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

[Anonymous]

Anonymous wrote:

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.

what about the rights of the full term infant who suffocated to death in his mother's birth canal?

[Anonymous]

Anonymous wrote:

Anonymous wrote:The mom was saying she didn't get enough information from the birth assistant or from Birthcare. But she hasn't said anything publicly yet about Karen Carr. We don't know yet if Karen Carr advised her of the possible risks.

Huh, the way I read it she was referring to both the birth assistant and "the midwife" which are all assuming is Karen.

No, I read it as she is refering to her Birth Care midwife, who she saw for postpartum care. Karen Carr never worked at Birth Care. Not sure if she would have provided postpartum care herself had things gone well, but it would have been at the client's home.

[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?

How did you possibly draw that conclusion from her post? She said that having a backup OB allowed her to transfer care rather than "dumping" the client. She also said that clients are almost always transfered far too late, sometimes hours too late, so that it is an extreme emergency situation, which could have been avoided with more prompt treatment. She is saying they should have transfered sooner not that they should have stayed at home.

[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?

She doesn't sound pertubed AT ALL. She also didn't complain THAT patients were transferred to her, but that they were transferred too late and in an unstable condition, crashing. Out of poor judgement and inadequate knowledge or training, or a false sense of pride or who knows what. She also rightly said that this disaster situation now becomes her liability for a bad outcome, that is the sad truth. Lawyers will often go for the deepest pockets, that is our glorious legal system. What can you get from a noninsured, maybe not even high school educated CMP? I don't know, but not as much as from a hospital. Thus: Poor judgement, delays, disaster situation, =dumping.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I used Karen for a homebirth and was at risk for post partum hemorrhage due to uterine fibroids. I was definitely informed about this risk by Karen as well as counseled on the treatments she would have available at the birth and we had a plan for hospital transfer, if necessary. I didn't hemorrhage so we didn't have to go there, but the risks were discussed.

All the people who think midwifery is all "kumbaya and candles" may not realize that midwives and clients have serious conversations about risks, treatments, plans, etc.

Thank you for sharing. I am the PP who asked for clients of Karen and BirthCare to speak to what is discussed (benefits/risks)

I am a former BirthCare client. Even though I was young and healthy and my baby was full term, when I experienced a relatively minor complication in my 39th week, they insisted I go to a hospital to have the baby. They did find me midwife care inside a hospital, but they were very clear that they felt the risk was now too high to give birth at home or at a birth center. I do not buy for a second that BirthCare did not advise a 43 year old FTM with a breech baby to go to a hospital. They are very cautious. And I can also tell you that BirthCare midwives talked to me much more about risks and benefits to every possible procedure than any doctor ever has. They kept me fully informed at all times about my health, meaning I had access to my chart, so I know they took detailed and highly accurate notes about every single appointment.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I am a former BirthCare client. Even though I was young and healthy and my baby was full term, when I experienced a relatively minor complication in my 39th week, they insisted I go to a hospital to have the baby. They did find me midwife care inside a hospital, but they were very clear that they felt the risk was now too high to give birth at home or at a birth center. I do not buy for a second that BirthCare did not advise a 43 year old FTM with a breech baby to go to a hospital. They are very cautious. And I can also tell you that BirthCare midwives talked to me much more about risks and benefits to every possible procedure than any doctor ever has. They kept me fully informed at all times about my health, meaning I had access to my chart, so I know they took detailed and highly accurate notes about every single appointment.

This is why the are licensed and trusted and provide a wonderful service -- and should really distance themselves from the unlicensed CPM crowd.

[Anonymous]

Anonymous wrote:This is so amazingly insulting. I have had two babies and I can tell you that I was in no mind to be thinking about whether or not I needed to call 911 at any point in my labor. I was completely absorbed in getting the baby out. To completely put this on the mother is disgusting to me.
43, first baby - I couldn't even image doing anything that would be slightly risky.

why is it insulting? Mother's make bad choices every day and choices that harm their children. And this was one of them.

[Anonymous]

Are people in trouble if they are just reading the thread and post thoughts generally about birth or ask general questions?

[Anonymous]

I just wanted to add my 2 cents to a PP who described her experience with BirthCare as being highly conscientious where any risk was involved.
I had all three possible birth experiences: one in the hospital, one in a free-standing birth center, and the last one at home with a BirthCare midwife. I can only say that my BirthCare experience was superlative in every way possible. It was very clear to me from Day 1 of my prenatal care which criteria would risk me out of a homebirth -- and why -- and I was hyper-aware of them at all times during my pregnancy. In the end, I only tested positive for GBS, and was given IV antibiotics during my short and easy labor at home. The CNMs made very clear to me the risks of not accepting the antibiotics (which was also my choice). I was never as fully informed of any aspects of childbirth in my previous HCP experiences.
All in all, I was impressed with BirthCare's professionalism and even -- gasp! -- conservatism. It was clear to me that the BirthCare CNMs are committed to out-of-hospital birth, but only if it as safe as it can be.
I'm obviously a huge advocate of out-of-hospital birth, but I do believe that it is the mother, first and foremost, who needs to be low-risk and very well educated about the birth process.

[Anonymous]

Anonymous wrote:Are people in trouble if they are just reading the thread and post thoughts generally about birth or ask general questions?

of course not!

[Anonymous]

I was in this Bradley class and I think you should all know that our instructor was honest and fair minded. The couple that lost their little one w

[Anonymous]

The couple that lost their little one was well informed and believed they were doing what was best for their family. Those of you that have the poor taste to blame them Sould know that no one feels this loss more than them and no one loved their baby more than the did.

It is the Height of hubris to think for a moment that you could ever speak for their little one or advocate for him better than his parents. They had personal reasons for choosing a home birth and there really isn't any gaurantee that things would have gone better in the hospital.

This is a terrible tragedy that has been difficult to process for those of us who actually know what happened. I can tell you that the parents are heartbroken and if you knew them you would have nothing but the deepest sympathy for Them.

Having heard the details from the mother's lips I do not believe that anyone could have prevented this tragedy and I think it is wrong to blame the parents the midwife or the doula, who btw was a wonderful instructor and a woman I would hire as my doula if were pregnant again.

[Anonymous]

Anonymous wrote:The couple that lost their little one was well informed and believed they were doing what was best for their family. Those of you that have the poor taste to blame them Sould know that no one feels this loss more than them and no one loved their baby more than the did.

It is the Height of hubris to think for a moment that you could ever speak for their little one or advocate for him better than his parents. They had personal reasons for choosing a home birth and there really isn't any gaurantee that things would have gone better in the hospital.

This is a terrible tragedy that has been difficult to process for those of us who actually know what happened. I can tell you that the parents are heartbroken and if you knew them you would have nothing but the deepest sympathy for Them.

Having heard the details from the mother's lips I do not believe that anyone could have prevented this tragedy and I think it is wrong to blame the parents the midwife or the doula, who btw was a wonderful instructor and a woman I would hire as my doula if were pregnant again.

except an obstetrician and an operating room.

[Anonymous]

I've made enough stupid mistakes in my life to have sympathy for anyone who does---but life bites and then you live the rest of your life with the knowledge that your stupidity caused a preventable death.

OTOH, the professional holds a higher rate of responsibility, and should be punished to the fullest extent possible. There is a mistake--an error made due to systems, processes or other problems---and then there is willful disregard of procedure or risk. This is the case here. No simple error, but willful disregard of risk, and someone else paid the price for the professional's hubris.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The couple that lost their little one was well informed and believed they were doing what was best for their family. Those of you that have the poor taste to blame them Sould know that no one feels this loss more than them and no one loved their baby more than the did.

It is the Height of hubris to think for a moment that you could ever speak for their little one or advocate for him better than his parents. They had personal reasons for choosing a home birth and there really isn't any gaurantee that things would have gone better in the hospital.

This is a terrible tragedy that has been difficult to process for those of us who actually know what happened. I can tell you that the parents are heartbroken and if you knew them you would have nothing but the deepest sympathy for Them.

Having heard the details from the mother's lips I do not believe that anyone could have prevented this tragedy and I think it is wrong to blame the parents the midwife or the doula, who btw was a wonderful instructor and a woman I would hire as my doula if were pregnant again.

except an obstetrician and an operating room.

Because Lord knows NO ONE has EVER died after being in the hands of an OB in an OPERATING ROOM (one of the SAFEST rooms in existence) *sarcasm*