How accountable should midwives be held when a home birth goes tragically wrong? This is a tricky question, and one that’s being decided in an evolving way. An article for Slate by Libby Copeland gives this example: recently, a midwife named Karen Carr pleaded guilty to two felonies, including involuntary manslaughter, after a home birth delivery in which the client’s breech baby got stuck and subsequently died. Carr received a few days in jail and less than $10,000 in fines and restitution. The question is, should Carr have been punished more severely? And, equally importantly, how often are midwives prosecuted?
The facts of Carr’s case are as follows: the mother was a 43-year-old woman who wanted to have her first baby at home. This was despite the fact that there are risks attached to having a breech birth; in fact, one midwife practice had already turned the woman down. During the delivery, the baby’s head was trapped for twenty minutes, and when he was delivered, he never became conscious.
In other similar cases, the families have sometimes defended the midwife, saying that despite the tragic outcome, she honored their wish not to have a baby in the hospital. Another reason, according to Copeland, that midwives may not be prosecuted often is that women with high-risk pregnancies usually choose to deliver in hospitals.
But then there’s the additional problem that midwives often operate without licenses, even in the 27 states where they can be officially certified. In the case of Carr, who was practicing without a license, her lawyer explained that it was because state regulations prohibit licensed midwives from administering certain drugs, like anti-hemorrhaging medications, which many midwives see as an affront.
And as Copeland points out, there’s a “strain of civil disobedience in the culture of modern midwifery, a sense that the profession is serving the needs of women, even if state legislatures haven’t yet caught up and even if doing so comes with some legal risk.” Some say that tragedies like the one that happened in Virginia occur because many hospitals don’t permit vaginal births for breech babies, forcing women to have cesarean sections. And the demand for home births seems to be slowly rising.
So will cases like Carr’s change the way that midwives operate? And should midwives change, or should hospitals and state legislatures begin to accomodate the desires of parents who want to have home births?
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