A midwife has been indicted on criminal charges in the death of a baby after a complicated home delivery in Alexandria last September.

Karen Carr, a Baltimore midwife who has delivered more than 1,200 babies and is well known in the childbirth community, was indicted on a charge of involuntary manslaughter, as well as charges of child abuse, neglect and acting without a license. She was indicted by a grand jury last week on an additional charge of negligently allowing a child’s life to be endangered.

Carr did not return messages seeking comment Monday.

The case has prompted an outpouring of support in recent days from hundreds of local women who have given birth with Carr’s help, sparked the creation of a nonprofit group to support midwives and spurred emotional debates over childbirth methods.

Many women think that childbirth has been overly medicalized in the United States and that mothers should be able to choose whatever they are most comfortable with: a hospital birth, a home birth, a non-surgical delivery, and so on.

Others worry that in complicated deliveries, families risk injury to the baby and the mother if they don’t have immediate access to doctors and an operating room. They also are concerned that unless midwives have met certain education and experience requirements, it’s difficult for parents to gauge their skills.

Licensing requirements vary from state to state, adding to the confusion.

The parents of the baby were not willing to talk about the Carr case. Krista Boucher, the commonwealth’s attorney who brought the case to Alexandria Circuit Court, did not return a message seeking comment Monday.

Carr’s attorneys described the allegations in this way: A 43-year-old woman wanted to deliver the family’s first baby at home. She sought out an Alexandria midwife practice, BirthCare & Women’s HealthCertified Nurse-Midwives. But there was a complication; the baby was in the breech position, meaning that it was upside-down rather than having its head closest to the birth canal.

According to John Kenneth Zwerling, Carr’s attorney, BirthCare advised the mother that the case was too complicated for a home delivery, but she preferred to deliver at home. So she sought out a midwife experienced with difficult deliveries, he said.

During the delivery at the couple’s home on Sept. 11, with Carr, a birth assistant and a doula helping, the baby’s head essentially got stuck after the body had been delivered, Zwerling said. In such cases the baby cannot survive long, so Carr and the two others worked to manipulate the baby and the mother’s position to finish the delivery.

The baby, a boy, had a heartbeat but was not breathing, according to Zwerling. Someone called 911 immediately, and those in attendance pushed air into the baby’s lungs until an ambulance arrived, he said.

The baby was declared dead at a nearby hospital.

The owners of BirthCare did not respond to a request for comment Monday.

Nearly all breech deliveries in the United States are performed by cesarean section, in part because of concerns about lawsuits.

Many women don’t want to deliver in a hospital because they fear their choices — to avoid drugs, to avoid surgery, to be surrounded by their families, to be with the baby immediately after delivery — will be taken away, said Carolyn L. Gegor, program director of the Nurse Midwifery/Women’s Health Nurse Practitioner Program in the School of Nursing and Health Studies at Georgetown University Medical Center.

But while most certified nurse-midwives have master’s degrees and other training, other midwives have a wide range of education and experience, Gegor said. Some of them are extremely well qualified, she added — but it’s more difficult for mothers to know their skill level.

“In states where midwives who are not certified through the American College of Nurse-Midwives are not considered legal, they do become an underground group,” she said. “They’re forced to do that so they’re not prosecuted.”

Carr was certified to practice in Maryland, Zwerling said, but she did not have a license to practice in Virginia. “There’s no question she’s qualified,” he said.

Carr has been practicing almost 20 years and is well known and respected in the community, said Nicole Jolley, who considers her a mentor and established In Service to Women, an organization that will try to raise the estimated $150,000 in legal fees to defend Carr.

Carr faces up to 35 years in prison if convicted of all charges. She has been released on bond.

Jolley said she hopes the new nonprofit will raise enough funds to defend other midwives and advocate for home births. Carr “is a specialist in our field,” with vast experience with complicated deliveries, Jolley said.

On a Facebook page Jolley created, more than 600 supporters signed up within days, writing vivid testimonials about how Carr helped bring their children into the world and, in some cases, expressing outrage that a midwife would be prosecuted for practicing without a license.

Staff researcher Jennifer Jenkins contributed to this report.