6.5.11

"Birth at home"-promoting midwife convicted of two felonies in death of breech-birth child.

Carr, who is a certified professional midwife but who state records indicate is not licensed in Virginia, is an advocate of home births and has worked with hundreds of women in the Washington region, many of whom offer high praise for her work and care. And she has held herself out as being especially adept at high-risk deliveries: When she met the boy’s mother — who was 43, in her first pregnancy and had a child in breech position — Carr told her that she had done 40 to 50 breech births in homes without problems, according to court records.
Looks like she talked herself and a lot of prospective parents into thinking that her skill and knowledge would eliminate the very real risk that a breech birth represents. That kid would have been alive today and the parents' pride a little ruffled maybe, if they had gone to a hospital. If you do a difficult and dangerous thing 40 or 50 times in a row with no ill effects - does that prove that it's not inherently risky? Or rather, does it prove that you can get lucky and your skill and knowledge can help, but that 1-2.5% (assuming the 1 in 40 or 1 in 50 is true or even remotely representative) chance of the baby dying in a midwife-assisted home breech birth is still too much of a risk?
Fifty to 75 people — including numerous babies — joined Carr in Alexandria Circuit Court on Thursday, standing when she walked into the courtroom in what supporter Nicole Jolley said was a show of respect. Jolley said Carr has “amazing skill.”
Excellent. Amazing skill in persuading people that home births are the way to go. Amazing skill at letting a baby have its head stuck in the birth canal for 20 minutes. Amazing skill at talking people into believing in a social fad - that of performing a high-risk birth at home when a healthy outcome can be virtually guaranteed in a hospital setting. Giving birth is inherently risky, to both mother and child. Reducing those risks to an acceptable level is incumbent on the parents and properly licensed, knowledgeable medical personnel. A midwife practicing normal low-risk home births is great, I'm all for it - but that person needs to know when to say "Stop, we need to go to the hospital, this is too risky." If you don't know when to say that, you're putting children at risk, you're smooth-talking parents into doing unhealthy dangerous stuff and you're putting yourself at liability of getting convicted of multiple felonies.

This woman, in collusion with the parents, are responsible for the death of a child that was wholly unnecessary. She got what she deserved. The parents - well, they'll have to deal with the repercussions of making bad decisions and trusting the wrong people, for the rest of their lives. You can't really charge them with a crime for being stupid and gullible and ignorant, but it certainly looks like their ignoring competent medical advice lead to the death of their child.

Difficult, high-risk medical condition? Might want to go to a hospital.

Difficult, high-risk pregnancy? Might want to go to a hospital to give birth. 

Mankind hasn't quite figured out how to take all the risk out of giving birth yet, but we have figured out that it's better to do so in a clinical setting with a whole bunch of resources to assist if things don't turn out the way they usually do.
After Carr was arrested, Jolley, a certified professional midwife, founded In Service to Women, a group focused on providing legal aid to midwives and uniting home-birth advocates. She said the group has raised $45,000 in less than two months, and hundreds of people joined the group on Facebook to offer testimonials about Carr’s contributions to the community.
“The outpouring of support has been amazing,” Jolley said. “Her services are coveted.”
Proving that people are gullible fools and will follow anyone that talks a smooth talk and gets the proper reputation with the proper people to build a client list with some good names on it. You're basically playing Russian Roulette with a high-risk home birth, except the chances of a dead baby aren't 1 in 6 as with a six-shooter, they're maybe more like 1 in 20 or 1 in 100 with a smart, skilled midwife. But you're still taking unnecessary risks. You're taking chances that you didn't need to take, all for the benefit of who?

You. The parent. You wanted a home birth and you got it. To hell with the risk to the kid. If it's the kid you care about, then give the kid a maximum possible chance of survival. Will that be provided by one single knowledgeable and skilled midwife - or by a whole building full of surgeons and technicians and nurses? Your call. Your choice.
The parents sought out Carr in August after nurses at a licensed birthing center in Alexandria said they could not deliver at home because of the fetus’s position in the womb; breech births are most often delivered by Caesarean section because the risk of complications from a breech delivery — in which the baby is positioned feet-first — are high, according to medical officials.
Seems to me that the parents cared more about the home-birth-advocacy thing than they cared about the kid. Those parents were unlucky, where apparently many others that had made the same bad decision had simply gotten lucky and avoided that 1-2.5% chance if the midwife's claim of 40-50 successful home breech births is indicative.
Carr agreed to do a home delivery and, prosecutors said, declined to call for help when things got out of control. A medical examiner ruled that the death was due to complications from a breech birth at home.
Harold Fox, director of the Department of Obstetrics and Gynecology at Johns Hopkins and who employs midwives, reviewed the case for prosecutors and determined that the delivery was high-risk and should have been performed in a hospital. According to court records, he said that “all of the actions of the Defendant created a gross departure from the accepted standard of care.” 
Personnel at Children’s Hospital contacted the Virginia Department of Health Professions after the baby’s death, a call that initiated a criminal investigation. Alexandria prosecutors interviewed every witness in the case before proceeding with an indictment this year. Boucher said the boy’s parents are “understandably devastated,” adding that they did not seek out prosecutors but agreed to help once an investigation was underway. 
In the final analysis, the parents' bad choices had as much to do with this as the midwife. Unfortunately I don't think there are any laws that will let you prosecute parents for making bad decisions and not giving their children a fighting chance to survive a difficult high-risk birth.

Stop believing what people tell you. Do your own research. Don't trust someone just because they say they've done this successfully 40 or 50 times. Do you really want to be involved in that 41st or 51st time when it all goes haywire and some poor innocent kid dies?

Superstition.
Religious fundamentalists.
Anecdotal evidence-believers.
Conspiracy theorists.
Social fad followers, including vegans.
Cult members following a charismatic leader.
People who believe their friends above competent medical or other authority.

Two very simple rules:
1. Trust no-one...
2. ...and believe in nothing that anyone tells you...
...until proven otherwise beyond a reasonable doubt.


Just because your friends swear by something or because you read a few articles or some stuff on the internet, doesn't mean there's not that 1-2.5% risk of your child dying - a risk that you could easily eliminate by talking to competent personnel and getting some sound advice from a variety of properly licensed, vetted and educated sources. As opposed to some snake-oil salesperson who talks a good talk and knows the immense value of network marketing - a phenomenon not unlike a snowball going downhill getting bigger and bigger after you get a certain critical mass of people who believe in you and then help you get more followers or clients.


Reminds me of these tribal knowledge guys who swore that they were right in the face of overwhelming scientific evidence to the contrary, and unfortunately managed to send a guy to his death with their pseudo-science: http://www.newyorker.com/reporting/2009/09/07/090907fa_fact_grann

And also the differences in how men and women (ok, this is a huge generalization, there are lots of exceptions, you may be one) approach different sources for learning and authoritative information:
http://marketingtowomenonline.typepad.com/blog/2010/05/word-of-mouth-men-trust-authority-women-trust-common-experience.html


UPDATE:
http://www.washingtonpost.com/local/midwife-karen-carr-convicted-in-alexandria-babys-death-is-under-investigation-in-md/2011/05/11/AFlrp22G_story.html
Last week, Karen Carr was convicted of two felonies for her role in the September death of a baby boy she delivered in an Alexandria home. This week, her cellphone keeps ringing with women who want her to deliver their babies.
Carr has since been banned from delivering babies in Virginia as part of her plea agreement.
"Underground" midwife without license, two felonies. Barred from delivering babies in a state where she supervised the unnecessary death of a child. Phone keeps ringing.

People are stupid and take unnecessary risks.
The newborn’s death in Alexandria was followed by another death in rural Maryland in November, a case now under investigation by the St. Mary’s County Sheriff’s Office.
The D.C. Department of Health issued a cease-and-desist order against Carr in January after the death of the baby in Alexandria and another case in the District in October, in which a baby she was delivering had to be rushed to a hospital.
The District’s cease-and-desist order states that investigators discovered that Carr had been delivering babies for “many years” without a license and that she “has caused or may cause immediate and irreparable harm to the public.” The U.S. attorney’s office in the District is investigating Carr’s midwife practice, according to law enforcement sources.
“The lack of integrity and veracity demonstrated by the defendant’s taking advantage of a plea arrangement to her benefit, standing before the court under oath and affirming that she was pleading guilty because she was in fact guilty, and then turning right around and claiming that she did nothing wrong, is extremely disturbing,” Boucher said. “It evidences the same arrogance that got her into trouble in the first place, and it does not bode well for her future clients.”
The newborn death rate is two to three times higher for planned home births than for those that take place in hospitals, said George Macones, chairman of the committee on obstetrical practice at the American College of Obstetricians and Gynecologists, which has long opposed home births. Some home-birth advocates say such studies are flawed.
Absolutely. Let's make more and better studies so we have better material on which to make decisions. Women absolutely should have the option of a home-birth. Excuse me - FAMILIES or single mothers should have the option of a home birth. Everyone has an axe to grind. Everyone wants you to change your life to dance to your tune. I'm biased. So are you. But let's agree that taking unnecesssary risks involving other people's lives is, well, unnecessary.
“There’s no question that if you come to a hospital, there’s a one in three chance you end up with a C-section, and it’s certainly true that some of them aren’t medically indicated,” Macones said. But at home, where there is less monitoring of the baby, there is more chance of a bad outcome, he said. “Obstetrics can be a risky business. Things can go wrong.”
Like many non-nurse-midwives, she worked underground.
Kirsty Welch was not at all satisfied with the service she received from Carr. She hired Carr to deliver her son in March 2008 and thinks Carr made a series of bad decisions that ultimately led her to be rushed to the hospital for emergency treatment.
Welch said Carr showed up at her home near Old Town Alexandria late in the delivery process. Carr was on her cellphone for much of the delivery, she said, speaking to another client who was also going through labor.
Showing up late? Not unusual - babies don't always come on time. Part of a home birth, unless you want the midwife to stay at your house for a week or two. Acceptable risk? I don't know, but I'll give the midwife/home birthers the benefit of the doubt on that.

Cellphone?? WHAT?
“Her attention was elsewhere,” said Welch, now 32.
After a healthy boy was born, Welch began to hemorrhage. She said Carr administered drugs to her before quickly leaving for the other delivery. An assistant stayed behind, and Carr stayed in touch with her by cellphone.
“Even with Karen on the phone, they never told me how serious the situation was,” Welch said. “She left me there, and if someone hadn’t stepped in, I could have died.”
Ultimately, Welch’s doula, or maternity aide, became concerned and called paramedics. Welch said Carr and another assistant implored her not to tell authorities that they had administered pitocin and another drug to her. Virginia law prohibits non-nurse midwives from administering drugs.
Smart girl to make the call. Telling your clients to lie to the authorities to protect you? Telling people that if paramedics of all people find out the truth, then you'll be in trouble? How about a little of that shiny TRANSPARENCY? Where's Wikileaks when you need them?
“The idea of her continuing to practice absolutely bothers me,” Welch said. “We felt really comfortable with her, and it was a false sense of security. I don’t want her to put anyone else in danger.”
“The drugs probably did save her life,” Carr said. “I’m glad I used them. But I also — it always puts me in a precarious position, especially in Virginia, when I use them. That I’m not really allowed to do that.”
Translation: What I did was illegal and I didn't want to get caught so I told people to lie about it.
Two women who supported the mother during the September delivery said in interviews that both Carr and the mother knew the risks involved in such a delivery. They both said everything was going well, until it wasn’t.
Because we're stupid and we believe and trust our friends over competent research and medical authority. We think because things go well a few times that means what we're doing is fine and we can keep doing it. It's a false sense of security based on small sample statistics. It's anecdotal evidence. It's arrogance.
“Everybody was on board with everything,” one of the women said. Both spoke on condition of anonymity because it is a legal case; neither was charged. “No one is going to put their child at risk on purpose, nor is any midwife,” the woman said. The mom and midwife thought everything was safe. That’s all that matters. And they were both wrong. . . . It was devastating.”
Stupid people rarely recognize when they're being stupid. Learn to be humble. Do some research to see if there are any risks associated with this big medical thing you've got coming up in six or nine months.

Or you can trust some random snake-oil saleswoman tribal witchdoctor with candles and soothing music who talks a good talk that was recommended by your best friend who tried to talk you into doing it so she'll feel better about the risks she took herself.

Good luck. If you're stupid and willing to take unnecessary risks with high-risk home delivery of a breech birth or something similar, just because you'll do anything to avoid the scar of a C-section - including accidentally kill your unborn child - then you're gonna need that luck.

2 comments:

  1. This is great! Unfortunately, I fell for this crap and buried my child. I've since taken on the homebirth world with other women who have been harmed in some way.

    ReplyDelete
  2. I'm terribly sorry for your loss. Could you do the world a huge favour and tell others about how this happened to you so that people can learn from your mistakes?

    Put up a blog post about it. Talk to a newspaper about it. Get the story out there any way you can. Ten minutes of work on your part might save a few lives down the road.

    ReplyDelete