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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

I'm not a big fan of c-sections, but I think what you are missing is the fact that more high risk women have c-sections than vaginal births, so it would make sense for more women who have had c-sections to die than women who birth vaginally.

I have to admit, I really don't get the argument from people - knowing what we do from press reports - that either this women or her baby were just as likely to die from a c-section. I think arguments like that don't help the home birth movement any b/c it does make you seem totally irrational and more interested in the birth experience than in the outcome of such experience.

YES!!!!!

[Anonymous]

Anonymous wrote:

Anonymous wrote:
When you have no problems with the pregnancy and no problems during delivery (I've had 3 such low risk pregnancies and deliveries), a c-section isn't even muttered. Why would it? Things progress as planned (i.e., spontaneous labor, some pushing, healthy baby). While many people don't want to admit it, OBs generally do NOT push c-sections on low-risk women. While reasonable people can debate whether things like frank breech should automatically mean a c-section, posters like the one I'm quoting seem to be missing the reality that many high-risk women (rightly or not) have c-sections. These women may be high risk for reasons totally unrelated to the baby, but due to simply being pregnant (e.g., overweight women, gestational diabetes, etc.).

I wish this was true, but I have known far too many low-risk women who have had C-sections pushed on them for highly questionable reasons. In many cases, C-sections result from failed inductions, many of which are themselves unnecessary (and might be requested by either the doctor or the patient, so it is not always just the doctor). In other cases, unnecessary C-sections are encouraged by doctors for reasons having to do with time management issues. I have had L&D nurses point blank tell me they see this all the time.

In this particular case, a C-section was probably the most appropriate/prudent choice. However, let's not pretend that unnecessary sections aren't performed every day in this country to the detriment of mothers and babies.

[Anonymous]

I do agree that chasing after very specific definitions of "ideal" births CAN lend itself to losing sight of the baby's safety. It won't be magical, it won't be painless, it won't be miraculous. The feeling of holding your child is - hospital or not. Very different.

I agree. A lot of these posts remind me of women who have to have the PERFECT hideously expensive overly scheduled wedding, and have hissy fits when they can't have everything exactly the way they want, or when a baby starts to cry during the ceremony, or when the photographer loses a roll of film, or the ushers bring Grandma Jane down before Grandma Rose, or whatever. They lose sight of the fact that the marriage is the important thing, not the wedding. The ironic thing is, I'm sure many of the women who are so concerned about the birth experience feel those in search of the perfect wedding are silly, spoiled little brats, and look down their noses at them. They would be (and will be) be AGHAST that someone could compare them to those myopic little twits (to borrow a phrase). Nevertheless, it's an apt analogy.

As a father, I can tell you that I couldn't care less about the birth experience. Not even a little. I wanted my wife and child to emerge healthy - that was the only consideration. I simply do not understand anyone who prioritizes ANYTHING over that. And yes, yes, I know, the mother could have had some rare condition that made a c-section more dangerous than an at-home breech birth for a first-time mother. But there's been absolutely no indication of that in any of the accounts I've read. In the absence of any evidence to suggest such a condition, it's not reasonable to assume that one exists. Occam's razor, you know.

[Anonymous]

Anonymous wrote:
As a father, I can tell you that I couldn't care less about the birth experience. Not even a little. I wanted my wife and child to emerge healthy - that was the only consideration. I simply do not understand anyone who prioritizes ANYTHING over that. And yes, yes, I know, the mother could have had some rare condition that made a c-section more dangerous than an at-home breech birth for a first-time mother. But there's been absolutely no indication of that in any of the accounts I've read. In the absence of any evidence to suggest such a condition, it's not reasonable to assume that one exists. Occam's razor, you know.

I am disillusioned with much about the homebirth/natural birth world, but this black and white reduction of the issues to "birth experience" versus "health" is missing a whole lot, and honestly, "as a father" -- well, it's not your experience, is it?

Yes, it is possible to make much too much of a c-section. I can't stand it when some NCB advocates trumpet every little increase in health risk from intervention yet downplay real, often larger risks from VBAC, breech, etc.

But c-section *is* major abdominal surgery and it does not leave a woman in a condition of perfect "health." Even if the c-section was an absolute life-saving necessity and doubtlessly should have been done, it does not exactly leave a healthy mother, still less one without higher risks to herself and her child in future pregnancies.

"Doing it for the experience" is such a straw man.

[Anonymous]

I care very much about my birthing experiences. Just like I care very much about my sexual experiences.

I don't want to be raped. I prefer to be made love to. I'll accept just plain good, fun sex.

I feel the same way about birthing a baby.

I don't want to be ripped apart to birth a baby. I don't want to be cut open, for a c-section or an episiotomy.

I don't want to have anything roughly, forcefully slammed into my vagina - to check my cervix or for any other reason.

I don't want to be held down against my will, by hands or monitoring equipment or an IV line forcing me on my back to birth.

I don't want to be threatened or verbally abused: told that I'm killing my baby because I want to labor in my own way rather than in a way that's convenient to medical personnel.

I don't want to be drugged up in order to make things easier for someone else. And I don't want to be called names for choosing natural birth.

I want for the person assisting with my child's birth to be gentle, not rough; caring, not cruel; concerned about my well-being as well as my child's, not preoccupied with what time it is or whether there will be a lawsuit or countless other people that have to be tended to.

My birth experiences haven't been perfect. There have been complications. But, with both of my births, I felt as though I was being seen and respected as a person, not as a womb or a paycheck or an inconvenience. I felt as though I was treated with consideration. These are things that matter a great deal to me. And if I hadn't experienced them, how would I have been able to look at my children without anger and resentment? How would I have been able to treat them gently, with respect and consideration? How they got here is as important to me as the fact that they did get here. The journey matters, as does the destinati

[Anonymous]

Stupid trackpad. But, I can end this with destination.

I birthed with a CNM the first time and a CPM the second time, and have no regrets.

[Anonymous]

My birth experiences haven't been perfect. There have been complications. But, with both of my births, I felt as though I was being seen and respected as a person, not as a womb or a paycheck or an inconvenience. I felt as though I was treated with consideration. These are things that matter a great deal to me. And if I hadn't experienced them, how would I have been able to look at my children without anger and resentment? How would I have been able to treat them gently, with respect and consideration? How they got here is as important to me as the fact that they did get here. The journey matters, as does the destinati

I get most of this (although the italicized part escapes me - you treat them gently, with respect and consideration, because they're your children - that doesn't change because you've been wronged by others).

But here's the question - if focusing on the manner of the birth would have significantly increased the risks to your child, would you have still kept that focus? Or would you have accepted a less ideal experience to decrease yoru child's risks?

[Anonymous]

Anybody who equates a hospital birth (with an epidural or other interventions) with being forcibly raped has some serious mental problems...

[Anonymous]

And I should add (to 16:09 PP) - if you've never experienced birth in the hospital setting with an OB, why in the world would you think that the god-aweful picture you are painting is even remotely accurate.

I will say this again - you are really doing a disservice to homebirths by spouting out such total BS and fear mongering about hospitals.

[Anonymous]

To 16:09 - I agree with not being forced to undergo unwanted procedures. I'm just not sure what it has to do with this case.

[Anonymous]

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Anonymous wrote:The fact that certain posters can't seem to understand that the risks (c-section risks versus head entrapment risks) were in no way comparable in terms of the likelihood of them happening is extremely frustrating.

Its the old planes versus cars saw -- more likely to die in a car crash than a plane crash, but some people still can't get over their perceived fears and recognize that they assume more risk every time they take a drive than when they fly.

And thank God that there are some people (thanks Deb) who are more concerned about ensuring the ethical behavior of their co-professionals than about closing ranks and pretending that there are no concerns about Karen Carr's course of action.

13:16 here. You hit the nail on the head.

I pretty much agree with this, BUT I am reserving judgment here because we do NOT know if there were extenuating circumstances here that made C-section a very undesirable option for this mother. There ARE women for whom c-sections are much riskier/traumatic than average. I think everyone has a right to discuss the issues in this thread (and I think it's a good thing), but to sit back and place blame on anyone without knowing all the facts is not fair or just. None of us know what really happened...and if anyone here does, it's not like they're going to actually say...what a breech of trust that would be to this woman and her family. I wouldn't be talking about someone I knew personally like this, would you?

Thank you. Excellent point.

What extenuating circumstance on Earth could have possibly made a home birth with an illegal CPM for an unbelievably high risk pregnancy (43 y/o, first time mom, breech baby) more desirable than a more medicalized birth.

The fact is that this woman already risked out of a home birth (by Birth Care). Instead, she went midwife shopping, and found an illegal one who would do it, and she found a birth assistant who was looney enough to attend this disaster, when all signs pointed to the fact that it was going to be an dangerous birth.

Well, I don't know, what if she had a heart condition that made anesthesia very dangerous for her, what if she was the type of patient who would normally risk out of c-section (they exist). She'd have to weigh her options...and maybe they were very limited. Perhaps because vaginal would be less risky for her, and she wasn't able to find a skilled OB to deliver her baby vaginally, she took her chances with a midwife who was experienced in delivering breech babies vaginally. I DON'T KNOW THE FACTS. Do you? Why does this have to be about blaming someone instead of discussing hypothetical situations? The former is just petty (and CRUEL imo), and the latter is actually informative.

First, they don't even put you under full anesthesia for a c-section. Second, if she would normally risk out of a c-section, don't you think that a really top-notch high-risk OB would be able to control for this? Or make better attempts to control for this than an illegal, rogue CPM delivering high-risk babies at home? I mean seriously? You sound like a buffoon.

Some of these hypotheticals people are discussing are just ridiculous.

The decision to just take your chances on your kitchen floor in this situation just seems absolutely nuts.

There is nothing diificult to understand about this - for some women the statistical risk from a c-section, for whatever reason, is higher than the statistical risk from a vaginal frank breech birth. So to make up numbers, lets say because you have a bleeding disorder, you have a 1% risk of dying from a c-section. Not inconcievable - major surgery is very dangerous for some people. The risk of the baby dying from a vaginal frank breech birth (over a c-section) is .5% (also made that up, don't know what it is). If you make the fairly logical decision that you want to do what carries the lowest risk of death period, then you choose the vaginal breech. But because there are no OBs who know how to do this, your only option is a CPM. Do you still judge the mother so harshly? Or is she not allowed to value her own life at all? Just because she had a bad outcome does not mean she made the illogical choice - WE DON'T KNOW THE FACTS.

so you are suggesting the better option for a woman with a bleeding condition and breech fetus is a home birth with a CPM??

*Bangs head against wall*.

What OB or hospital would take her and do a vaginal breech birth? If that option exists, by all means tell us where. Other than c-section, what would you have her do? OBs will not take high-risk patients near their delivery dates, and very few know how to deliver a vaginal breech birth.

[Anonymous]

16:09 here

http://myobsaidwhat.com/
That's just the latest thing I've been reading. I've read hundreds of birth stories over the years, as well as heard numerous horror stories from people in person. The absolute worst took place in hospitals. I don't have to have gone into a warzone to know that's not where I want to be.
Now, I've said what I had to say. I have no reason to explain myself or my decisions to anyone here. Especially when I'm just going to be attacked for my point of view. I just wanted to share that some of us have no problem with wanting a good birth experience and a good outcome, and find both to be very important. I'll let you all go back to your flaming and woman-hating now. I'll make sure to donate more money to Karen Carr's defense in your names.

[Anonymous]

What OB or hospital would take her and do a vaginal breech birth? If that option exists, by all means tell us where. Other than c-section, what would you have her do? OBs will not take high-risk patients near their delivery dates, and very few know how to deliver a vaginal breech birth. \

That apparently wasn't an option. Perhaps it should be, but it wasn't. So, once again - "so you are suggesting the better option for a woman with a bleeding condition and breech fetus is a home birth with a CPM??"

[Anonymous]

And I should add (to 16:09 PP) - if you've never experienced birth in the hospital setting with an OB, why in the world would you think that the god-awful picture you are painting is even remotely accurate.

Because she heard it from the homebirther crowd! The same people who fed this exact line of bullshit to the mom in this case and made her so afraid of hospitals that she chose a birth experience that killed her baby.

And if I hadn't experienced them, how would I have been able to look at my children without anger and resentment?

You would look at your children differently if you had to have a c-section? SERIOUSLY?

A good friend of mine desperately wanted a "natural" birth and had the doula and everything to go with it. For various reasons which I don't recall exactly but do remember thinking they were valid, both her children were delivered via c-section despite her every effort to the contrary. She perceived these circumstances as her own failure to be woman enough to do the natural thing, and it launched her into a prolonged depression which threatened her health and ended her marriage. All because of bullshit from people who compare having a baby in the hospital to rape. Unbelievable.

[Anonymous]

Anonymous wrote:

I am SO tired of the repeated assumption running throughout this entire thread that the baby would have survived a c/s. No, the risk of a c/s does NOT pertain only to the mother. Babies can and do die as a direct result of a c/s.
My second child was in the breech position when I went into labor. While I did (and still do) believe that a vaginal birth is a viable option for a breech presenting baby, I also would never trust any care provider (OB or otherwise) who does not have vaginal breech birth training and experience. As my OB at the time did not, I agreed to a c/s. Unfortunately, while being extracted from my uterus, my baby's head became *entrapped*. After several minutes, the OB finally had to slice my uterus vertically in order to free my baby. He was blue and lifeless.
An entrapped head can happen in BOTH a vaginal and a c/s birth. The myth that a c/s is always the safe alternative to a vaginal birth for a breech presenting baby is just that...a myth. I've had 2 c/s for breech presentation....not once did any OB ever mention this as a possibility.
Thankfully, my son survived. However, had he not, I doubt any police would have shown up to arrest the OB despite the fact that this injuries were a *direct* result of the c/s which had been essentially forced/coerced (I've left out many details leading up to the c/s). It wouldn't have mattered that the OB had less experience than Karen. It wouldn't have mattered that both situations are perfectly *legal* under VA law.
Really, enough with the falsehood that a c/s would have guaranteed a different outcome.

I am honestly sorry that you had a scary, bad experience with your c-section. I'm also saddened that you feel it was forced upon you/or that you were coerced, and whether that was the case or not, unfortunately you feel that way, and that's what matters in the end.

Nonetheless, my question is: Is your son NOW completely healthy, of normal intelligence, or did he suffer anoxic brain injury?
If he is healthy, I assure you - several minutes did not pass, to get your son's head out! I have seen this happen in the operating room and it takes only seconds to widen the incision. Were you in direct view of your abdomen? During an awake surgery you are in a scary helpless situation, seconds may seem like minutes. Your baby would not have survived several minutes without oxygen (did he have to have CPR?), and it does not nearly take that long to widen the incision- it should never take that long to widen the incision! Of course I wasn't there ... but I think your overall unhappiness about feeling forced in to a c-section you never wanted may have made this a worse memory than it was if recounted by someone else who was in the room at at that time.

But what may have happened if you had been at home and the head had become entrapped as happens with 8-10% of vaginal breech deliveries?

I am also saddened how much you hate your OB years after, with you and your child both healthy - I presume?-, so much that you would like him/her arrested and thrown into jail it appears?? I hope that is not really how you feel??

Not pertaining to you, but the general sense I get from many discussing here..: When even patients who have a great outcome after a difficult situation have so much hatred, mistrust and ill-will towards OBs and other in-hospital providers, requesting statistically more risky courses of action, yet ready to sue in a heartbeat, who wants to be in those professions for years to come? In an era where medical malpractice premiums for OBs range between $50,000 and $200,000 per year depending on state and where many counties in other states have OBs leaving their practices altogether, and you can hardly find any, I can't help but express my gratitude towards those professionals I have encountered over the years that were kind, and highly skilled, still practicing in this demanding profession.

This is a great example of why, without all the facts (from all sides), we should be careful about judgment of the situation. It absolutely was several minutes. My husband was there as was my doula (both could clearly see exactly what was happening). We've also read the op report. They had to page someone from a different part of the hospital...that alone can take several minutes. My son was blue, limp, not breathing and did require resuscitation. My feelings play no part in the facts as stated.

I do not hate the OB nor do I want her thrown in jail....I never said those things. I was simply drawing a parallel between the two situations in order to show the absurdity of Ms. Carr's arrest.

All that aside, my point that head entrapment can happen with a c/s too...a c/s is no guarantee of safety.

Not touching the mistrust of HCPs discussion. I could write a novel that goes way beyond the scope of this discussion.