have a backup physician when CPMs (depending on the state, this varies) are not required to. BTW - not all CNMs across the country are required to have physician backup.
So, really, where would you prefer CPM moms to transfer to? Stay home with a situation that needs hospital attention because you don't want to receive them? Come on.
Is this how moms without prenatal care are treated? A go somewhere else attitude, when it comes time for them to walk in and have their baby? And are they treated poorly, too?

What an interesting reading of the comment. The fact that a CNM has a physician backup means that her homebirth patient can be transferred to a physician's care quickly and smoothly, without having to explain the mother's history 17 times before getting help. And you interpret that as the CNM being "perturbed?" I call it smart and safe medicine.

And the fact that CPMs often transfer women well after they should, leaving the CNM and OB holding all of the liability, means that the CNM doesn't want to accept homebirth transfers? Where are you getting this stuff? A "go somewhere else" attitude? No, I think what you're seeing is the frustration at having to fix someone else's mess, with the added bonus of being legally and morally accountable for the outcome. Nowhere does it imply that mothers are treated poorly. OBs and CNMs who go through years of study and on-the-job training (and I'm talking orders of magnitude more births than CPMs) don't do it because they hate women and want to hurt them however they can. By and large they do it because they love women, they love delivering babies, and nothing gets them fired up faster than unsafe providers who jeoparize the health of those women and babies.

I just bet that a (legal...) CPM who gets the reputation for transferring prudently and efficiently and who listens to and learns from criticisms about how to better recognize problems would be much better received than a CPM who tends to come in with babies who are already beyond help. It's being part of a team instead of being the maverick who knows better than everyone else.