Karen Carr the midwife accepts plea deal

[A.D.]

I don't know if she made mistakes or not, to answer a pp's question. I wasn't there! Being a human being and fallible, I'm SURE there were mistakes made. What it boils down to is this: This mother WANTED a homebirth...desperately. Why? I don't know. Karen has safely delivered 40-50 breech babies. I'd say that qualifies her to do it. Should she have been practicing in VA w/out a license. No. But out of the goodness of her heart, and not so much the good sense in her head, she decided to help this woman have the homebirth she wanted when nobody else would help her. Karen did not kill this baby. Period. Tragically, this baby died. Some babies do. At home, in hospitals, in birth centers, etc. A pp said the sentence is laughable. Yes, it is. It is laughable b/c she SHOULDN'T HAVE HAD TO PLEA TO ANYTHING BUT PRACTICING W/OUT A LICENSE! :angry:

 

This baby died because a combination of arrogance and ignorance caused this mother and this "professional" to attempt a birth that they had been advised was not suitable for a homebirth.

If Karen was a decent human being, which I sincerely believe she is not, she would not have agreed to participate in a homebirth like this just because the mother wanted it. She would not have placed some bizarre infatuation with the birth process over the life of the child.

But she did, and sadly the baby died, and she is being let off with a slap on the wrist. A normal person would probably be affected by this for the rest of their life, but I have no doubt Karen will be back to putting herself above the law in no time.

[Guest Dulcimeramy]

A.D., not one of your 66 posts here has anything at all to do with homeschooling. All of your posts but one are strongly worded opinions on very controversial topics.

 

Do you homeschool or after-school children? Just curious.

[Mimm]

A.D., do you have some kind of strange and personal grudge against this midwife because your posts are overly hostile. Even the people here who think that the midwife was wrong in choosing to deliver this baby at home considering the circumstances (of which I am one) aren't so venomous. You're accusing the midwife of all kinds of inhuman feelings and motives you have absolutely no proof of. If these stories affect you so much, perhaps you should avoid them.

[amey311]

I think it's important to know that there is a limit to how much say an individual can have in her own medical care. That's why there are documents to sign when you're doing something Against Medical Advice. Somethings very much are AMA, and there are reasons for that. How much say should someone have in their own medical care? There are standards of care for a reason.

 

The deep, dark cynic in me wonders if there was a delay in calling 911 BECAUSE she knew she was there illegally, and to call emergency services would put her on the radar. Maybe if she'd told this mother "no" the mother would've found someone else or chosen a hospital birth. Maybe this mother would've had an unassisted birth - that's what I've seen from the people who want a "my birth, my way" experience.

 

It is all warm and fuzzy to say that the midwife in this situation was doing this to help this mother, but sometimes people need to be told "no" because the situation is not good.

 

Remember, also: she didn't HAVE to accept the plea! She chose to. She chose to plead guilty. She was "indicted on a charge of involuntary manslaughter, as well as charges of child abuse, neglect and acting without a license. She was indicted by a grand jury .... on an additional charge of negligently allowing a child’s life to be endangered." She plead guilty to "guilty pleas to separate counts of child endangerment and performing an invasive procedure without a license."

 

That's a pretty pared down verdict, and maybe if she'd gone to trial she would've been found guilty of just practicing without a license.

 

I haven't gone looking, but was the manslaughter charge JUST "involuntary manslaughter" or was it "criminally negligent manslaughter" (which they could've charged her with, arguing that her failing to act caused the death).

[Slartibartfast]

This baby died because a combination of arrogance and ignorance caused this mother and this "professional" to attempt a birth that they had been advised was not suitable for a homebirth.

If Karen was a decent human being, which I sincerely believe she is not, she would not have agreed to participate in a homebirth like this just because the mother wanted it. She would not have placed some bizarre infatuation with the birth process over the life of the child.

But she did, and sadly the baby died, and she is being let off with a slap on the wrist. A normal person would probably be affected by this for the rest of their life, but I have no doubt Karen will be back to putting herself above the law in no time.

 

I think "bizarre infatuation with the birth process" is pretty inflammatory. Do you know this mother personally so you would know her thought process during her pregnancy?

 

Do you know how birth friendly the hospitals are around the area in question?

 

Instead of pointing at the mother and calling her "ignorant" why not wonder about the system that led her to make that decision? What are the the c-section rates for hospitals around her? Was she able to even find a Dr who would entertain the idea of a natural birth?

 

In some areas it is becoming impossible and rather than blame the mother we should do what we can that women have choices about their own bodies that do not involve them being forced into MAJOR surgery.

 

I don't blame this mother for looking for a midwife in the slightest.

[lionfamily1999]

The deep, dark cynic in me wonders if there was a delay in calling 911 BECAUSE she knew she was there illegally, and to call emergency services would put her on the radar.

I thought the same thing.

[Alice]

Isn't the first thing you learn in CPR is to tell someone on to call 9-1-1?

 

If the family had a landline, someone could have dialed 911 and left the line open and yelled into it while the call was traced.

 

It was her(the medical professional's) job to tell someone to call 911. In learning CPR, one of the first things you are supposed to do (before starting) is yell at someone to call 911.

 

That's what I was taught. Even to the point that if its an adult victim you call first THEN start CPR. Children get CPR for a bit, then stop, make the call, restart...if there's nobody around to call for you.

 

I swear that is what I was told too.

 

I get tired of cases that end badly being used to blame midwives. Birth is as safe as life gets. There are no guarantees in life.

 

For an adult, you call 911 first and delay CPR. For a child, you wait and call 911 after 2 minutes of CPR. This is because of the difference in usual mechanism of arrest in adults and kids. However, if you are not alone you always always always designate someone to call 911. Always. This would also be the case in neonatal resuscitation.

 

I can imagine that she might have been caught up in trying to save the baby. I can imagine that the time went by without her realizing until too late that she should have called sooner. I can imagine that she designated someone to call 911 but they didn't because of the intensity of the situation. However, she was the medical professional in charge and part of her job and responsibility was to make sure someone called. If a child arrested in my office and I didn't call 911 or make sure someone else did, would I be liable? Absolutely.

 

I don't know what training in neonatal resuscitation midwives have but I'd imagine that she knew how important it was for the baby to get proper ventilation and certain meds (primarily epinephrine) quickly. So she should have known how vital getting the baby to the hospital was. It has nothing to do with the abilities of the ambulance responding, it's all about getting the baby somewhere where they have the meds and equipment and expertise.

 

I have no idea what would have happened had this baby been born in a hospital. Mistakes happen in hospitals. Bad things happen. Babies die. However, I do know the baby would have had more of a chance for survival if for no other reason that the person doing the resuscitation would have had the tools they needed.

 

I feel bad for the midwife in this case. I do think she made series of mistakes but one of the hardest things in medicine is knowing that you will make mistakes and those mistakes have the potential to have terrible consequences. I think it's likely that the mistakes she made were from being too caring and too passionate about helping moms and babies rather than from being a bad person or incompetent. At the same time, she's resposnbile for her actions as anyone else would be. I think the plea agreement sounds about right, she is held accountable but the punishment isn't harsh. No matter what and how much support she has from patients, she is living with the consequences and I would imagine regret from her decisions. I know I've made mistakes and been up nights with regret. Luckily, I've never had a mistake result in this kind of tragedy but I think if we are honest every medical professional has their own cases that they will always regret something they did.

[lionfamily1999]

Didn't she wait 13 minutes to call?

 

Those times when I've had to dial 911 it may have felt like I waited forever, but time drags so incredibly slowly when you're hyped up on adrenaline. I would think that we (dh and I) had wasted so much time trying to fix whatever the problem was ourselves, only to find five minutes had gone by.

 

13 minutes is a very long time.

[G5052]

I don't think a newpaper article can adequately cover something like this though. It gives a summary, but not the full trial. Did the father and mother understand the risks and what was happening when the situation went downhill? Where there other medical details that made a breech delivery more dangerous in this situation than most breech deliveries? Who else was there, if anyone?

 

I had a breech baby with an unusually large head that I chose to have via C-section at the first sign that he was getting stuck. We chose a hospital delivery and overall were happy with it. The doctor had done breech deliveries, but felt that we were rapidly entering a dangerous period that could go either way. She left the decision to me, and I fully understood the risks both way and chose to have a C-section.

 

Was that the right decision? We both came out of it well, but it is hard to say if a breech delivery would have come out well too. Bottom line is that there was a hard decision, and I chose what I felt was the best path.

[Murphy101]

So, just wondering... looking back you don't think they should have had you all on the way to the hospital? See, I like births that are more natural, too. And yet, at a certain point, I want medical intervention. Where the line is, is perhaps hard to know... but I think it's there.

:(

 

:001_huh: only if during the time they loaded and trasnported you are okay with neither getting any more care. EMTs could not have done one thing the MW wasn't doing. If at all possible, even EMTs try to stabilize before transporting.

 

Calling 911 likely would not have saved that baby. It is an automatic procedural issue in this case, not a it would have changed the circumstances issue. As far as I can tell from what I've read. Of course, I wasn't there.

 

Actually I just took a newborn CPR class in the NICU and the official recommendation is to try to help the newborn FIRST and THEN call 911. The first few minutes are too important to using them calling.

 

Yes. Me too.

 

Also, I want to make something VERY clear that most people forget - as long as that baby is attached to a pulsing umbilical cord - baby is getting oxygen and blood circulation. The WORST thing to do, and yet is done almost every single time in an ambo or at hospital, is to cut that PULSING cord.

 

So being stuck does not necessarily mean the baby was oxygen deprived. For that matter, even being born does not mean that unless the cord stops pulsing or is cut. The placenta might not be birthed and thus still functioning for as long as 20 or 30 minutes after the baby is born.

 

I don't know if the MW did something wrong or not. I wasn't there.

 

But just not calling an ambulance is not enough on its own for me to convict her.

 

And babies are born every day needing some resuscitation in the hospital and they do not automatically call a code in those situations. They evaluate color, heart rate and such first while they continue to work on the baby.

[FaithManor]

:001_huh: only if during the time they loaded and trasnported you are okay with neither getting any more care. EMTs could not have done one thing the MW wasn't doing.

 

I would like to point out that if a basic rig with only EMT's arrived at the scene, then yes, they would not have been able to do anything that MW wasn't already doing.

 

But, if it's Michigan, California, New York, etc. and other states that have extensive medic training and run their ALS rigs with paramedics only or medic plus EMT team, then there is a lot that would have been done. ALS (advanced life support) rigs have full pediatric crash carts and medics are trained to intubate, bag, and rescucitate infants and even preemies. They carry pediatric doses of several kinds of ALS drugs including epinephrine and have pediatric I.V. capabilities for fast delivery of those drugs.

 

It is entirely possible that this child could have been saved if medics in that state have the same level of training as the above mentioned states.

 

Either way, even if only EMT's arrived, the one thing that would have happened is that neither the parents or the MW would not be answering questions about why they didn't follow such a basic protocol as dialing 911.

 

Faith

[Pretty in Pink]

I would like to point out that if a basic rig with only EMT's arrived at the scene, then yes, they would not have been able to do anything that MW wasn't already doing.

 

But, if it's Michigan, California, New York, etc. and other states that have extensive medic training and run their ALS rigs with paramedics only or medic plus EMT team, then there is a lot that would have been done. ALS (advanced life support) rigs have full pediatric crash carts and medics are trained to intubate, bag, and rescucitate infants and even preemies. They carry pediatric doses of several kinds of ALS drugs including epinephrine and have pediatric I.V. capabilities for fast delivery of those drugs.

 

It is entirely possible that this child could have been saved if medics in that state have the same level of training as the above mentioned states.

 

Either way, even if only EMT's arrived, the one thing that would have happened is that neither the parents or the MW would not be answering questions about why they didn't follow such a basic protocol as dialing 911.

 

Faith

 

Absolutely. This MW is getting off lightly, IMO.

[Murphy101]

I would like to point out that if a basic rig with only EMT's arrived at the scene, then yes, they would not have been able to do anything that MW wasn't already doing.

 

But, if it's Michigan, California, New York, etc. and other states that have extensive medic training and run their ALS rigs with paramedics only or medic plus EMT team, then there is a lot that would have been done. ALS (advanced life support) rigs have full pediatric crash carts and medics are trained to intubate, bag, and rescucitate infants and even preemies. They carry pediatric doses of several kinds of ALS drugs including epinephrine and have pediatric I.V. capabilities for fast delivery of those drugs.

 

It is entirely possible that this child could have been saved if medics in that state have the same level of training as the above mentioned states.

 

Either way, even if only EMT's arrived, the one thing that would have happened is that neither the parents or the MW would not be answering questions about why they didn't follow such a basic protocol as dialing 911.

 

Faith

 

See that is COMPLETELY dependent on what county you live in here. It cannot be assumed.

 

Also, what a MW has can vary by area too. My midwife can't intubate, but she does come with oxygen and a few syringes of various meds a doctor has okayed her to carry for emergencies. In some areas a CNM might have more than that at hand. So we can't assume all home deliveries mean zero medical equipment, meds, or training is available.

[Heather in OK]

Disclaimer: I don't know Karen or the family. I wasn't at the birth. I don't have experience yet catching breech babies. I have been in a resuscitation situation.

 

Do midwives not normally have some sort of assistant? Some other adult in the vicinity that she just had to say "Call 911."

Assistant or not, even alone you can say, "Call 911 please" and continue working on the baby.

 

It just makes me cringe everytime I see something about this story because we NEED midwives. We need people who stand up for women and babies against a medical system that can sometimes be utterly insane. and I had MDs for my births. I still see the absolute value of midwives in the system. And I'm not fond of witch hunts either. I don't have enough expertise to tell which scenario this is. This midwife seems to have a lot of people who respect and love her though.

:iagree: Thank you for your post.

 

I am a homebirthing mama. It is MY responsibility to make choice for MY birth and MY child.

 

Crap happens sometimes that is unpreventable. I am prepared for that by my choice to birth at home.

 

Did I sue because of the complications I endured? No. I forgave him for being human :)

But in the end, when something happens, even if YOU chose that for your birth, they aren't going to come after YOU (yes, sometimes CPS comes after the family). They are going to come after the care provider. We get the phone calls asking what happened at the birth. We are the ones prosecuted. Yes, I know in this situation she was practicing in a state she wasn't licensed in. But it's the same pretty much everywhere...the midwife (or whoever was acting as care provider) takes the fall.

 

If only all clients were as forgiving as you. Not all home birth clients who have a tragic outcome forgive and go on.

 

Actually I just took a newborn CPR class in the NICU and the official recommendation is to try to help the newborn FIRST and THEN call 911. The first few minutes are too important to using them calling.

 

Yeah, but she waited 13 minutes.

 

I still don't understand why she didn't utilize another adult to make the call, while she kept working on the baby. I would assume that she makes sure that there is another adult available, even if not an assistant. It takes her less than 2 seconds to yell "Call 911." And if a baby needs CPR, isn't that an indication that they need to end up at a hospital......even if her efforts are successful?

 

For an adult, you call 911 first and delay CPR. For a child, you wait and call 911 after 2 minutes of CPR. This is because of the difference in usual mechanism of arrest in adults and kids. However, if you are not alone you always always always designate someone to call 911. Always. This would also be the case in neonatal resuscitation.

 

I can imagine that she might have been caught up in trying to save the baby. I can imagine that the time went by without her realizing until too late that she should have called sooner. I can imagine that she designated someone to call 911 but they didn't because of the intensity of the situation. However, she was the medical professional in charge and part of her job and responsibility was to make sure someone called. If a child arrested in my office and I didn't call 911 or make sure someone else did, would I be liable? Absolutely.

 

I don't know what training in neonatal resuscitation midwives have but I'd imagine that she knew how important it was for the baby to get proper ventilation and certain meds (primarily epinephrine) quickly. So she should have known how vital getting the baby to the hospital was. It has nothing to do with the abilities of the ambulance responding, it's all about getting the baby somewhere where they have the meds and equipment and expertise.

 

I have no idea what would have happened had this baby been born in a hospital. Mistakes happen in hospitals. Bad things happen. Babies die. However, I do know the baby would have had more of a chance for survival if for no other reason that the person doing the resuscitation would have had the tools they needed.

 

With NRP there is about a ONE MINUTE time span that you assess the baby, give stimulation, give O2 (either free flow or positive pressure), and begin compressions (if needed). ONE MINUTE. Within the next thirty seconds, if the heart rate is still below 60bpm you can then begin further measures (i.e. ephinephrine, intubation, etc).

 

So this is why I question why she waited 13 minutes to have someone call.

 

The deep, dark cynic in me wonders if there was a delay in calling 911 BECAUSE she knew she was there illegally, and to call emergency services would put her on the radar. Maybe if she'd told this mother "no" the mother would've found someone else or chosen a hospital birth. Maybe this mother would've had an unassisted birth - that's what I've seen from the people who want a "my birth, my way" experience.

 

It is all warm and fuzzy to say that the midwife in this situation was doing this to help this mother, but sometimes people need to be told "no" because the situation is not good.

I agree with your view of why she waited. And I absolutely agree that sometimes you have to tell people "no, I'm sorry I can't do your birth".

 

 

Also, I want to make something VERY clear that most people forget - as long as that baby is attached to a pulsing umbilical cord - baby is getting oxygen and blood circulation. The WORST thing to do, and yet is done almost every single time in an ambo or at hospital, is to cut that PULSING cord.

 

So being stuck does not necessarily mean the baby was oxygen deprived. For that matter, even being born does not mean that unless the cord stops pulsing or is cut. The placenta might not be birthed and thus still functioning for as long as 20 or 30 minutes after the baby is born.

 

I don't know if the MW did something wrong or not. I wasn't there.

 

We have no idea when the cord stopped pulsing. Sometimes it takes a while. In the resuscitation I was at, the cord stopped IMMEDIATELY after the baby was out. So yes, they are getting great oxygen via the cord but it's not a guarantee. You must always be observing and ready to act when it's necessary.

[Catherine]

It sounds like her handling of the birth situation itself was as good as can be expected under the circumstances. I do think it's somewhat hypocritical of parents to look so hard for someone to take their case (it's not like they hadn't been turned down for a homebirth by several practitioners already, if I understand the article correctly), and then sue her in court when their high risk baby has died of a predictable complication.

 

I'm dismayed by the over medicalization of normal processes, truly I am. I had my own kids with midwives, but I think people have to be sensible. Not every breech baby needs a c-section, but at minimum they should be in a monitored. There's plenty of blame to go around here. It's a shame that one midwife is shouldering the blame-she and the baby's parents both showed poor judgement.

 

I have definitely heard of this woman. She's well-known here.

[Murphy101]

Assistant or not, even alone you can say, "Call 911 please" and continue working on the baby.

 

So this is why I question why she waited 13 minutes to have someone call.

 

I agree with your view of why she waited. And I absolutely agree that sometimes you have to tell people "no, I'm sorry I can't do your birth".

 

We have no idea when the cord stopped pulsing. Sometimes it takes a while. In the resuscitation I was at, the cord stopped IMMEDIATELY after the baby was out. So yes, they are getting great oxygen via the cord but it's not a guarantee. You must always be observing and ready to act when it's necessary.

 

I agree with everything you posted.

 

No doubt about it, even in an uneventful delivery - close monitoring for the first 48 hours is normal. Their color, their eating and temperature and so forth. Obviously in an eventful one that is considerably ramped up.

 

Also I was not saying I knew the cord was pulsing. Idk. But some were assuming the baby was oxygen deprived the entire time he was stuck or whatever and we don't know that either.

 

I wonder - did she tell someone to call and they didn't? Did no one there mention calling an ambulance prior to the 13 minutes wait?

[Jennifer3141]

:001_huh: And babies are born every day needing some resuscitation in the hospital and they do not automatically call a code in those situations. They evaluate color, heart rate and such first while they continue to work on the baby.

 

:iagree:

If doctors called a code every.single.time. a newborn baby needed resuscitation, there would be a LOT more dead 50 years olds from cardiac arrest because there would be no one to take care of them!! They'd all be working on babies.

And there would be a lot of babies leaving the hospital with broken ribs, sternums, etc.

And my DH would quit. He don't do babies. :D

Hmmm... maybe we're onto something here. Someone else could do math with the kids today!

[Mary in VA]

It sounds like her handling of the birth situation itself was as good as can be expected under the circumstances. I do think it's somewhat hypocritical of parents to look so hard for someone to take their case (it's not like they hadn't been turned down for a homebirth by several practitioners already, if I understand the article correctly), and then sue her in court when their high risk baby has died of a predictable complication.

 

 

 

Just want to point out this was a criminal case, the Commonwealth of Virginia brought the action. The parents may still bring a civil suit, although nothing has been mentioned of that yet.

 

Mary

[Impish]

The midwife chose to attend a birth that she was unlicensed for.

She choose to plead guilty.

 

She didn't have to do either.

[AngelBee]

The midwife chose to attend a birth that she was unlicensed for.

She choose to plead guilty.

 

She didn't have to do either.

Well...the parents didn't have to hire someone that was unlicenced.

 

I have had 3 births with lay midwives in MN. I made a CHOICE specifically to hire an unlicensed midwife.

 

I can't say after the fact that it is their fault due to not being licensed if something goes wrong. That was a chance I took when I hired them.

 

Anytime you hire anyone, you take a risk. These are humans being entrusted with everything important to you. Life.

 

But the reality is that you will not always have good results. It isn't always someone's fault. Sometimes it just is. :(

[AngelBee]

I get tired of cases that end badly being used to blame midwives. Birth is as safe as life gets. There are no guarantees in life.

:iagree:

[amey311]

http://www.washingtonpost.com/local/midwife-faces-involuntary-manslaughter-charges/2011/04/18/AFTsqs1D_story.html

 

This article has some more information on some of the 911, etc particulars, including that there were other people in attendance:

 

During the delivery at the couple’s home on Sept. 11, with Carr, a birth assistant and a doula helping, the baby’s head essentially got stuck after the body had been delivered, Zwerling said. In such cases the baby cannot survive long, so Carr and the two others worked to manipulate the baby and the mother’s position to finish the delivery.

The baby, a boy, had a heartbeat but was not breathing, according to Zwerling. Someone called 911 immediately, and those in attendance pushed air into the baby’s lungs until an ambulance arrived, he said.

 

 

THat "immediately" bit is the only place I saw that comment. Everywhere else it says things more like this: http://www.ongo.com/v/875532/-1/4051F5BFF3FA0AF1/midwife-pleads-guilty-to-felonies-in-death-of-alexandria-newborn

 

Law enforce*ment of*ficials said it is rare to see a midwife charged with a crime in connection with a failed de*liv*ery, but a combination of factors led pros*ecutors to pursue the case. They said Carr was unlicensed in Vir*ginia, agreed to perform a high-risk breech de*liv*ery in a woman’s home af*ter oth*er care providers refused, and ignored warning signs that the de*liv*ery

was not go*ing well.

Ul*ti*mately, pros*ecutors said, Carr al*lowed the baby to re*main with his head stuck in the birth canal for 20 minutes and then, af*ter de*liv*ery, tried to resus*ci*tate him for 13 minutes before call*ing for emergency med*ical help. The boy nev*er gained consciousness or displayed brain activ*ity, and he died two days lat*er at Chil*dren’s National Med*ical Center in the Dis*trict when life support was re*moved.

 

Edited May 6, 2011 by amey311
To add another article and quote

[meggie]

I get tired of cases that end badly being used to blame midwives. Birth is as safe as life gets. There are no guarantees in life.

 

When I went in to get my IUD, I couldn't help but think about how much at risk we women are in general. Pregnancy and birth carries risks. But so does every single type of birth control, except abstinence. I read about the risk of IUDs and tubal ligations and the pill and the patch. Plus, on any of them there is a risk of getting pregnant anyway, which brings us back to square one of the risks of pregnancy and labor. There are risks for birthing at a hospital, there are risks for birthing at home. In all honesty, no matter what we do there are risks. So bravo to me and every other mother out there. "There are no guarantees in life"

[Sue G in PA]

Here is what bugs me: "Carr ALLOWED the baby's head to remain in the birth canal". I'm sorry. She ALLOWED? If I know Karen, and I do, she was working feverishly and doing everything humanly possible to get that baby out safely (without breaking it's neck or otherwise maiming it). That comment leads one to believe she was sitting there forcibly holding the baby's head inside the birth canal. Please. :glare:

[AnthemLights]

The deep, dark cynic in me wonders if there was a delay in calling 911 BECAUSE she knew she was there illegally, and to call emergency services would put her on the radar..

 

Would this necessarily be the case though? My first was a home birth. I was considered high-risk because of some pre-existing health conditions, but we decided to go ahead and have the baby at home. A good friend of ours was a midwife (a pretty awesome one by the way), but she either wasn't registered or maybe midwifery was illegal in NY at that time...details are kind of fuzzy....she was at my birth, just as a helper. DH caught the baby and cut the cord. Daughter was born not breathing. Midwife, husband, and MIL all worked over her. Finally got her breathing, but too weakly. I have no idea how much time passed. To me it seemed like forever. Midwife suggested we transport. We lived only 10 minutes from hospital and DH said he could make it faster driving than calling the ambulance. So hubby, baby, MIL and I jumped in the car and 5 minutes later arrived at the hospital. Midwife/friend just faded to the background and was never mentioned in any report.

 

Looking back, maybe we were not wise, but providentially it all ended well. Baby who was 3 weeks early was diagnosed with Intrauterine growth restriction and had to spend 11 days in neonatal until her lungs got stronger. There was so much that could have gone wrong.

[Osmosis Mom]

Wow, that's a really long time to have a baby stuck. And then not to have someone call 911 right away, maybe as she was trying to help him? I'm very pro-homebirth, pro-midwife, but I think she did the right thing by taking the deal.

 

My first-born was stuck for something like that with an OB who did a suction after a mw mishandled my delivery. In retrospect then both dd and I could easily have died. Delivery is scary. An acquaintance of mine delivered at a high profile hospital with the very famous doctor, her baby was stuck, he pressed it back in, did a c-section and she ended up with a dd who was a vegetable (as in no brain activity except the basics).

[Sue G in PA]

I guess I missed the post about Karen waiting to call b/c she knew she was not licensed and that might have put her at risk. Ummm....NO WAY NO HOW! 2 of my births with her were transports (my choice, no emergency)...one to a MD hospital where she is not legal to practice with only a CPM license. She NEVER once put herself first before my health of that of my baby. Karen is a very self-sacrificing human being. It angers me to no end that some people would think she would risk a baby or mother's life just to cover her own rear.

[ktgrok]

http://www.washingtonpost.com/local/midwife-faces-involuntary-manslaughter-charges/2011/04/18/AFTsqs1D_story.html

 

This article has some more information on some of the 911, etc particulars, including that there were other people in attendance:

 

 

 

THat "immediately" bit is the only place I saw that comment. Everywhere else it says things more like this: http://www.ongo.com/v/875532/-1/4051F5BFF3FA0AF1/midwife-pleads-guilty-to-felonies-in-death-of-alexandria-newborn

 

Ok, that first one sounds much more likely. When they are born and not breathing, but have a heartbeat, well, its common. Sometimes babies take a few minutes to breathe. If the midwife was immediately using resuscitation equipment to breathe for the baby, and it had a hearbeat, it sounds like she was doing everything possible. Honestly, there isn't much more you can do for a baby that is full term, other than breathe for it.

 

Given what was mentioned in the other post, about the baby forced back in and delivered surgically, only to be in a vegetative state for life...well I'd rather the baby die at home than live like that.

[Jumping In Puddles]

A.D., not one of your 66 posts here has anything at all to do with homeschooling. All of your posts but one are strongly worded opinions on very controversial topics.

 

Do you homeschool or after-school children? Just curious.

 

I've always thought A.D. was a second account for a regular board member. :sneaky2:

 

 

It sounds like her handling of the birth situation itself was as good as can be expected under the circumstances. I do think it's somewhat hypocritical of parents to look so hard for someone to take their case (it's not like they hadn't been turned down for a homebirth by several practitioners already, if I understand the article correctly), and then sue her in court when their high risk baby has died of a predictable complication.

 

I'm dismayed by the over medicalization of normal processes, truly I am. I had my own kids with midwives, but I think people have to be sensible. Not every breech baby needs a c-section, but at minimum they should be in a monitored. There's plenty of blame to go around here. It's a shame that one midwife is shouldering the blame-she and the baby's parents both showed poor judgement.

 

:iagree:

[phathui5]

I have no problem saying that I am very disappointed in the plea agreement. This woman's arrogance and illegal behavior contributed to the death of an innocent child, and the sentence she has received is laughable.

 

Do you actually know Karen? If anything, her failing is that she ends up agreeing to take on clients that other providers have turned away, because they call her and tell her that if she won't come, they'll be birthing at home unassisted.

[Shellydon]

Do you actually know Karen? If anything, her failing is that she ends up agreeing to take on clients that other providers have turned away, because they call her and tell her that if she won't come, they'll be birthing at home unassisted.

 

 

IMO, it is better to say no than to do what she did in this instance.

[Jean in Newcastle]

Dh (an RN) was saying that now that she has a criminal record, he wonders if she will be able to be certified in any state. At least as a nurse, he is not able to be licensed if he has a record. His opinion was that her career is probably over - legally anyway.

[amey311]

Dh (an RN) was saying that now that she has a criminal record, he wonders if she will be able to be certified in any state. At least as a nurse, he is not able to be licensed if he has a record. His opinion was that her career is probably over - legally anyway.

 

I think that was mentioned in one of the articles. She has to give up her license to practice, pay a $5000 fine, return the cost of the birth to the family, and spend 5 days in jail.

 

One could then argue that by taking on this one high risk birth, she has made it so she can no longer attend birth at all. And we'll never know if her refusal to take this woman as a client would've made the woman revisit other choices.

 

I've had a birth center birth and a homebirth. I'm not anti home birth (but my HB attendant was legal, and while she couldn't attend me if I needed to be transported, she would've stayed with me at the hospital as my doula, and she was on good terms with several doctors at hospitals, so I wouldn't have been going in blind).

[brehon]

Hindsight is always 20/20. I KNOW Karen and she simply does NOT mess around if a baby or mother is in danger. Baby's head was stuck for 20 min in birth canal...so what if she called 911 after a minute, 2 minutes? What could untrained EMS workers do that she couldn't? They are NOT trained in childbirth! We had called an abmo during my last delivery b/c I was bleeding during labor and Karen was concerned. They got there as I was pushing and looked utterly and completely clueless as to what to do. One of them looked at Karen and asked, "You got this?" and she rolled her eyes and said. "yes". They stuck around "just in case", chatting in my living room. Anyway, as for trying to revive baby for 13 min. before calling 911...Karen's main focus was that baby. Why isn't anyone questioning why the FATHER of the child didn't call 911? It makes my stomach turn that Karen had to plead guilty to these charges, but she did it to save those parents more grief and pain having to go through a long trial, etc. Wow...I'm sorry. I didn't mean to go on like that. Karen is like family to me and I can't stand hearing her name dragged through the mud.

 

As to the first bolded part of your reply that is absolutely untrue where I work. I'm a paramedic who has field delivered several little ones, including a severe shoulder dystocia and and one who didn't respond well for several minutes. I AM trained to handle all sorts of pregnancy and birth complications. Perhaps the EMS system which would respond to your area is different. However, national guidelines and standards have paramedics (not EMT-Basics, though) learning advanced life support procedures and medications for pregnancy and childbirth.

 

As to the second bolded part - waiting 13 minutes, especially if she were actually performing CPR as opposed to "only" performing artificial respirations, is absolutely unacceptable and contrary to all standards. Yes, some babies won't respond immediately. Still and all 13 minutes is a very long time. Brain damage begins within 4-6 minutes. And, yes, I can do things that Karen probably can't do (basing this on what has been written here and other places) to help this little one.

 

I know this woman is dear to your heart, Sue. I'm sure she did the best she could in a very difficult situation. She did, however, make at least one mistake by not calling 911 earlier than she did, especially after the baby came out and she spent all that time trying to help him.

 

Perhaps this issue of calling early is on my mind right now because I lost a patient the other day I probably could have saved had the nursing home called earlier. Instead the staff performed CPR for 10 minutes with the patient still on the bed. Patient had no chance after that length of time.

[Catherine]

You are right that it's judgement. But please be aware that there are definitely standards of practice that guide many areas of "judgement." It is NOT merely judgement to choose to delay calling 911. The very first lesson taught in Basic Life Support (CPR) courses is to CALL 911 or call for help if you find someone "down." Yes it's true that it may take a few minutes for advanced EMTs who can resuscitate a newborn to arrive. That in no way changes the rules, which exist to protect people. If basic EMTs arrive first, they will certainly defer to experienced people.

[Oops, duplicate account :/]

You beat me to it..

 

 

Do midwives not normally have some sort of assistant? Some other adult in the vicinity that she just had to say "Call 911."

 

Absolutely

 

I have no problem saying that I am very disappointed in the plea agreement. This woman's arrogance and illegal behavior contributed to the death of an innocent child, and the sentence she has received is laughable.

 

Agreed

 

I thought the same thing.

 

Ya, me too. Makes it harder to make that call when youre doing something illegal.

 

I am so angry reading the details surroundingthe birth, um death, of this precious baby. As a homebirth supporter (all four of my babe were born at home) this MW irresponsibility makes me livid. :cursing::cursing:

[Sue G in PA]

As a homebirth supporter (all four of my babe were born at home) this MW irresponsibility makes me livid. :cursing::cursing:

 

Were you there? Do you know the FACTS about what happened or are you just reading the articles and going by heresay? Have you spoken to Karen? Have you heard her side? How about the mother of this precious baby? All you people so quick to judge and persecute Karen w/out knowing the FACTS or knowing HER just make me sick. :glare: And with that, I will excuse myself from this thread as it is making my already crappy Mother's Day weekend 100x worse. :auto:

[Oops, duplicate account :/]

Were you there? Do you know the FACTS about what happened or are you just reading the articles and going by heresay? Have you spoken to Karen? Have you heard her side? How about the mother of this precious baby? All you people so quick to judge and persecute Karen w/out knowing the FACTS or knowing HER just make me sick. :glare: And with that, I will excuse myself from this thread as it is making my already crappy Mother's Day weekend 100x worse. :auto:

 

Sue, I have had four homebirths with 3 different midwives. My first and foremost concern was the safety of my baby in as much as I can be responsible. I grilled my midwives thoroughly befoe I chose them and during pregnancy. I read and read myself about birth. I guess I can't have a valid opinion because I didn't know her. :confused: I run birth (home and hossy) scenarios I come acrooss by my mw all.the.time. And my 'baby' is 2.5 years old.

[WIS0320]

Were you there? Do you know the FACTS about what happened or are you just reading the articles and going by heresay? Have you spoken to Karen? Have you heard her side? How about the mother of this precious baby? All you people so quick to judge and persecute Karen w/out knowing the FACTS or knowing HER just make me sick. :glare: And with that, I will excuse myself from this thread as it is making my already crappy Mother's Day weekend 100x worse. :auto:

 

I'm going to gently suggest that because you know this woman personally, love and respect her and have used her services that you are not impartial about the circumstances that led to her current legal situation.

 

People can really excel in a certain area and still occasionally make mistakes and sometimes those mistakes mean that there are negative consequences. I personally feel badly for all involved, especially the parents who put a huge amount of trust into their midwife and then had the situation go completely awry to the point that their baby died. I know people can say that birth sometimes is not a guarantee for a live baby but frankly, in this instance the parents had solid advice from another group of midwives that another type of in hospital delivery would be safer and they chose to disregard that advice and hire Karen Carr. The baby would most likely not be dead now if the mother had a scheduled C-section.

 

I don't like the over medicalization of birth in the USA either but at times medical interventions and surgery are indicated. I am pro-life and I do not believe a mother has the right to damage a baby inside her body, even when it comes to her birth choices, simply because she wishes for a particular birth experience. The bottom line is whether or not you think a baby's right to be alive is more important that the choices a mother makes when carrying the baby and I personally do think that the right to be alive trumps just about any preference on the part of the mother carrying the baby. I understand that others out there disagree with this which is why this has become such a hot topic discussion.

[Sue G in PA]

Jen, Karen was my midwife for SIX of my children. 6. You are welcome to your opinion as is everyone else and I suppose that is the operative word...opinion. Everyone has one. Everyone will. Only a few people know the facts. I don't even know the facts except that I know Karen. And I know she did everything humanly possible to save that baby. Period.

[Jean in Newcastle]

Jen, Karen was my midwife for SIX of my children. 6. You are welcome to your opinion as is everyone else and I suppose that is the operative word...opinion. Everyone has one. Everyone will. Only a few people know the facts. I don't even know the facts except that I know Karen. And I know she did everything humanly possible to save that baby. Period.

 

Sue, I'm glad that Karen has you as a friend. But when this topic was originally posted here (by you I believe) it was pretty obvious that people were going to look at the only data they have (the news reports) and form opinions. And the nature of the case makes it pretty hard not to. This thread is a spin-off on that and of course people are going to have opinions on the ruling. And no, we're not going to judge her on her personality or her character or her friendship because we don't have that relationship that you have. And because it really is the facts as presented in the news and court proceedings that people are commenting on, not her as a person.

[Oops, duplicate account :/]

I'm going to gently suggest that because you know this woman personally, love and respect her and have used her services that you are not impartial about the circumstances that led to her current legal situation.

 

People can really excel in a certain area and still occasionally make mistakes and sometimes those mistakes mean that there are negative consequences. I personally feel badly for all involved, especially the parents who put a huge amount of trust into their midwife and then had the situation go completely awry to the point that their baby died. I know people can say that birth sometimes is not a guarantee for a live baby but frankly, in this instance the parents had solid advice from another group of midwives that another type of in hospital delivery would be safer and they chose to disregard that advice and hire Karen Carr. The baby would most likely not be dead now if the mother had a scheduled C-section.

 

I don't like the over medicalization of birth in the USA either but at times medical interventions and surgery are indicated. I am pro-life and I do not believe a mother has the right to damage a baby inside her body, even when it comes to her birth choices, simply because she wishes for a particular birth experience. The bottom line is whether or not you think a baby's right to be alive is more important that the choices a mother makes when carrying the baby and I personally do think that the right to be alive trumps just about any preference on the part of the mother carrying the baby. I understand that others out there disagree with this which is why this has become such a hot topic discussion.

:iagree: especially with you last paravraph. In a perfect world mom could have attemlted a brech vaginal delivery in the hossy. Not that every thing would have gone well but that BABE would have had the utmost care available. My huge fat opinion is that

 

1. Mom should have had a medically necessary cesarean (sucks but most likely babe would be alive and well)

 

2. Mom should have been trasferred when babe got stuck (a breech and for 20 min...WTH!)

 

3. 911 should have been called IMMEDIATELY

 

I'm still p#$$#d so I probably shohld just chill and stop posting on this thread now.:glare:

Edited May 8, 2011 by JENinOR

[brehon]

For an adult, you call 911 first and delay CPR. For a child, you wait and call 911 after 2 minutes of CPR. This is because of the difference in usual mechanism of arrest in adults and kids. However, if you are not alone you always always always designate someone to call 911. Always. This would also be the case in neonatal resuscitation.

 

I can imagine that she might have been caught up in trying to save the baby. I can imagine that the time went by without her realizing until too late that she should have called sooner. I can imagine that she designated someone to call 911 but they didn't because of the intensity of the situation. However, she was the medical professional in charge and part of her job and responsibility was to make sure someone called. If a child arrested in my office and I didn't call 911 or make sure someone else did, would I be liable? Absolutely.

 

I don't know what training in neonatal resuscitation midwives have but I'd imagine that she knew how important it was for the baby to get proper ventilation and certain meds (primarily epinephrine) quickly. So she should have known how vital getting the baby to the hospital was. It has nothing to do with the abilities of the ambulance responding, it's all about getting the baby somewhere where they have the meds and equipment and expertise.

 

I have no idea what would have happened had this baby been born in a hospital. Mistakes happen in hospitals. Bad things happen. Babies die. However, I do know the baby would have had more of a chance for survival if for no other reason that the person doing the resuscitation would have had the tools they needed.

 

I feel bad for the midwife in this case. I do think she made series of mistakes but one of the hardest things in medicine is knowing that you will make mistakes and those mistakes have the potential to have terrible consequences. I think it's likely that the mistakes she made were from being too caring and too passionate about helping moms and babies rather than from being a bad person or incompetent. At the same time, she's resposnbile for her actions as anyone else would be. I think the plea agreement sounds about right, she is held accountable but the punishment isn't harsh. No matter what and how much support she has from patients, she is living with the consequences and I would imagine regret from her decisions. I know I've made mistakes and been up nights with regret. Luckily, I've never had a mistake result in this kind of tragedy but I think if we are honest every medical professional has their own cases that they will always regret something they did.

 

I think the above reply, especially the bolded, bear repeating. Most people's opinions are based on the facts as they are commonly known: a medical professional waited over 10 minutes to summon help/ensure someone called 911 and someone else (a baby) died.

 

I'm a Field Training Officer and I stress 2 things to students and new hires all. the. time: (1) we have medications, equipment, and procedures which can harm a patient if given/utilized incorrectly and (2) because of nr 1 make sure that you give the right medication/use the right equipment/provide the right therapy for the right reason. And when you're sure, double check. A corollary of #2 is know when you're in over your head and get help.

 

I don't believe anyone suggested that she "let" this babe die (as in did nothing to help). I'm sure she worked very hard to resusitate the little one. She also made several poor decisions and mistakes. Of course we all make mistakes. In medicine, however, those mistakes can cost people their lives. I'm equally sure she's devastated at the outcome.

 

:grouphug: to you, Sue. I know this has been hard for you.

Edited May 7, 2011 by brehon
verb agreement...

[Danestress]

I don't think they necessarily could be charged with child endangerment because they hired someone unlicensed.

 

But the midwife can be. She can be an absolutely wonderful person - I have no doubt. I'm sure she's in the business because she loves babies and Moms. And I have no doubt that she took this case because she wanted to help the Mom have the type of birth she wanted and reasonably expected that it would work out well.

 

But you can't practice without a license. Every doctor, nurse, lawyer knows that. It's very basic, and she was very foolish to do it. I don't believe for a minute that she delayed calling 911 out of concern for her licensing problems. Surely, though, she should have considered that it would look that way. That's the kind of thing that makes it foolish to practice without a license. It made HER vulnerable in a way that will have lasting effects:(

[Amy in NH]

I sometimes think we have lost the ability in the US to just have bad stuff happen. We have to blame SOMEONE all the time. Sometimes babies die. Sometimes teenagers do too. It's awful. But not everyone gets 98 joy filled years on the planet. If a medical professional does something deliberate to take someone's life (barring medicial suicide IMO), then we should slap them silly. But if it's just one of those random death things, I think we as a society should mourn it but accept it.

 

:iagree: This is a major problem with our society.

[Slartibartfast]

I don't like the over medicalization of birth in the USA either but at times medical interventions and surgery are indicated. I am pro-life and I do not believe a mother has the right to damage a baby inside her body, even when it comes to her birth choices, simply because she wishes for a particular birth experience. The bottom line is whether or not you think a baby's right to be alive is more important that the choices a mother makes when carrying the baby and I personally do think that the right to be alive trumps just about any preference on the part of the mother carrying the baby. I understand that others out there disagree with this which is why this has become such a hot topic discussion.

 

I totally disagree.

 

Women have the right to decide about major surgery. The instance that changes we have gone off the rails. We are more than incubators. How about the mother's right to be alive? Does the baby trump that?

 

There are inherent risks to major surgery and we have NO idea about what the mother's reasoning was. We should probably just assume she had a "real" reason rather than some "experience" reason people just dismiss.

 

I have been risked out by a midwife, I accepted it. I know I probably could have found another midwife to deliver me anyways, my state has no restrictions on midwifery. I chose not to because I didn't want to be a statistic but that was my choice and my right.

 

I still do not believe we should be forced to have surgery. I wouldn't see an OB at all if that was the case.

Edited May 8, 2011 by Sis

[mykdsmomy]

I don't know Karen and I've never had a homebirth but honestly I'm baffled why she is getting her feet held to the fire when so many medical professionals in brick and mortar positions screw up all the time and they don't have the same accountability. My ds11 was born premature and had many complications. I saw MANY mistakes happen during his three month stay at the hospital. In addition to that, after he was discharged he went undiagnosed (even though he had seen several specialists and I was insisting that he had a small bowel stricture) for a year before we found a GI surgeon willing to listen to us and found the stricture that he could have died from!!! We weren't allowed to take him home....we had to take him straight to the hospital and the surgery was done the next morning for fear he would rupture his small intestines if he was sent home.

 

OR my grandma (different hospital) who was healthy as a horse one day, was taken my ambulance to the hospital with shortness of breath and chest pains and was diagnosed with a UTI but NOT monitored for a possible heart attack (which they discovered later she had)....they took their time treating her and she died as a result or their negligence.

 

No one was held accountable in either situation....why? The hospitals have these physicians backs.

[TravelingChris]

I think it was an extremely bad judgement to have a home birth for a first time mother who is 43 and has a breech baby. I certainly understand why licensed midwives stayed away. A first time mother at 43 is already a high risk situation. Add to that a breech baby and I can't see how anybody except someone who does not accept normal medical practices would see a home birth as an acceptable alternative. I think there is a huge difference between a mother who is having her 6th child at age 43 and a first time mother at the same age.

 

Now do I think that doctors don't make mistakes? Absolutely not. But this was a situation where a ceaserean should have been performed and the baby would probably still be alive and so would the mother. Instead we have a dead baby. Can bad things happen at birth? Certainly, but we try to prevent them. Once they are happening, calls for assistance should be happening either immediately or in a very short time afterward.

[Heather in WI]

I want to cry every time I think of that poor baby who was healthy one minute and dead the next. :crying:

 

The midwife was unlicensed in this state. She chose to deliver a first time mother of advanced age whose baby was in a breech position. She didn't call 911 when the baby was stuck for 20 minutes or for 13 minutes after birth.

 

She plead guilty to two felonies. I think that sounds about right, but I personally think the punishment (5 days in jail, $5,000 fine and repay the family $3,200) is extremely lenient.

[kalanamak]

She plead guilty to two felonies. I think that sounds about right, but I personally think the punishment (5 days in jail, $5,000 fine and repay the family $3,200) is extremely lenient.

 

Actually, the result could be seen as pro-midwifery. She'll not be able to be a professional in this capacity again, and it was a warning to others who want to be so risky, but I don't know that anything was served jailing her. If they really wanted to "swat-down" midwifery, it could have been a much stiffer sentence.

 

Prison can be seen as punishment, as a preventative of future acts, and as an "example" to make others pause. I think the misery of the situation, and losing professional status is enough of a warning to others. I suspect she WON'T be out there doing births now, so jailing her will not "protect" the public, and I suspect she is not a conscienceless thug, and will suffer for her act the rest of her life. But I may be wrong. I have to rely on the judge, who knows much more of the situation than I.