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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So if preventing unsafe practice is why midwives are supposed to be licensed and regulated, why did they wait for a death to crack down on her? Those who are familiar with the "homebirth community" know she could have been a lot more underground.

What should they have done? Sent in a pregnant police officer undercover to have a homebirth and catch one person practicing midwifery without a license? If no one complains, this really isn't on the radar of law enforcement.

Yes, law enforcement should do that. This is a public health threat. People with no medical education, no liability insurance, no state license, and no supervision are putting out a shingle and portraying themselves as "experts in normal birth." A lot people think that a midwife is a midwife when in fact, there are two types of midwives: (1) Certified Nurse Midwives with legitimate degree and schooling and (2) law midwives who learn from buddies or from a home study correspondence course.

Law enforcement will have to be involved once a child or a mother dies. If this really is illegal, and lay midwifery is specifically illegal in a dozen states, then why shouldn't law enforcement get involved BEFORE there is a dead baby or dead mama?

This all sounds abstract. Let's say an otherwise healthy baby become a vegetable because of a home birth gone wrong. The baby will need a lifetime of caregiving shifts by dedicated relatives, physical therapy, special equipment, wheelchairs, bathtubs with a lift. Maybe all of this will cost $3.7 million over the course of the baby's expected life. The lay midwife doesn't have liability insurance or much less a city business license because she was practicing illegally. Let's say this isn't someone else's child. Let's say it's your niece or your grandson.

Ok, let's get our facts straight. Several states now license CPMs, including VA. It is only a few states where attending a home birth is explicitly illegal (but it is illegal for the midwife to attend, not for the parents to choose home birth, even in those states), and that doesn't matter here because this birth took place in VA. This particular midwife chose not to be licensed in VA, but she could have been had she applied for the license. We can haggle over the CPM credential, but I think it is a stretch to say that it includes "no medical education." Licensed CPMs attending home births is NOT illegal in VA. They are also not required by law to carry liability insurance. Ms. Carr was practicing illegally because she chose not to be licensed, but there are plenty of licensed CPMs in VA who attend home births legally and are reimbursed by insurance for doing so because they are licensed providers.

I appreciate you trying to insert falsehoods into my written statement. I never said that homebirth was illegal. I said that in a dozen states it is specifically illegal to practice lay midwifery. These people practice under the radar and make decisions in which the life and safety of the mother and baby often falls as a secondary thought. There is documented evidence of medical professionals who say there ERs often get homebirths gone wrong in which the lay midwife holds off crucial (professional) medical help too long because she is afraid of getting busted. It is also DEAD ON ACCURATE to say that nothing in the CPM regulations requires any sort of formal medical education. This is why NARM doesn't require a CPM applicant to have a high school education or college degree. To obtain a CPM certificate a lay midwife must attend births. There often is training and apprenticeships involved, but there is no accredited legit school that a CPM applicant must attend. Some lay midwives learn about this through the Ancient Art Midwifery Institute, a home study online course (with a 1995 Web site) that is not accredited. There is no formal education required. Sorry, that's a fact, Jack.

[Anonymous]

I started out this discussion very pro-Karen Carr (she was my midwife and was great at my son's birth) but I am questioning the wisdom of my decision now. I thank my lucky stars that everything went fine at his birth. The points about liability insurance and the possibility of waiting too long to go to a hospital because of fear of exposure resonate with me and make sense.

I still want to hear the testimony of the parents and Karen at a trial before deciding how I feel about this particular case. On its face, it looks like Karen made a very bad decision to take on such high risk clients.

I wonder what (if any) effect this case will have on the CPM credential. I predict a rise in business for CNMs in the DMV area and maybe nationwide depending on how much publicity this case gets. If I have another baby (and if I'm "low risk"), I will probably go with a CNM who is experienced in home birth, who works with doctors regularly and who has liability insurance.

[Anonymous]

Virginia does not require liability insurance of any of its licensed providers in order to have a license. Most CPMs across the country do not have it - would you pay an extra $1-2K for your birth for your CPM to carry it?

[Anonymous]

Anonymous wrote:Virginia does not require liability insurance of any of its licensed providers in order to have a license. Most CPMs across the country do not have it - would you pay an extra $1-2K for your birth for your CPM to carry it?

Doesn't Florida now require insurance for CPMs? Why should they not have to pay for malpractice? Where is the quality control?

[Anonymous]

Practicing midwifery with no insurance is putting her own family's financial well-being on the line - not a decision which makes her look very responsible. Carrying insurance doesn't mean you're expecting to be sued, it means you're protecting your family.

[Anonymous]

Anonymous wrote:Doesn't Florida now require insurance for CPMs? Why should they not have to pay for malpractice? Where is the quality control?

Florida also subsidizes it.

[Anonymous]

Anonymous wrote:Practicing midwifery with no insurance is putting her own family's financial well-being on the line - not a decision which makes her look very responsible. Carrying insurance doesn't mean you're expecting to be sued, it means you're protecting your family.

At an extra $1-2K/birth? When people are already calling around to other midwives for the cheapest fee? It would put the midwives out of business.

[Anonymous]

How do CNMs manage to afford insurance? Or are they also uninsured for homebirth?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Practicing midwifery with no insurance is putting her own family's financial well-being on the line - not a decision which makes her look very responsible. Carrying insurance doesn't mean you're expecting to be sued, it means you're protecting your family.

At an extra $1-2K/birth? When people are already calling around to other midwives for the cheapest fee? It would put the midwives out of business.

Do people really choose midwives because they are cheaper than OB's? It might add to the price of the birth, but it's the responsible thing to do.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Practicing midwifery with no insurance is putting her own family's financial well-being on the line - not a decision which makes her look very responsible. Carrying insurance doesn't mean you're expecting to be sued, it means you're protecting your family.

At an extra $1-2K/birth? When people are already calling around to other midwives for the cheapest fee? It would put the midwives out of business.

Do people really choose midwives because they are cheaper than OB's? It might add to the price of the birth, but it's the responsible thing to do.

I don't think price is the driving force for why most people choose midwives to attend their birth. I think it has more to do with birth preferences (hospital, home, birth center) and whether a "natural" childbirth is desired by the family. However I have heard some stories about uninsured people choosing homebirth because it is a lot less expensive than hospital birth. But I don't think that's the majority of cases.

[Anonymous]

I can only speak for myself, but I can tell you that I carry a 250k/1 million policy for myself, the CNM that works part time for me and the two RNs that work as our assistants. How do I afford it? I studied hard ( while raising a young family on my own),and have a baccalaureate as well as master's degree, I worked hard for a decade prior to opening a homebirth practice as a hospital-based CNM and I chose to open a homebirth practice in a state that allows me to do so legally and where there is a market for my practice.

I am also married to an attorney who advised me wisely

Deb O'Connell CNM, CPM, MS

Anonymous wrote:How do CNMs manage to afford insurance? Or are they also uninsured for homebirth?

[Anonymous]

Anonymous wrote:I can only speak for myself, but I can tell you that I carry a 250k/1 million policy for myself, the CNM that works part time for me and the two RNs that work as our assistants. How do I afford it? I studied hard ( while raising a young family on my own),and have a baccalaureate as well as master's degree, I worked hard for a decade prior to opening a homebirth practice as a hospital-based CNM and I chose to open a homebirth practice in a state that allows me to do so legally and where there is a market for my practice.

I am also married to an attorney who advised me wisely

Deb O'Connell CNM, CPM, MS

Anonymous wrote:How do CNMs manage to afford insurance? Or are they also uninsured for homebirth?

Thanks, that's what I was trying to figure out- insurance is available for homebirth providers.

For those saying that midwives will go out of business- what about everyone else who is a small business owner and has to buy insurance for her building/merchandise/employees? I don't think they can get away with saying that insurance will put them out of business and so they shouldn't have to buy it. CPMs may need to (as a group) figure out a business model that works with the cost of insurance figured in.

[Anonymous]

Anonymous wrote:

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.

Can I get an Amen?

[Anonymous]

Anonymous wrote:How do CNMs manage to afford insurance? Or are they also uninsured for homebirth?

Not all homebirth CNMs have insurance here. Not required by law.

[Anonymous]

Anonymous wrote:I can only speak for myself, but I can tell you that I carry a 250k/1 million policy for myself, the CNM that works part time for me and the two RNs that work as our assistants. How do I afford it? I studied hard ( while raising a young family on my own),and have a baccalaureate as well as master's degree, I worked hard for a decade prior to opening a homebirth practice as a hospital-based CNM and I chose to open a homebirth practice in a state that allows me to do so legally and where there is a market for my practice.

I am also married to an attorney who advised me wisely

Deb O'Connell CNM, CPM, MS

Anonymous wrote:How do CNMs manage to afford insurance? Or are they also uninsured for homebirth?

When I was planning for a birth center birth, I had to sign a document stating that I was aware of the risks (some of which were spelled out in the document itself). I assumed that this would lessen the midwives' liability in the event that something did go wrong.