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

[Anonymous]

To all the people who are concerned about the level of training that CPMs receive - there are variations. Sure there are the ones who learn in the car on the way to the birth. There are also schools, most of which are 3 years of training. The one I am thinking of in particular is 2 years of academic work, in which the student midwives DO learn the anatomy and physiology of labor and delivery (that's for the PP who is concerned that they are all operating on a basis of trial and error) and as in any clinical setting, they do a lot of practical learning.

I think that it's really important to both care deeply about what you do and actually be knowledgeable about it, but I don't think that going to nursing school and then continuing on to get a Master's degree in Midwifery is the ONLY way to become qualified. If anything, I think that requirement is a bit of a hinderance to people who really only want to catch babies. It does make sense for midwives to know first aid things for newborns - defined by whatever criteria you want - but I don't think that it is absolutely necessary for them also to have done clinicals in elder care or orthopedics or psychiatry (okay, maybe SOME psychiatry ). I think that that's the one of the main differences between midwifery education many are touting in Europe and midwifery education here - in Europe, it is possible to go do very rigorous academic and professional medical training just in midwifery. But it's not nursing school. It's not (always) a Master's degree. As an example, Anne Thiel who does the prenatal yoga classes at Tranquil Space in Dupont is a German midwife. She has delivered hundreds of babies and is professionally trained in her country, but she's not a RN so she doesn't deliver babies in the US. It would be really nice if there was more than one way to become qualified, and I think it would go a long way toward ensuring that there are more avenues of accountability and less reason for women to go underground.

Home birth is not for everyone. I was born at home in 1981 as were my siblings years later, but I personally was not comfortable with a home birth for my first baby, despite knowing intellectually all the reasons for and against birthing at home. I couldn't get comfortable with the idea, and so we chose to go to a birth center instead. I will reconsider the issue for my next baby, and if medical complications arise, I will likely err on the side of caution. It is both depressing and baffling to me how much hostility and derision is coming out on this thread towards the choices of other women, though frankly I don't know why I'm surprised. There is so much misinformation out there surrounding this issue that I am kind of happy this thread exists. I was glad to hear from the new mom (congrats, by the way!) that she felt educated by this thread. I hope that many of you reading will think about these things and try to see past your own comfort zone to learn something new.

[Anonymous]

Anonymous wrote:"If you think it's ok that a person with cancer might have the right to choose not to go to doctors and may, instead, go to a homeopath or an herbalist, or an acupuncturist, or even a snake oil salesman because that person is the only person who should be making these choices for herself, then you should be willing to allow pregnant women the choice of going to a lay midwife."

They can go see those people, but those people cannot tell the patient that they will cure their cancer -- that is called fraud. Arguably, if those assertions resulted in the patient's death, there might be some charges with regard to manslaughter (hey -- wasn't there a L&O episode about that?)

If a lay midwife represents that there should be no concern about a vaginal breech delivery (or a delivery of any kind) that is also fraud.

That's true but there is no reason to believe that Karen Carr committed fraud. I am not sure if fraud is one of the charges against her but again, innocent until proven guilty. According to all of her former clients who have posted on this forum and others, she is very clear about risks. She provides a service that some women want but she does not promise a good result.

[Anonymous]

Anonymous wrote:"If you think it's ok that a person with cancer might have the right to choose not to go to doctors and may, instead, go to a homeopath or an herbalist, or an acupuncturist, or even a snake oil salesman because that person is the only person who should be making these choices for herself, then you should be willing to allow pregnant women the choice of going to a lay midwife."

They can go see those people, but those people cannot tell the patient that they will cure their cancer -- that is called fraud. Arguably, if those assertions resulted in the patient's death, there might be some charges with regard to manslaughter (hey -- wasn't there a L&O episode about that?)

If a lay midwife represents that there should be no concern about a vaginal breech delivery (or a delivery of any kind) that is also fraud.

I am hoping that no care provider anywhere is telling anyone that he/she can cure cancer or guarantee a healthy baby?

[Anonymous]

Anonymous wrote:

Anonymous wrote:This thread has been on my mind, probably because I was 39 weeks when it started. I was planning to give birth in a hospital all along but I very much enjoyed the diversity of opinions. The thread also scared me a little. FF to Monday. I gave birth to a baby boy who was positioned with his hand over his face ( elbow at an angle.) I pushed for 4 hours and required intervention because of the baby's heart rate. I was very thankful to be in a hospital. I know this is just my experience and in no way provides any type of statistic, I just can't imagine having experienced this event at home.

Well, at home, with nuchal hands often they have you get on your knees and forehead with your butt up in the air to help baby disengage from your pelvis, meanwhile they can do some rebozo work with jiggling and lifting your belly to get baby to bring his hand down, or sometimes they can reach in and push baby's hand out of the way if he's already come through the pelvis like that. (This can be done at a hospital with a doula, too.) Guessing that these options were not presented to you?

I'm sorry, but when I became a certified doula, I was not taught to reach inside mom and push the baby's hand out of the way. This is the whole problem folks. Doula, birth assistant, lay midwife, or whatever...where is the scope of practice? Who is accountable for what? As a doula, I often use the rebozo to assist with COMFORT measures, but not to change fetal presenation, etc. - that's not the role of a doula plain and simple! So quit confusing people.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This thread has been on my mind, probably because I was 39 weeks when it started. I was planning to give birth in a hospital all along but I very much enjoyed the diversity of opinions. The thread also scared me a little. FF to Monday. I gave birth to a baby boy who was positioned with his hand over his face ( elbow at an angle.) I pushed for 4 hours and required intervention because of the baby's heart rate. I was very thankful to be in a hospital. I know this is just my experience and in no way provides any type of statistic, I just can't imagine having experienced this event at home.

Well, at home, with nuchal hands often they have you get on your knees and forehead with your butt up in the air to help baby disengage from your pelvis, meanwhile they can do some rebozo work with jiggling and lifting your belly to get baby to bring his hand down, or sometimes they can reach in and push baby's hand out of the way if he's already come through the pelvis like that. (This can be done at a hospital with a doula, too.) Guessing that these options were not presented to you?

I'm sorry, but when I became a certified doula, I was not taught to reach inside mom and push the baby's hand out of the way. This is the whole problem folks. Doula, birth assistant, lay midwife, or whatever...where is the scope of practice? Who is accountable for what? As a doula, I often use the rebozo to assist with COMFORT measures, but not to change fetal presenation, etc. - that's not the role of a doula plain and simple! So quit confusing people.

I am pretty sure that person meant that the care provider reaches in.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This thread has been on my mind, probably because I was 39 weeks when it started. I was planning to give birth in a hospital all along but I very much enjoyed the diversity of opinions. The thread also scared me a little. FF to Monday. I gave birth to a baby boy who was positioned with his hand over his face ( elbow at an angle.) I pushed for 4 hours and required intervention because of the baby's heart rate. I was very thankful to be in a hospital. I know this is just my experience and in no way provides any type of statistic, I just can't imagine having experienced this event at home.

Well, at home, with nuchal hands often they have you get on your knees and forehead with your butt up in the air to help baby disengage from your pelvis, meanwhile they can do some rebozo work with jiggling and lifting your belly to get baby to bring his hand down, or sometimes they can reach in and push baby's hand out of the way if he's already come through the pelvis like that. (This can be done at a hospital with a doula, too.) Guessing that these options were not presented to you?

I'm sorry, but when I became a certified doula, I was not taught to reach inside mom and push the baby's hand out of the way. This is the whole problem folks. Doula, birth assistant, lay midwife, or whatever...where is the scope of practice? Who is accountable for what? As a doula, I often use the rebozo to assist with COMFORT measures, but not to change fetal presenation, etc. - that's not the role of a doula plain and simple! So quit confusing people.

I am pretty sure that person meant that the care provider reaches in.

And if you have never done rebozo to change fetal presentation, then, that's the whole point of rebozo/spinning babies is it not? If a midwife tells you to jiggle or lift mom's belly while she grabs baby's head and turns it to OA, do you not do it?

[Anonymous]

Anonymous wrote:

Anonymous wrote:This thread has been on my mind, probably because I was 39 weeks when it started. I was planning to give birth in a hospital all along but I very much enjoyed the diversity of opinions. The thread also scared me a little. FF to Monday. I gave birth to a baby boy who was positioned with his hand over his face ( elbow at an angle.) I pushed for 4 hours and required intervention because of the baby's heart rate. I was very thankful to be in a hospital. I know this is just my experience and in no way provides any type of statistic, I just can't imagine having experienced this event at home.

Well, at home, with nuchal hands often they have you get on your knees and forehead with your butt up in the air to help baby disengage from your pelvis, meanwhile they can do some rebozo work with jiggling and lifting your belly to get baby to bring his hand down, or sometimes they can reach in and push baby's hand out of the way if he's already come through the pelvis like that. (This can be done at a hospital with a doula, too.) Guessing that these options were not presented to you?

Actually I did all of those things. Being on my hands and knees made the baby's heart rate decelerate even more. The Dr tried to manipulate the baby both externally and internally. Trust me when I say this would have been a dangerous situation at home.
BTW I would have been a fine candidate for a home birth.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This thread has been on my mind, probably because I was 39 weeks when it started. I was planning to give birth in a hospital all along but I very much enjoyed the diversity of opinions. The thread also scared me a little. FF to Monday. I gave birth to a baby boy who was positioned with his hand over his face ( elbow at an angle.) I pushed for 4 hours and required intervention because of the baby's heart rate. I was very thankful to be in a hospital. I know this is just my experience and in no way provides any type of statistic, I just can't imagine having experienced this event at home.

Well, at home, with nuchal hands often they have you get on your knees and forehead with your butt up in the air to help baby disengage from your pelvis, meanwhile they can do some rebozo work with jiggling and lifting your belly to get baby to bring his hand down, or sometimes they can reach in and push baby's hand out of the way if he's already come through the pelvis like that. (This can be done at a hospital with a doula, too.) Guessing that these options were not presented to you?

Actually I did all of those things. Being on my hands and knees made the baby's heart rate decelerate even more. The Dr tried to manipulate the baby both externally and internally. Trust me when I say this would have been a dangerous situation at home.
BTW I would have been a fine candidate for a home birth.

Well, that provider did right by you and I'm glad to hear it. As a doula, it feels good to see care providers really doing everything possible to help moms and babies, including the unconventional things. (BTW I've seen several hospital transfers for this and also several times the fetal manipulation/repositioning works and baby comes at home)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This thread has been on my mind, probably because I was 39 weeks when it started. I was planning to give birth in a hospital all along but I very much enjoyed the diversity of opinions. The thread also scared me a little. FF to Monday. I gave birth to a baby boy who was positioned with his hand over his face ( elbow at an angle.) I pushed for 4 hours and required intervention because of the baby's heart rate. I was very thankful to be in a hospital. I know this is just my experience and in no way provides any type of statistic, I just can't imagine having experienced this event at home.

Well, at home, with nuchal hands often they have you get on your knees and forehead with your butt up in the air to help baby disengage from your pelvis, meanwhile they can do some rebozo work with jiggling and lifting your belly to get baby to bring his hand down, or sometimes they can reach in and push baby's hand out of the way if he's already come through the pelvis like that. (This can be done at a hospital with a doula, too.) Guessing that these options were not presented to you?

Actually I did all of those things. Being on my hands and knees made the baby's heart rate decelerate even more. The Dr tried to manipulate the baby both externally and internally. Trust me when I say this would have been a dangerous situation at home.
BTW I would have been a fine candidate for a home birth.

Well, that provider did right by you and I'm glad to hear it. As a doula, it feels good to see care providers really doing everything possible to help moms and babies, including the unconventional things. (BTW I've seen several hospital transfers for this and also several times the fetal manipulation/repositioning works and baby comes at home)

The original poster stating she pushed for 4 hours obviously debunks the people saying an OB will only let you push for a max of 3. This just shows how misinformed so many are!

I'm glad your baby is doing well and the doctors were able to take care of your needs in the hospital. This is precisely why I plan to have my baby at a hospital because of the 'what if' scenarios. I don't want to have to wait for an ambulance and always wonder if those extra minutes caused this issue or that issue.

[Anonymous]

Here's the deal folks - you can have as little or as much intervention as you want in the hospital. Talk with your practitioner!! We don't force anything on anyone - we give you the options, the risks and you can make the decisions. BUT in my particular hospital setting when your uterus ruptures during your labor as a VBAC we can get you to the OR and your baby out in under 7 min. Any longer would cost the life of mom or baby or both. Is uterine rupture rare even in a VBAC? Sure - about 1 in 500. But someone has to be that one and if you are at home someone will die - probably both of you. Do other bad things happen in what would otherwise appear to be low risk pregnancies - absolutely. And there's not a thing you can do about any of them at home. Is your "birth experience" worth dying over??? I have taken care of too many train wrecks in my 20+ yrs. as an OB nurse caused by CPMs and the like deciding they know better than thousands of years of medical advances. Labor at home until - oops, didn't expect that in your "low risk" pregnancy - let's dash to the hospital and get those nice people to clean this mess up. Put your baby first and get the safest care possible.

[Anonymous]

Anonymous wrote:Here's the deal folks - you can have as little or as much intervention as you want in the hospital. Talk with your practitioner!! We don't force anything on anyone - we give you the options, the risks and you can make the decisions. BUT in my particular hospital setting when your uterus ruptures during your labor as a VBAC we can get you to the OR and your baby out in under 7 min. Any longer would cost the life of mom or baby or both. Is uterine rupture rare even in a VBAC? Sure - about 1 in 500. But someone has to be that one and if you are at home someone will die - probably both of you. Do other bad things happen in what would otherwise appear to be low risk pregnancies - absolutely. And there's not a thing you can do about any of them at home. Is your "birth experience" worth dying over???

"There have been no reported maternal deaths due to uterine rupture. Overall, 14 to 33 percent of women will need a hysterectomy when the uterus ruptures. Approximately 6 percent of uterine ruptures will result in perinatal death. This is an overall risk of intrapartum fetal death of 20 per 100,000 women undergoing trial of labor. For term pregnancies, the reported risk of fetal death with uterine rupture is less than 3 percent. " -- http://consensus.nih.gov/2010/vbacstatement.htm

I think the risk of UR might be just a little bit higher than 1 in 200 for mothers with one prior c/s and no prior cesarean. I'm willing to grant that the mortality statistics in the NIH consensus statement probably reflect the availability of intervention within hospitals, but I would be surprised if c-section in most hospitals was regularly done within 7 minutes of suspicion of UR (let alone 7 minutes of the UR itself) and that this is the sole reason the deaths are so rare. I just don't think it's at all true that "probably both of you" will die in the event of a UR at home, or in the hospital.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Here's the deal folks - you can have as little or as much intervention as you want in the hospital. Talk with your practitioner!! We don't force anything on anyone - we give you the options, the risks and you can make the decisions. BUT in my particular hospital setting when your uterus ruptures during your labor as a VBAC we can get you to the OR and your baby out in under 7 min. Any longer would cost the life of mom or baby or both. Is uterine rupture rare even in a VBAC? Sure - about 1 in 500. But someone has to be that one and if you are at home someone will die - probably both of you. Do other bad things happen in what would otherwise appear to be low risk pregnancies - absolutely. And there's not a thing you can do about any of them at home. Is your "birth experience" worth dying over???

"There have been no reported maternal deaths due to uterine rupture. Overall, 14 to 33 percent of women will need a hysterectomy when the uterus ruptures. Approximately 6 percent of uterine ruptures will result in perinatal death. This is an overall risk of intrapartum fetal death of 20 per 100,000 women undergoing trial of labor. For term pregnancies, the reported risk of fetal death with uterine rupture is less than 3 percent. " -- http://consensus.nih.gov/2010/vbacstatement.htm

I think the risk of UR might be just a little bit higher than 1 in 200 for mothers with one prior c/s and no prior cesarean. I'm willing to grant that the mortality statistics in the NIH consensus statement probably reflect the availability of intervention within hospitals, but I would be surprised if c-section in most hospitals was regularly done within 7 minutes of suspicion of UR (let alone 7 minutes of the UR itself) and that this is the sole reason the deaths are so rare. I just don't think it's at all true that "probably both of you" will die in the event of a UR at home, or in the hospital.

Curious: Are you a medical professional? Dr or nurse?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Here's the deal folks - you can have as little or as much intervention as you want in the hospital. Talk with your practitioner!! We don't force anything on anyone - we give you the options, the risks and you can make the decisions. BUT in my particular hospital setting when your uterus ruptures during your labor as a VBAC we can get you to the OR and your baby out in under 7 min. Any longer would cost the life of mom or baby or both. Is uterine rupture rare even in a VBAC? Sure - about 1 in 500. But someone has to be that one and if you are at home someone will die - probably both of you. Do other bad things happen in what would otherwise appear to be low risk pregnancies - absolutely. And there's not a thing you can do about any of them at home. Is your "birth experience" worth dying over???

"There have been no reported maternal deaths due to uterine rupture. Overall, 14 to 33 percent of women will need a hysterectomy when the uterus ruptures. Approximately 6 percent of uterine ruptures will result in perinatal death. This is an overall risk of intrapartum fetal death of 20 per 100,000 women undergoing trial of labor. For term pregnancies, the reported risk of fetal death with uterine rupture is less than 3 percent. " -- http://consensus.nih.gov/2010/vbacstatement.htm

I think the risk of UR might be just a little bit higher than 1 in 200 for mothers with one prior c/s and no prior cesarean. I'm willing to grant that the mortality statistics in the NIH consensus statement probably reflect the availability of intervention within hospitals, but I would be surprised if c-section in most hospitals was regularly done within 7 minutes of suspicion of UR (let alone 7 minutes of the UR itself) and that this is the sole reason the deaths are so rare. I just don't think it's at all true that "probably both of you" will die in the event of a UR at home, or in the hospital.

Curious: Are you a medical professional? Dr or nurse?

You are just so smart aren't you? Yes, I'm a doctor, a nurse, and a medical professional, but I prefer the term Certified Professional Midwife. My training wasn't wasted in a classroom with fancy high fallutin PhDs and professors and know-it-alls. I learned as an apprentice to a really wise midwife and I studied the ancient art of midwifery in the reality-based classroom of life and living and birth goddesses not some chemically laden, plastic warehouse with asbestos tiles and artificial lighting and a sprinkler system for its toxic artificial lawn. Some babies just aren't meant to live outside the womb. This is unfortunate for the parents and for the midwife who has to figure this out during a traumatic episode. But some babies die in hospitals too so surely it must be a acceptable occurrence. I can always tell there is trouble afoot when my crystal glows orange as I drag it over the mom's nipples. I don't need a machine and fancy radioactive plastics to diagnose trouble. My crystal tells me everything I need to know.

[Anonymous]

Honeybunch, I think I can fly, too. But that crash landing, it hurts like hell. There is a reason they invented airplanes...and hospitals.

Look at all those poor third world women, wishing for medical help. They just don't buy the birthing goddess thing. At all.

[Anonymous]

After we replace your blood volume, your poor anoxic baby has cp and the iq of a mosquito, you can't have any more children and you spend three weeks in hospital with complications: some things are worse than death.