The Public Flogging of Karen Carr

There’s recently been national coverage on a case out of Virginia, involving a Karen Carr, an unlicensed midwife who was brought up on involuntary manslaughter and child neglect charges after an infant died during a breech birth. The mother specifically sought Ms. Carr after her prior midwives would not attend the birth because of the positioning, since the mother was uncomfortable going to the hospital where she believed she would be pressured to have a C-section. The mother did not press charges – instead, Inova Alexandria Hospital, where the midwife brought the baby, contacted county prosecutors.

It’s no secret that many Ob-Gyns and hospitals push pain medication and C-sections. When I was pregnant with my first child not so long ago, and went to an orientation at the hospital for expecting parents who planned to deliver there, the head nurse told me upon hearing that I hoped for an unmedicated birth, “Listen, sweetie, either you’re going to be on drugs, or I am.” The national C-section rate is at an astronomical 32%, and when asked what a hospital could have provided in the Virginia case that the midwife could not, several medical experts replied to ABC News that a hospital could have delivered the baby via C-section (the precise thing the mother was trying to avoid by having a home birth). And of course, as anybody familiar with the work of Ina May Gaskin and her companions can tell you, there are midwifery techniques for dealing with birth complications – including breech presentations – which most ObGyns either do not know or don’t have the time/flexibility to provide in a hospital setting.

And in the case of Ms. Carr, while she was unlicensed, she wasn’t untrained (from the Washington Post article):

Carr earned certification as a midwife in 1997 through the North American Registry of Midwives. The certification — certified professional midwife, or CPM — is recognized in some states and not others. It doesn’t have minimum education requirements, but the process includes apprenticeships and exams.

The confusing part for parents, Macones said, is that there are several types of midwives and they have similar titles, so it might not be clear what level of education and training a practitioner has. CPMs learn through an apprenticeship model, while certified nurse midwives have years of academic study and clinical internships.

In Maryland and the District, there is no license for CPMs, only for nurse midwives. In Virginia, CPMs can practice if they get a license; according to state records, the state has 55 licensed CPMs.

To get a license in Virginia, however, a midwife has to agree she will not administer medications (including, say, anti-hemorrhaging medications). You almost have to wonder, what’s the point, then?

In between prosecuting the midwife and finger-pointing at the mother, is anybody looking at the actual reasons that this happened? No, of course not – this is a story which replicates myth, about an “arrogant” midwife and a “dumbass” mother, both too arrogant and caught up in lofty romantic ideals to pay attention to hard (throbbing) science. This is yet another reminder how the medical community and society as a whole responds to women’s bodies (especially when there may be a baby involved).

Women, particularly when it comes to reproduction, are seen as stubborn and emotional self-centereds who need to be managed. This crops up in people asking whether midwifery is “merely unreflective defiance”, it crops up in the repeated comments regarding Karen Carr’s “arrogance,” and in the repeated characterization of women who have home births as selfish creatures more interested in an “experience” than in the health of their infant. Women die while receiving breast implants, people struggling with cancer refuse chemotherapy, we make ourselves sick on birth control and most people shrug and say, “Hey, informed consent.”

Add a fetus and that goes out the window.

Birthing at home can be dangerous. Birthing in a hospital can be dangerous, especially if you’re having a C-section. Birthing, in general, can be dangerous. Women die regularly from childbirth all over the world, but the differences in those rates are not based on whether they’re “at home” or “in the hospital” – it’s because of their age, it’s because of their stress levels, it’s because of their health going into the pregnancy and during the pregnancy, and it’s because regardless of whether they’re at home or in the hospital in some places there aren’t enough qualified birth assistants at all. A low-risk home birth in the United States is not much more dangerous, if at all than giving birth in a US hospital (it’s certainly much safer than giving birth in a hospital in many countries), and home birth midwives are utilized successfully in other “developed” nations.

But the dismay and even vitriol towards midwives and women who’ve had home births is really about “protecting” the fetus at the expense of the mother. The mother, being an imperfect container, is seen as the biggest threat to her baby and therefore must be managed and controlled. Any significance or enjoyment the mother may get out of the birth experience is, at best, a happy side benefit – what’s really important is the product.

And that’s assuming we consider the baby all that important. There’s been a chart going around the past few years about the “tragic death toll of home births” – check out the bottom, though, to see that it only covers white women. You can go to the website for the Center of Disease Control and run the numbers yourselves (they don’t list all the death rates per 1000, but they give you the data so you can figure it out yourself). I looked at the data for 2005. Turns out the data for women in Asian/Pacific Islander and Black/African-American populations shows a lower infant death rate for births attended by certified midwives out of the hospital than the death rate for births attended by doctors inside the hospital.

Is that getting published? No, of course not. Because the concern about midwives isn’t about making sure women can make educated decisions, or about giving them the best possible care – it’s about using fear to control and manage women. Karen Carr now gets to be the scapegoat – a well-publicized case to remind the public that our bodies are terrifying, dangerous things, and the best thing for everyone is if we listen to the nice men in the white coats.

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