The Alexandria delivery was the beginning of what she has called the “unraveling” of her practice. Carr has since been banned from delivering babies in Virginia as part of her plea agreement.
The newborn’s death in Alexandria was followed by another death in rural Maryland in November, a case now under investigation by the St. Mary’s County Sheriff’s Office.
The D.C. Department of Health issued a cease-and-desist order against Carr in January after the death of the baby in Alexandria and another case in the District in October, in which a baby she was delivering had to be rushed to a hospital.
The District’s cease-and-desist order states that investigators discovered that Carr had been delivering babies for “many years” without a license and that she “has caused or may cause immediate and irreparable harm to the public.” The U.S. attorney’s office in the District is investigating Carr’s midwife practice, according to law enforcement sources.
In a recent interview at her home in Baltimore, where she maintains a patient office and a small lab, Carr said she had been “traumatized” by the baby’s death in Alexandria but now regrets pleading guilty to child endangerment because she did everything she could to deliver a healthy baby.
“I feel like I sold my soul,” Carr said.
Alexandria prosecutors Krista Boucher and Shelby Caputo said they pursued the case against Carr not because she is an unlicensed midwife, but because they think she was criminally negligent, waiting too long to call for help that might have saved the baby, among other factors. Health-care professionals referred the case to the commonwealth’s attorney’s office after the baby was pronounced dead at the hospital.
“The lack of integrity and veracity demonstrated by the defendant’s taking advantage of a plea arrangement to her benefit, standing before the court under oath and affirming that she was pleading guilty because she was in fact guilty, and then turning right around and claiming that she did nothing wrong, is extremely disturbing,” Boucher said. “It evidences the same arrogance that got her into trouble in the first place, and it does not bode well for her future clients.”
As part of her plea, Carr received a four-year sentence, all suspended except for several days that she spent in jail in Maryland after her arrest.
Carr has earned an intensely loyal following among women and advocates who believe that mothers should be able to deliver their babies in the comfort of home. She is one of the most visible symbols of a group willing to flout state laws in favor of their principles, namely to give women autonomy in choices regarding the birth of their children.
“The institutionalization of health care has taken a lot of the heart out of it,” Carr said in the interview, curled up on the sofa at her cozy home, where she has done pre- and postpartum checkups for years. An office on Wisconsin Avenue in the District, where she saw clients, is closed.
When women choose her, Carr said, they know that she will deliver their baby, not whichever doctor is on call. Moms describe their experiences warmly, saying she’ll walk in calmly, perhaps kiss them on the forehead, play the music they choose, let a big sister help catch the baby when it emerges, and light a candle so as not to startle the newborn with too much bright light.
“She’s incredibly knowledgeable,” said Michele Kazmier, a certified nurse midwife from Georgetown, whose daughter Carr delivered in October. “I’m 43 years old. If I had another child, I would almost be uncomfortable delivering with anyone else.”
Although home births have remained a statistical rarity in the United States — fewer than 7 in 1,000, according to the Centers for Disease Control and Prevention — a midwife being charged with a crime as the result of a delivery also is unusual.
Carr’s supporters say that most births are normal and healthy, not medical emergencies to be treated in a clinical setting. And they say mothers should have choices: to avoid surgery, to deliver without drugs, to give birth at home surrounded by family.
Leading members of the medical community respond that hospitals — where 99 percent of all U.S. births take place, according to the CDC — are the safest places to have a baby, with modern medical interventions available.
The newborn death rate is two to three times higher for planned home births than for those that take place in hospitals, said George Macones, chairman of the committee on obstetrical practice at the American College of Obstetricians and Gynecologists, which has long opposed home births. Some home-birth advocates say such studies are flawed.
“There’s no question that if you come to a hospital, there’s a one in three chance you end up with a C-section, and it’s certainly true that some of them aren’t medically indicated,” Macones said. But at home, where there is less monitoring of the baby, there is more chance of a bad outcome, he said. “Obstetrics can be a risky business. Things can go wrong.”
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.
Carr did not want a license. And she didn’t want to become a certified nurse midwife, who are greater in number and often link their practices to a physician or a hospital.
Like many non-nurse-midwives, she worked underground.
William L. Harp, executive director of the Virginia Board of Medicine, said practicing without a license is, simply, “unlawful.” Harp said the board has no way to regulate those who are not licensed, and that all cases involving unlicensed midwives are referred to local prosecutors.
Carr said she thinks that doctors turn too quickly to surgery during childbirth. About one-third of the 4.25 million births in the United States in 2008 were performed by C-section, according to the CDC’s latest data.
“Doctors spend most of their lives trying to convince people that home births are dangerous,” she said. “It’s about money and power. . . . It’s a guaranteed moneymaker.”
Carr said she delivered 135 babies last year and that she charges about $2,400 to $3,200 per delivery. Those fees, which she often reduces based on need and has even waived, barely cover her expenses, she said.
“A lot less than the hospital,” she said. “And far better service.”
Kirsty Welch was not at all satisfied with the service she received from Carr. She hired Carr to deliver her son in March 2008 and thinks Carr made a series of bad decisions that ultimately led her to be rushed to the hospital for emergency treatment.
Welch said Carr showed up at her home near Old Town Alexandria late in the delivery process. Carr was on her cellphone for much of the delivery, she said, speaking to another client who was also going through labor.
“Her attention was elsewhere,” said Welch, now 32.
After a healthy boy was born, Welch began to hemorrhage. She said Carr administered drugs to her before quickly leaving for the other delivery. An assistant stayed behind, and Carr stayed in touch with her by cellphone.
“Even with Karen on the phone, they never told me how serious the situation was,” Welch said. “She left me there, and if someone hadn’t stepped in, I could have died.”
Ultimately, Welch’s doula, or maternity aide, became concerned and called paramedics. Welch said Carr and another assistant implored her not to tell authorities that they had administered pitocin and another drug to her. Virginia law prohibits non-nurse midwives from administering drugs.
An ardent supporter of midwifery and home births, Welch said she thinks women should have the choice to deliver at home. She said midwives should be allowed to carry drugs and that she believes the drugs she received during her delivery saved her life.
But Welch contacted Alexandria authorities this week after learning that Carr had been convicted of felonies connected to a baby’s death. She didn’t go to authorities in 2008 because she didn’t want to do damage to midwifery in general.
“The idea of her continuing to practice absolutely bothers me,” Welch said. “We felt really comfortable with her, and it was a false sense of security. I don’t want her to put anyone else in danger.”
Carr said she left Welch with an experienced birth assistant and told the assistant to take Welch to a hospital if she started bleeding again. She said she also gave her drugs to control the bleeding.
“The drugs probably did save her life,” Carr said. “I’m glad I used them. But I also — it always puts me in a precarious position, especially in Virginia, when I use them. That I’m not really allowed to do that.”
She feels very strongly about a woman’s right to choose the way in which she gives birth.
“I am concerned about the people I take care of — I take huge risks,” Carr said. “This is a whole lifestyle — this isn’t just, ‘I go to peoples’ houses when they have a baby.’ I’m on call 24 hours a day, seven days a week, so I can attend to people who wish to have a baby in their home. It’s not a small thing. I do it because I care about them, I care about their babies, I care about their birth. . . . It’s something I feel very passionate about.”
Carr’s supporters came to her defense when she was charged. They are affectionate and full of praise for her skills. When babies die in hospitals, they say, no one hears about it.
“If I had a breech baby, there isn’t anyone else I would want but Karen there,” said Lorrie Leigh of Columbia, a mother of six, four of them delivered by Carr.
It was a case most obstetricians would call high-risk: The first-time mother in Alexandria was 43, and the baby was breech, which essentially means upside-down from the normal head-first position.
The baby’s position wasn’t the problem, Carr said; the problem was that the baby’s head became stuck.
Two women who supported the mother during the September delivery said in interviews that both Carr and the mother knew the risks involved in such a delivery. They both said everything was going well, until it wasn’t.
“Everybody was on board with everything,” one of the women said. Both spoke on condition of anonymity because it is a legal case; neither was charged. “No one is going to put their child at risk on purpose, nor is any midwife,” the woman said. The mom and midwife thought everything was safe. That’s all that matters. And they were both wrong. . . . It was devastating.”
The other woman, a student midwife who apprenticed with Carr for about a year, said this was the third breech birth she had attended with Carr after another in Virginia and one in Maryland. Both of those previous deliveries went “perfectly,” she said.
“This was a reasonable decision,” she said.
The baby’s family did not return a message.
Officials at Children’s National Medical Center in the District, which ultimately handled the baby’s case, declined to comment, citing medical privacy laws.
“I was very traumatized by attending that birth,” Carr said, hands clasped. “It really shook my faith in the process in a way that nothing ever has done. It was just — a very desperate, heartbreaking situation to be in.”
In November, Carr attended to a mother pregnant with twins in rural Maryland. One was having trouble breathing after delivery, so paramedics were called, but by the time they got there, the baby was doing better, and the ambulance was sent away.
“Some hours later, the baby started going down again, so I brought the baby to the hospital. And it didn’t make it,” Carr said. “I’m not sure what happened to that baby, why it wasn’t breathing.”
Hospitals lose babies, too, she said.
“When you work with birth, you’re going to run into death,” she said. “It’s just inevitable.”
Staff writer Del Quentin Wilber and researcher Jennifer Jenkins contributed to this report.