Much has been said in the press (and for goodness sake, the Washington Post most of all!) about Karen Carr and the case of the breech baby who died in Alexandria, Virginia last year. For the two of you who haven’t read about this, a 43-year old woman, in her first pregnancy, having a breech baby, wanted a homebirth. Her CNM care providers explained she was high-risk and they couldn’t keep her as a client for either a home or birth center birth, referring her instead to their back-up obstetricians. The mom chose to ignore their advice and searched for a midwife who would agree to do what she wanted… to help her have her primip breech baby at home. Carr, a CPM in Maryland, but not licensed in Virginia became the (unlucky) midwife. She didn’t have a license in Virginia because they have a regulation that says a midwife cannot carry medications, including pitocin, which can save lives if the woman hemorrhages after the baby is born. Instead, she chose to forego a license in order to carry the life-saving medications, to me, a valid choice.
Let me state here that, to me, the least of the issue is Carr not having a license. She’s a perfectly acceptable midwife on one side of the line, but becomes a danger to society if she takes one step over that (state) line? That’s stupid logic and while I am not one to flagrantly ignore the law, sometimes there are extenuating circumstances when the law hasn’t caught up to the reality of the situation. Carrying life-saving medications was a choice to care for women, not to slap the legislators.
So, on September 11, 2010, the worst-case scenario of a breech birth occurred; the baby’s body was born and the head was stuck inside, above the mother’s pubic bone, still inside the uterus because the cervix wasn’t completely dilated/dilated enough to allow the head to be born. Knowing how the press skews facts, I am taking what is said with a salt lick, but even if we gave a lot of grace for the reported information, the times before Carr called for help were, in my opinion, ghastly. Twenty minutes of head entrapment and then another thirteen of resuscitation before calling EMS. The tension in my body reading that is enough to give me stomach cramps.
On Thursday, May 5, 2011, Carr plead guilty to charges of child endangerment and performing an invasive procedure without a license. She apparently regretted the decision to plead guilty to the child endangerment charge, saying she tried to do everything she could to save the baby. I don’t doubt that for one second.
Googling “Carr” and “breech” gives loads of sites where the discussions/arguments about the case rage on.
Instead of adding to the debates, I thought looking at this from a different viewpoint might be of interest.
It isn’t uncommon for midwives, student midwives and doulas to say, “I wasn’t there,” when asked to comment on cases that end badly for either mom or baby. It’s a genuine way to show compassion to the midwife and situation at hand. But I feel there is a valid lesson to be learned in discussing, and even dissecting, the heard-about event. If no one present knows the absolute facts, discussing the case as if can be just as valuable. By playing out scenarios that have gone awry, midwives build on their knowledge base, deciding in a non-emergent, un-stressful moment what they would and would not do as a midwife in a similar situation. From transferring a woman to the hospital for exhaustion to a fetal death, every scenario holds endless lessons. Sure, a part of it might be that hindsight is 20/20, but leaping off another’s difficulties/tragedies is an excellent way to learn. I’ve come to call this the What-If Game. Here are some What-If’s that immediately come to mind with regards to the Carr case. Let the discussions begin.
- What if you were asked to attend a birth that other midwives turned away?
- What if you were asked to assist at a birth where the midwife didn’t have much experience in the variation of the norm? (GDM, rising blood pressure, GBS+, etc.)
- What if you were asked to assist a midwife at the birth of twins or a breech and you knew the midwife had minimal experience with that type of delivery?
- What if you were asked to midwife a women who says she’s fully informed and still wants to birth at home despite having serious reservations yourself, but have made a commitment to helping women achieve the births they desire?
- What if you were asked to work in a state where you were illegal and had no solid back-up?
- What if you’re the midwife in a homebirth and things turn dangerous and the mother refuses to transport to the hospital?
- What if you saw things were turning dangerous and you were illegal; do you have your speech ready for EMS? Practice it with others!
- What if you are practicing illegally as a midwife, are you willing to go to prison for a mom’s right to birth at home?
- What if complications arose and you, an illegal midwife, knew you were going to get shit if you transported, would you delay calling for help? Hoping things would resolve before you had to take that shit?
- What if you were an assistant or doula and saw things going to hell in a handbasket and the midwife wasn't saying "Call 911!" and you knew the mom or baby needed emergency care?
- What if you weren’t permitted by law to carry medications, would you anyway?
- What if you weren’t permitted to suture, would you anyway?
- What if it was up to you to decide the line between following the law and supporting a woman’s right to choose?
Let the discussions begin.