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

[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??? 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.

I'm not going to speak to a home VBAC, which I'd never do, but as someone who homebirthed with a CNM (3 CNMs present, actually), there absolutely are "bad things" that can be handled at home, at least while a transfer is arranged. Some entirely at home. And many have warning signs that would result in a transfer before anything went poorly. But again, I'm talking about masters level degree care providers, not CPMs.

[Anonymous]

Mama Tao, is that you?

[Anonymous]

Anonymous wrote:

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.

I have been supporting the side of freedom of choice in this discussion and I have to say that this post really irritates me. I know it must be hard for CNMs, CPMs, and OBs to read this discussion. Everyone must be feeling defensive and rightfully so, but this kind of post is just uncalled for and doesn't help anyone navigate this complex issue. And that's if you are being sarcastic, PP. If you are being serious, then you are just nuts and everyone should ignore you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

I have been supporting the side of freedom of choice in this discussion and I have to say that this post really irritates me. I know it must be hard for CNMs, CPMs, and OBs to read this discussion. Everyone must be feeling defensive and rightfully so, but this kind of post is just uncalled for and doesn't help anyone navigate this complex issue. And that's if you are being sarcastic, PP. If you are being serious, then you are just nuts and everyone should ignore you.

The post is most certainly a poor attempt at satire. I bet the PP is feeling very clever.

[Anonymous]

Sadly, though the post may be satire, this statement:

"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."

Is taken straight from the NCB advocate playbook.

[Anonymous]

Anonymous wrote: 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.

This post tells me everything I need to know!

[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?

Something I posted requires health care professional credentials to make it true? I quoted from the National Institutes of Health website, and everything else I said was based on statistics and, yes, anecdotes of how real uterine rupture situations have unfolded. Becoming a doctor or nurse would be required to make my opinion a valid one that it's not likely true that *both* mother and baby will probably die from a uterine rupture that occurs at home? I said a couple of things here that prove I'm not just arguing from a preferred pro-VBAC conclusion: that the risk of UR is likely *higher* than the PP (a nurse) stated; and that I admit the mortality statistics given in the NIH statement most likely reflect the availability of intervention in hospitals, not homebirths. Doesn't mean if 6% of babies died in the hospital that "most" will die at home, or if none of the mothers died in the hospital that most will die at home!

[Anonymous]

Anonymous wrote:Before my son was born, I thought that the birth experience was all about me.

AMEN. Birth is part of parenthood, where NOTHING is about you anymore. It's going to hurt and you'll beg for it to be over - no experience is great. Safety first, however that needs to happen.

[Anonymous]

Interesting letter to the editor in the April 26th edition of the Post - written by MFMs Dr. Poggi and Dr. Ghidini. http://www.washingtonpost.com/opinions/at-home-births-carry-safety-concerns/2011/04/25/AFX0YKtE_story.html

"Women are drawn to home births because of concerns that a hospital delivery will result in a less natural and more “medicalized” experience. But it is important to recall that all that is natural, including intrapartum fetal death, is not necessarily desirable."

Totally agree with this - I can think of any number of things that occur in nature that are not desirable, like botulism and tetanus.

Go to any cemetery where people from centuries past are buried - you'll find a lot of gravestones of women and their babies who died in childbirth. Not from c-sections, not from medical intervention, but from natural childbirth. Dying in childbirth, stillbirth, infant death - all of these were accepted, and even expected, as a natural part of life. Numerous pregnancies and large families were common because of a lack of contraception but also because of an expectation that not all of the children would survive to adulthood.

Thank goodness for the medical advances that have made such tragedies far less common today.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Before my son was born, I thought that the birth experience was all about me.

AMEN. Birth is part of parenthood, where NOTHING is about you anymore. It's going to hurt and you'll beg for it to be over - no experience is great. Safety first, however that needs to happen.

I never thought that the birth experience was "all about me" but I never thought it WASN'T about me either.

[Anonymous]

The human body has a total of about 6 to 8 liters of blood ie 6000 to 8000 liters. A pregnant full term uterus receives approximately 600 cc per minute. When the uterus ruptures you have about 10 minutes to get the kid out and pack the uterus. I am an obgyn. I have had a a patient rupture her uterus. Both are fine. No ambulance will get you to the or fast enough. Let's stop all this foolishness. Home births are wonderful experiences for low risk patients. Vbacs, twins, malpresentation, primip breeches, previas, vasoprevia, succenturiate lobes, uncontrolled diabetics are not low risk. If you or your practitioner takes on the risk then you both should deal with the consequences including fetal and maternal death. Yes babies do die in the hospital but at least those parents can sleep knowing that they did everything they could to ensure a safe delivery. People spend years trying to get pregnant. Once you pee on the stick and it turns positive, you become a parent right then and there--in the bathroom. Your only job is to worry and protect your child. So, you give up mercury ridden fish, caffeine, and refined sugar. You suffer without cold medicine and sleep because you would do anything for your child. Why when it counts would you put your birth needs over your baby's. Just something to think about. Ps: I think midwives are wonderful, I think homebirths are great for certain people, and despite the uterine rupture I still encourage vbacs.

[Anonymous]

I read the letter to the editor of WaPo referenced by the PP the other day and - although I neither promote nor oppose homebirth and personally have no desire to give birth at home - I thought the doctors' comments presuming to know why women choose home birth were totally arrogant. Perhaps women who choose homebirth do so not merely over concerns of having a "medicalized experience" but rather due to concerns that the medicalized experience that has become the norm in this country has earned the US rankings at the bottom of industrialized countries for neonatal and maternal deaths. Perhaps these particular Ob/gyns would better spend their time focusing on how to improve outcomes and looking in the mirror to figure out why the last place many women want to be to deliver their babies is a hospital, instead of harping on a sensational and anomolous homebirth outcome that made the news.

[Anonymous]

Anonymous wrote:The human body has a total of about 6 to 8 liters of blood ie 6000 to 8000 liters. A pregnant full term uterus receives approximately 600 cc per minute. When the uterus ruptures you have about 10 minutes to get the kid out and pack the uterus. I am an obgyn. I have had a a patient rupture her uterus. Both are fine. No ambulance will get you to the or fast enough. Let's stop all this foolishness. Home births are wonderful experiences for low risk patients. Vbacs, twins, malpresentation, primip breeches, previas, vasoprevia, succenturiate lobes, uncontrolled diabetics are not low risk. If you or your practitioner takes on the risk then you both should deal with the consequences including fetal and maternal death. Yes babies do die in the hospital but at least those parents can sleep knowing that they did everything they could to ensure a safe delivery. People spend years trying to get pregnant. Once you pee on the stick and it turns positive, you become a parent right then and there--in the bathroom. Your only job is to worry and protect your child. So, you give up mercury ridden fish, caffeine, and refined sugar. You suffer without cold medicine and sleep because you would do anything for your child. Why when it counts would you put your birth needs over your baby's. Just something to think about. Ps: I think midwives are wonderful, I think homebirths are great for certain people, and despite the uterine rupture I still encourage vbacs.

I agree with you but the bigger question is: should it be illegal for women to make choices that most of us think are too risky? Should people be charged with manslaughter and child neglect?

[Anonymous]

"I agree with you but the bigger question is: should it be illegal for women to make choices that most of us think are too risky? Should people be charged with manslaughter and child neglect?"

The law apparently says yes. And, not only in this context, but also where parents make decisions to withhold medical care from their children, even when providing the care conflicts with their religious beliefs.

[Anonymous]

Anonymous wrote:I read the letter to the editor of WaPo referenced by the PP the other day and - although I neither promote nor oppose homebirth and personally have no desire to give birth at home - I thought the doctors' comments presuming to know why women choose home birth were totally arrogant. Perhaps women who choose homebirth do so not merely over concerns of having a "medicalized experience" but rather due to concerns that the medicalized experience that has become the norm in this country has earned the US rankings at the bottom of industrialized countries for neonatal and maternal deaths. Perhaps these particular Ob/gyns would better spend their time focusing on how to improve outcomes and looking in the mirror to figure out why the last place many women want to be to deliver their babies is a hospital, instead of harping on a sensational and anomolous homebirth outcome that made the news.

That op ed was TERRIBLE. I tried commenting twice and my comments are not there. They also quoted "studies" without referencing, but the only study that shows the threefold risk for low risk patients is that long-ago disputed ACOG study that has basically been disproven subsequently and scores of factual mistakes in it have been identified. The authors came off like arrogant bullies. I hope they lose a handful of patients for it. I would have dropped my doc for writing something like that. And I had a hospital birth all the way - never even THOUGHT about a homebirth. But still, I don't like bullying.