Midwife pleads guilty to felonies in death of Alexandria newborn

May 5, 2011

A midwife who supervised the delivery of a baby boy who died in an Alexandria home last year was convicted of two felonies Thursday as part of a plea agreement that bars her from working as a midwife in Virginia.

Karen Carr, 44, of Baltimore entered guilty pleas to separate counts of child endangerment and performing an invasive procedure without a license, stemming from the Sept. 11 death of a newborn. Carr, by accepting the plea, acknowledged that she was not licensed to work as a midwife at the time and that the baby died as a result of her negligence.

Law enforcement officials said it is rare to see a midwife charged with a crime in connection with a failed delivery, but a combination of factors led prosecutors to pursue the case. They said Carr was unlicensed in Virginia, agreed to perform a high-risk breech delivery in a woman’s home after other care providers refused, and ignored warning signs that the delivery was not going well.

Ultimately, prosecutors said, Carr allowed the baby to remain with his head stuck in the birth canal for 20 minutes and then, after delivery, tried to resuscitate him for 13 minutes before calling for emergency medical help. The boy never gained consciousness or displayed brain activity, and he died two days later at Children’s National Medical Center in the District when life support was removed.

“When you add everything together, it was criminally negligent,” said Krista Boucher, chief deputy commonwealth’s attorney in Alexandria. “The baby never had a chance.”

The case has elicited strong emotions and intense debate, much of it continuing online, about childbirth options in the region. While a vast majority of women give birth in hospitals, many use midwives to assist them. A relatively small number of women choose to give birth at home.

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.

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.”

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.”

Stuart Sears, one of the lawyers representing Carr, said his client “chose to accept this plea because she recognized this was going to be an incredibly difficult trial for everyone involved, including her, her supporters and the family that lost their child.” He said she understands that there has been long-standing debate about what is an acceptable risk when considering home births, hospital births and C-sections.

“It’s a valid debate among medical professionals and certified midwives and certified nurse midwives,” Sears said. “It’s probably best resolved by them than by lawyers.”

Prosecutors had charged Carr with involuntary manslaughter and child abuse, charges that were reduced in the plea agreement. Carr was sentenced to four years on each count but had all but five days suspended. She also was fined $5,000 and ordered to pay back the $3,200 fee she charged the boy’s parents.

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.

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.” Fox declined to comment Thursday.

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.

Boucher said she believes Carr acted recklessly, both operating without a license and not providing the help and care that was needed to save the boy.

“It’s important for all persons who care for children, whether it’s midwives or teachers or doctors, to understand that there is a point beyond which negligent practice becomes criminal,” Boucher said.

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