Update to Karen Carr (negligent midwife case)

WinesNot Whines · May 2011

According to the Post story, she pled guilty, will serve 5 days in jail, is barred from practicing in Virginia, and has to pay around $8,000 in fines.

What do you think about the outcome? I feel like she got off pretty easy, all things considered.

smacb · May 2011

I think some of the culpability goes to the parents for attempting a home birth against medical advice. In my opinion they bear more of the responsibility then the midwife.

mssaint · May 2011

smacb:
I think some of the culpability goes to the parents for attempting a home birth against medical advice. In my opinion they bear more of the responsibility then the midwife.

This.

Although I do think that the midwife has some responsibility, especially when they said that she didn't call for help for a while, etc.

vtmezzo · May 2011

The whole thing is just so so sad. I wonder if she agreed to attend the birth because she feared they might try to go it alone if she turned them down? In any case, I can't believe she put herself at that kind of risk and attended a birth in a state where she was unlicensed. This is one of the reasons why I wouldn't choose to birth at home - knowing that I was a VBAC patient I just felt the risks were too high - and although I might be "forced" into a c-section again, I couldn't forgive myself if something were to go wrong. It's unfortunate though that this case has shed such an unfavorable light on the entire home birth community - plenty of mothers are excellent candidates and should have the choice to birth as they wish without judgment.

Hey Jellisy · May 2011

I don't know, nothing is ever black and white, but I really believe the parents bear ultimate responsibility for that baby's death for blindly following ideology and not using any common sense. With my first I wanted a natural delivery so bad and it didn't work out, but I don't regret my choices for a moment. At the end of the day I get the greatest gift I could have ever imagined.

Sofka · May 2011

I also think the mother is more responsible, although that's a pretty light sentence for the MW. Some women go overboard in their attempts to go all-natural, IMO. Drs do know what they are talking about if they warn you not to do it!

hollace · May 2011

I think both parties are at fault. For starters, when a midwife group that you are working with suggests you seek medical care at a hospital due to the babies situation, in this case being breech, you should listen. Therefore, the parents certainly play a large role in this. I'm all for second opinions and wanting to fulfill your wishes, but sometimes you need to recognize that what you want may not be what's best for the situation.

On the other hand, the midwife was straight up crazy to 1) take this on after knowing another group turned her down, I don't care how much experience she has in high risk births and 2) while the RN license is reciprocal in MD and VA midwifery is not. She definitely put herself at risk on a professional basis by even chancing practicing outside the state. In my opinion that's probably what her sentencing is reflecting, regarding the fines and being barred in VA. I agree with the pp that the whole thing is sad but I think both parties need to have ownership of the outcome.

LindseyJW · May 2011

i think the outcome is more than appropriate. she should not have attended a birth as a professional without a license. she should have contacted emergency personnel as soon as she recognized that the situation was becoming an emergency.

karen IS a widely respected midwife in this area, specifically for her skill in attending births with elevated risk. unfortunately, she chose to do this in a state where she was not licensed. i really wonder whether charges would have been filed had she been licensed in Virginia to practice midwifery. she's not the first (or the last) midwife to lose a baby.

if a doctor agreed to assist in a vaginal breech delivery and the baby died, i wonder if she/he would also be charged with the same charges Karen faced. i doubt it.

vaginal breech deliveries do not actually carry much more risk than vertex deliveries. the reason that moms are encouraged to have surgical births for breech presentation is largely that OBs are no longer trained in performing them. i can't recall the study right now, but when i was pregnant, i looked into it when I thought my baby was breech. and i learned that there is no difference in the outcome for breech presentations whether baby is delivered vaginally or surgically. the outcome for perinatal death is the same, regardless of type delivery.

there are 1 or 2 doctors in this area who are skilled at vaginal breech deliveries and many more midwives. it is quite a sad state of affairs for moms and babies that the art of a vagainal breech delivery has been lost and that moms who want to deliver that way are forced to homebirth. i am quite a proponent of homebirth, but i also realize it is not for everyone. moms should have the option to birth in a hospital without being forced into surgery simply because their OB lacks competency. it is quite misleading to say that the risk is higher in a vaginal delivery. the risk is the same, whether the delivery is vaginal or surgical.

at the end of the day, OBs are surgeons, so I guess i really shouldn't be surprised.

ETA: it wasn't a doctor who warned the mom not to homebirth, it was her prior Midwife. she was with an alexandria based practice of certified nurse-midwives, who, by their insurance requirements, are not permitted to attend breech vaginal deliveries. they were not making a judgement statement in telling her to have a c/s or seek the care of another provider, they told her that they were not permitted to keep her as a client. i am very familiar with this practice and their philosophies on birth.

Artslvr · May 2011

Because Karen Carr attended the birth of my friend's TWO sets of twin grandbabies, and he respects her so much, I'm glad it seems like a "light" sentence.

pixieprincss · May 2011

Thanks for the follow up. I had not seen how this resolved in court. I am sad that Carr was operating outside of the law and that she and the family did not call for emergency backup help earlier. I am sad that sometimes--both in and out of the hospital--bad calls are made and families suffer. I am sad that Virginia has one less provider for skilled, low-intervention birthing. I am sad that incredibly OBs are actually losing skills as surgical birth becomes the default answer to normal variations in pregnancy (e.g. not delivering breech, the small number of drs who can do a version to right a transverse or breech baby, inducing babies who ultrasound shows are large which starts the domino effect and it turns out the baby was of a deliverable size, defaulting to c/s for twins, refusing to attempt VBAC, etc.). I am sad that a litigious society causes midwives and doctors to be fearful of taking on trickier-but-healthy patients for vaginal births out of protection for their livelihood.

hollace · May 2011

pixieprincss:
I am sad that a litigious society causes midwives and doctors to be fearful of taking on trickier-but-healthy patients for vaginal births out of protection for their livelihood.

Very well stated! I agree with this 100%. I was a breech vaginal birth (and a huge baby at 9+lbs) 31 years ago. My baby is currently sitting breech at 37 weeks and I don't think he'll move, he seems quite comfortable there...my mom made a statement about delivering breech. I told her, mom, they don't actually let you do that anymore...and I've got an OB that's been in this forever. Now, he isn't quick to cut either, he'll wait it out and see what happens, but ultimately I'm prepared for a section. Likewise, like you also stated, sometimes bad things just happen, whether in a hospital or at home. For that matter, sometimes things are uneventful and yet the outcome is maybe less then ideal...it's saddens me that people are unable to see that sometimes things just aren't going to go their way. We just don't have ultimate control of everything, as much as we would like to...

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