When head entrapment does occur, Dr. Manuel Porto, professor and chairman of obstetrics and gynecology at the University of California Irvine Medical Center, said there are a series of procedures available.
Porto said doctors usually perform a Duhrssen incision, a procedure in which the physician "literally [cuts] the cervix at the 10 and 2 o'clock position to release the trapped head. This requires appropriate exposure and an operative delivery table to be done safely and would require surgical repair after the procedure -- all things that would be unlikely to be available at home."
Patients interested in midwifery are informed of the benefits and risks before deciding on a home birth. Licensed midwives are trained in normal patterns of labor, Moray said, but if something becomes abnormal during the delivery, the midwife transfers care to physicians.
"The birth needs to proceed pretty quickly," said Moray. "If it's a long labor or it's a long second-stage, the pushing stage, then it's possible there are problems in which the mother should get to the hospital for a Caesarean."
"Twenty-five years ago, vaginal breech births were considered a variation of normal," Moray continued. "But Caesarean sections are becoming more common because doctors aren't being trained to do them anymore, and it is now even restricted by some institutions."
Had the mom in Carr's case been in a hospital, Moritz said, doctors probably would have performed a C-section to take out the baby, or, if the head was stuck while trying to deliver vaginally, special forceps could have been used to pull the baby. Midwives do not have such tools available to them.
"Over 95 percent of patients presenting for delivery with a singleton breech presentation at term in a hospital in the USA today will have a Caesarean delivery," said Porto. "The umbilical cord circulation is completely cut off generally in a trapped head situation like this. One must act swiftly to avoid the potential for serious brain injury -- ideally in the first five minutes."
When asked whether the outcome would have been different in a conventional hospital setting, Porto responded, "Yes, with little doubt."
Despite it all, Carr's backers still sing her praises. The Facebook page contains messages that express thanks and support from mothers who hired Carr as their midwife.
"Karen was such a blessing in my first pregnancy and birth that I went on to have 2 more homebirths," one woman wrote. "The peace and words and knowledge she shared with me -- I continue to share with other expectant mothers."