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

[Anonymous]

While I think only knowing the absolute basic facts here that I likely would not have chosen the homebirth option myself in this case, I do think we need to keep in mind that this was likely an agonizing decision for the parents and one was that was not taken lightly in an effort to chase some birth fantasy. They thought they were making the best choice for their child based on what they knew and were told. That they don't feel they were guided correctly and that they had very few options due to the extreme lack of knowledge and experience with vaginal birth for breech babies should really be the discussion here. I'm fairly astounded by some of the blaming that is going on here in the total absence of anything but the most basic facts.

[Anonymous]

^^^^^ agreed.

[Anonymous]

In talking with a friend who is an OB, I learned that they are trained and have performed vaginal breech deliveries but they are not the norm. This is also not to suggest that they will do this for you but they have specialized tools to assist in guiding the head, know how to monitor you, know what to look for in terms of distress. With this said, they do not feel it is the safest way to deliver the baby and that is why the option is not given as they are trying to minimize the risk for both you and the child.

3 years later my OB still loves interacting with my child who they delivered. I feel that when you choose a good OB you form a special bond with them just as they form a bond with you and the child they brought into the world. They don't want anything to happen to your or the baby- not because of lawsuits but because of human nature.

[Anonymous]

In talking with a friend who is an OB, I learned that they are trained and have performed vaginal breech deliveries but they are not the norm. This is also not to suggest that they will do this for you but they have specialized tools to assist in guiding the head, know how to monitor you, know what to look for in terms of distress. With this said, they do not feel it is the safest way to deliver the baby and that is why the option is not given as they are trying to minimize the risk for both you and the child.

3 years later my OB still loves interacting with my child who they delivered. I feel that when you choose a good OB you form a special bond with them just as they form a bond with you and the child they brought into the world. They don't want anything to happen to your or the baby- not because of lawsuits but because of human nature.

This is simply not true. The ob/gyns may read about the procedures but as residents they learn through observing and assisting. As breech vaginal deliveries have not been done in this area and many others for a while now many residents have never seen one. Other ob/gyns may have seen a few but this does not equal training. A mid wife should know what to look for in terms of distress and monitoring. The value in the hospital setting, if more doctors knew how and were willing or allowed to perform a breech delivery is the quick access to the OR if distress occurs.

[Anonymous]

Anonymous wrote: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.

I gave birth in a hospital twice and at home for the last. For my second child, I delivered at Sibley. I came in ready to push, not because I labored so long at home but because my labor was extremely fast. I didn't want an epidural but was immediately told I needed an IV -- I refused; told not to push because my doctor wasn't there and the OB sitting in the room didn't want to deliver my baby; and then there was the nurse who felt it was necessary to push against my stomach until I was in so much pain that I pushed her away. I left Sibley came home and developed a horrendous rash over my abdomen and down my legs. It was extremely painful and I thanked GOd that I didn't have a c-section because I would have torn my stitches out scratching the whelps that were there. It took weeks for my body to get back to normal after that hospital delivery.

Was my baby fine? Yes and I'm extremely grateful for that, but that is part of why I didn't want to give birth in a hospital again. Yes, it was about my birthing experience and about not having the horrible after hospital experience so I could enjoy my baby's first few weeks instead of being in absolute pain. Now having said that do I know I got the rash from the hospital for sure, no. But seeing as none of the doctors I saw could really tell me what was going on, I have to think it was the hospital.

And to other posters, yes I had prenatal care with both my OB (who is FANTASTIC) and my midwife (gasp Karen Carr). I had ultrasounds and if I or my health care providers had thought there was a reason not to give birth at home I wouldn't have. And yes, my kids go to doctors and get their vaccinations and I don't eat organic food. I am a conservative Republican, not a hippie and I've never even dreamed of giving birth in the rain outside.

The people who really sound like buffoons are the ones who make such ridiculous across the board statements about all sides in this discussion.

[Anonymous]

Anonymous wrote:

This is simply not true. The ob/gyns may read about the procedures but as residents they learn through observing and assisting. As breech vaginal deliveries have not been done in this area and many others for a while now many residents have never seen one. Other ob/gyns may have seen a few but this does not equal training. A mid wife should know what to look for in terms of distress and monitoring. The value in the hospital setting, if more doctors knew how and were willing or allowed to perform a breech delivery is the quick access to the OR if distress occurs.

Is the type of distress most specific to breech likely to be addressed as soon as it needs to be with a homebirth transfer? Particularly with a midwife who works outside the medical system entirely?

I have heard of OBs doing attempted breech vaginal deliveries in the OR so that a c/s can be done truly as soon as possible if needed.

[Anonymous]

Anonymous wrote:

In talking with a friend who is an OB, I learned that they are trained and have performed vaginal breech deliveries but they are not the norm. This is also not to suggest that they will do this for you but they have specialized tools to assist in guiding the head, know how to monitor you, know what to look for in terms of distress. With this said, they do not feel it is the safest way to deliver the baby and that is why the option is not given as they are trying to minimize the risk for both you and the child.

3 years later my OB still loves interacting with my child who they delivered. I feel that when you choose a good OB you form a special bond with them just as they form a bond with you and the child they brought into the world. They don't want anything to happen to your or the baby- not because of lawsuits but because of human nature.

This is simply not true. The ob/gyns may read about the procedures but as residents they learn through observing and assisting. As breech vaginal deliveries have not been done in this area and many others for a while now many residents have never seen one. Other ob/gyns may have seen a few but this does not equal training. A mid wife should know what to look for in terms of distress and monitoring. The value in the hospital setting, if more doctors knew how and were willing or allowed to perform a breech delivery is the quick access to the OR if distress occurs.

Are you an OB? Just curious since you say it's simply not true.

[Anonymous]

Everyone is assuming that Karen was an "expert" on breech births but I am curious as to how many breech births she has actually attended.

Breech occurs in 3-4% of the population. So, if she has attended 1200 births, that means she can be expected to have seen 48 breech births over a her 15 year career (or a little over 3 per year).

I ski 3 times a year, but that's certainly not frequently enough to make me "expert" at it.

[Anonymous]

I've been on both sides- first birth was a terrible failed induction which led to unneccessary C-section. 2nd kid was a homebirth VBAC (hbac), and 3rd was a NECESSARY C-section for some complications that happened towards the end of the pregnancy. My 2nd section was actually easy as pie and everyone- nurses, OB, etc, were very caring and did everything I wanted them to (like put LO to the breast as soon as they rolled me into recovery, not giving me sedatives in my IV, etc). Totally different experience compared to my first section (prob didn't hurt that I really felt it was necessary this time around). I was on Motrin the 2nd day in the hospital and my recovery was much faster than the first time.

If I'm being completely honest, I did "drink the homebirth" koolaid when I was preparing for my hbac. I completely turned on hospital birth and scoffed at anyone who said they were going to birth in a hospital or not try for a vbac. My hbac was successful but long and difficult. I had complications in this 3rd pregnancy that I hadn't had in my 2nd, and decided that a hospital vbac would be best this time around. The complications grew serious and I agreed with the doctors that a C-section would be best this time around and I have no regrets. I was treated super in the hospital and had a private room. My nurses were amazing (with the exception of one young one who didn't seem to know what she was doing). One of my nurses was amazing, she is a lactation consultant on the weekends and helped me with breastfeeding since I had some trouble after the section (just so you know, breastfeeding has been VERY successful this time around!!!). I have nothing but good things to say about this last experience.

I've realized that you can have awesome and terrible birth experiences, whether at home or in the hospital. Above all though, my baby was the most important. I chose a conservative CNM for my hbac who I know would have transferred me in a heartbeat if she had noticed anything wrong. I would not have felt comfortable with a CPM, esp a "radical" one. My doula recommended Karen to me but my comfort level just wasn't there (nothing to do with her skill level but rather MY comfort level).

I think the mindless belief in either hospital or home birth is dangerous. There is good and bad in both, and I do believe both should be held accountable. This mama that lost her baby should not have attempted hb with her risk factors. I've read through this entire thread and all I can think about is what pain she must still be going through. I am so thankful my LO is okay, and I don't know if I would have had the same outcome this time if I had decided to try another hb. My gut was telling me during the whole pregnancy that I needed to be in the hospital and possibly have a section (I never had that same gut feeling with my hbac baby). As moms we HAVE to listen to our gut instinct. At the same time providers (whether MW or OB) HAVE to stop being so polarized!!! Karen should never have agreed to attend this mama's hb, IMO. She was wrong and should be held accountable, but I think 30 years for manslaughter is CRAZY! Rapists and murderers get less time. And the hb community needs to stop demonizing OBs and hospital births.

[Anonymous]

Anonymous wrote:
Karen should never have agreed to attend this mama's hb, IMO. She was wrong and should be held accountable, but I think 30 years for manslaughter is CRAZY! Rapists and murderers get less time.

30 years is probably the maximum sentence allowable by law, but very unlikely to be given. A few years ago in Northern Virginia, a man was convicted of *voluntary* manslaughter (not involuntary like the charge here) and sentenced to 10 years -- and he had stabbed someone multiple times, in the chest and back. I know this isn't the only charge she's facing, but that sentence still seems very unlikely.

[Anonymous]

Anonymous wrote:Everyone is assuming that Karen was an "expert" on breech births but I am curious as to how many breech births she has actually attended.

Breech occurs in 3-4% of the population. So, if she has attended 1200 births, that means she can be expected to have seen 48 breech births over a her 15 year career (or a little over 3 per year).

I ski 3 times a year, but that's certainly not frequently enough to make me "expert" at it.

You can't possibly know that. It may be she gets a lot of clients with breech presentations every year because so many have been turned away by doctors. I have heard that a lot of people seek her out at the last minute when they find that their other caregivers are recommending C-section. It's quite possible that she gets a very high percentage of the breech babies in the area.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Everyone is assuming that Karen was an "expert" on breech births but I am curious as to how many breech births she has actually attended.

Breech occurs in 3-4% of the population. So, if she has attended 1200 births, that means she can be expected to have seen 48 breech births over a her 15 year career (or a little over 3 per year).

I ski 3 times a year, but that's certainly not frequently enough to make me "expert" at it.

You can't possibly know that. It may be she gets a lot of clients with breech presentations every year because so many have been turned away by doctors. I have heard that a lot of people seek her out at the last minute when they find that their other caregivers are recommending C-section. It's quite possible that she gets a very high percentage of the breech babies in the area.

It's quite possible and even likely that her breech birth percentage is higher than 3-4% because of the reasons people seek to birth with her. But I can't believe it's possible that "a very high percentage" of any kind of babies are born with her. Women who are interested in vaginal breech are probably as a group more likely to be interested in homebirth, true, and they only have so many options. (I don't know how the licensed CPMs deal with breech.) Most women who have breech babies will just have the c-section and probably without argument. It it looks like there are only about 600-700 homebirths a year in Virginia.

[Anonymous]

http://www.sogc.org/guidelines/documents/gui226CPG0906.pdf

I havent seen this document in the discussion. It makes for very interesting reading. Canada officially has very recently (2009) moved away from performing auto-c-sections for most breech presentations. Their guideline also supports the mother's choice to decide, and insists that she not be abandonned in labor regardless of what that choice may be. They are also very specifically concerned that very valuable skills have been lost over the past ten years as the world has adopted what they now view as an unwise auto c-section policy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Everyone is assuming that Karen was an "expert" on breech births but I am curious as to how many breech births she has actually attended.

Breech occurs in 3-4% of the population. So, if she has attended 1200 births, that means she can be expected to have seen 48 breech births over a her 15 year career (or a little over 3 per year).

I ski 3 times a year, but that's certainly not frequently enough to make me "expert" at it.

You can't possibly know that. It may be she gets a lot of clients with breech presentations every year because so many have been turned away by doctors. I have heard that a lot of people seek her out at the last minute when they find that their other caregivers are recommending C-section. It's quite possible that she gets a very high percentage of the breech babies in the area.

It's quite possible and even likely that her breech birth percentage is higher than 3-4% because of the reasons people seek to birth with her. But I can't believe it's possible that "a very high percentage" of any kind of babies are born with her. Women who are interested in vaginal breech are probably as a group more likely to be interested in homebirth, true, and they only have so many options. (I don't know how the licensed CPMs deal with breech.) Most women who have breech babies will just have the c-section and probably without argument. It it looks like there are only about 600-700 homebirths a year in Virginia.

Yes, but I am under the impression that she practices in MD, DC, VA, and PA. I'm not saying she has attended thousands of breech births but I do think it's possible that she has attended well over 48 in her 18 year (not 15 year) career.

[Anonymous]

She may gain some breech births as people may seek her out, but she may lose others (people who would otherwise have delivered with her, but decide to go with a hospital or c-section due to breech birth risks).

Of course, her career being 18 years rather than 15 years just makes the numbers worse not better. That makes only 66-67 births a year -- even assuming she has more than double the population rate of breech birth (say 10 percent) that is still only 6 breech births a year.