May 12, 2011 -- Karen Carr has won the thanks and praise of many moms by delivering more than 1,200 babies during her 25-year career as a midwife.
But last week Carr, 44, pleaded guilty to two felony charges in an infant death that she attended during a home delivery in Virginia last September. The state of Virginia argued that Carr was negligent during the home birth after the baby's head became entrapped for more than 20 minutes during the delivery. The baby died two days later.
Despite the charges and Carr's guilty plea, her fans still stand by her -- even raising money for her on a Facebook page created by In Service to Women, a group that supports midwifery and now hopes to help pay for Carr's legal fees.
Carr faced several charges, including involuntary manslaughter, according to the Washington Post. By pleading guilty, Carr accepted that her negligence contributed to the baby's death that and she was not licensed to attend a delivery in Virginia, the state that brought the charges against her.
It was the state of Virginia, not the parents of the baby who died, that brought the charges against Carr. The parents filed a request for confidentiality throughout the trial.
John Zwerling, Carr's attorney, said the parents were well aware of the risks involved with a vaginal breech home birth, but the mother was "desperate not to have a c-section."
"This is an ongoing drama between ob-gyns and midwives," said Zwerling. "They're the ones who really need to get this thing settled and work together."
"If she's attending 1,200 births, then she has quite a bit of experience," said Susan Moray, press officer for Midwives Alliance of North America. "If she had attended breech births in the past and the patients wanted to have a vaginal breech birth, then she might have been the ideal person to do that."
Carr is a licensed midwife in Maryland but not in Virginia, which technically made it illegal for her to deliver the baby there.
"The hospital brought it to our attention, and we filed charges, brought by the Commonwealth," said Krista Boucher, chief deputy commonwealth's attorney in Alexandria, Va. "We were delighted that she acknowledged that she was criminally negligent in open court."
During the pregnancy, the baby was in a breech position, and the parents hired Carr to attend the home delivery. In the breech position, babies enter the birth canal feet -- or buttocks -- first, not head-first.
The baby boy's head was stuck for nearly 20 minutes before it was pulled out. Carr performed CPR, but the baby was soon transferred to Inova Hospital in Alexandria and died two days later, according to court documents.
"Breech deliveries, in general, are done by Caesarean section for exactly the reason that happened in this case," said Dr. Jacques Moritz, director of gynecology at St. Luke's-Roosevelt Hospital in New York City. "The chance of head entrapment is small, but when it happens, it is devastating."
Moritz was quick to note that breech births can be difficult in hospitals, too, but "there are more things you can do in a hospital" to fix it.
"I'm as midwifery-friendly as they come, but a breech home delivery is just stupid," said Moritz, who was featured in the pro- midwifery documentary "The Business of Being Born."
Head Entrapment Requires Swift Response
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."