When Home Births Go Wrong, Should Midwives Go to Jail?

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?


Photo from Flickr.


Laura Mitchell
Laura Mitchell5 years ago

In the US, Registered Nurses can pursue education to become Certified Nurse Midwives (CNM). In this particular case, this was a lay midwife and lay midwifery training is no where near that of CNMs. And a breech presentation is a physician, NOT a midwife, patient.

Annmari Lundin
Annmari Lundin5 years ago

In countries like Sweden, more than 90% of abbies are delivered by midwifes in hospitals. In very few cases a doctor is involved in a birth. Only happens when there are a risk for the fetus or the woman. Also, in Sweden and other European countries. midwifes have an extensive education and training to perform their profession. We're not talking about amateurs! If the US would have an equally high standard in education and training as Europe have, then using midwifes would also have the affect of reducing the cost of delivery. But I guess the organizations for doctors and hospitals would go to any lengths possible to prevent such an outcome, because they would see their salaries and profits go down!

Too bad for the economy and health issues for American mothers-to-be!

Laura Mitchell
Laura Mitchell5 years ago

Kerrileigh, I think you are also missing the point I tried to make to Bob S: A midwife (lay or nurse) SHOULD NOT HAVE been caring for this patient during labor and delivery. Forget the maternal age issue (having a first baby at 40+ years old). The baby was BREECH and a breech delivery is beyond a midwife's scope of practice. She knew that and she did not get medical assistance (until it was too late). That's why she's criminally negligent.

Kerrileigh Grady

(cont) Sometimes before.

Along comes a culture pushing for safe AND natural birthing environments where mom is the boss and mom has as much control as the birthing process allows. Of course we're going to see the birth-as-medical-emergency-waiting-to-happen faction (which is, naturally, driven by profits and the specter of legal liability) up in arms. We need to keep in mind the danger of this thinking. The same attitude that will more readily criminalize midwives than doctors is the same one that results in mothers being arrested and handcuffed to labor beds or operating room tables because they dared to dictate how they wanted to give birth. See, for example: http://vimeo.com/4895023

Kerrileigh Grady

It's hard to say in this particular case, without hearing all the evidence, whether there was criminal negligence on the part of the midwife. I'll assume, since she was sentenced, that she did more wrong than simply attend a home birth that went wrong.

More generally, though, I would ask why midwives should be held more accountable than doctors. Would a doctor go to jail if a hospital birth goes wrong? I would hope, if there is criminal negligence, that the answer would be yes. In both cases. If either doctor or midwife is following the wishes of the mother, and if the mother is making her decision based on the information and pros/cons the birth attendant has given her, then regardless of what happens, they should not be held accountable.

Unfortunately, I think the bigger issue underlying this question is one of a mother's rights. When a mother wants a VBAC, she's often told by her hospital or doctor that she can't have it. When a mother wants the freedom to experience birth on her own terms, in as natural a setting as she can safely have, she is sometimes told she can't have it. Procedures and interventions are performed on birthing mothers *all the time* without their knowledge, much less their permission. The medical profession--as well as the surrounding culture that views birth not as a natural process needing aid but as a medical problem needing management--has seen to it that women lose their freedom and their rights as soon as a fetus becomes viable. Sometimes

Laura Mitchell
Laura Mitchell5 years ago

To Bob S: Yes, women have been giving birth at home for thousands of years. And how many of them and their babies have died? We see that today is areas of the world where access to trained medical personnel isn't available. From my perspective, you're missing the point. No, I don't think that hospital births should be mandatory.

But there are certain types of patients who ARE NOT midwifery and/or home birth candidates and this lady was one of them. She's having a her first baby at 40+ years, that puts her into the high risk category. At the very least, she should have been followed by a Certified Nurse Midwife/Obstetrician team, NOT a lay midwife. Then, the baby was breech. The problem with a breech delivery is the risk of head entrapment, which is what happened, and the baby asphyxiated and died. The midwife KNEW she needed help and she didn't try to get it. That's why she's criminally negligent.

Bob Sperlazzo
Robert Sperlazzo5 years ago

Do status quo doctors go to jail when things go wrong? Not usually. However, if the midwife checks everything right up to the last minute, these things should rarely occur. In fact, home births can be safer! We had all five of our kids at home. And we both participated in the births. Hospitals are cesspools for death and disease. And at home, you don't have the automatic cutting and the drugs (too potent for the tiny baby's body), all for the convenience of the doctors. Plus, you get to keep your baby with you from day one. Natural home birth -- it's been a proven method for thousands of years.

April Thompson
April Thompson5 years ago

So sad! But it is the mother's fault that her son died; she was high risk!

Bobbie P.
Bobbie P.5 years ago

I think every woman has the right to choose where to give birth and who is going to be responsible to do it. However if the midwife you prefer is not certified than you should probably go out and get some good references because you don't know if it's her first time. I mean if you choose to get an abortion your not gonna go grab a bum off the street with a coat hanger and say lets go. Further more I will say this mid wife is at fault knowing how high risk the pregnancy was and that the first midwife had refused due to complications she should and of fully informed the parents of the risks and suggested a hospital or some one with more expertise in this type of situation

Kathleen D.
Kathleen D.5 years ago

Midwives should be required by law to be certified or licensed to deliver babies in the privacy of the parents to be home. Regardless, the onus has to be on the parents who have contracted with the midwife. Anyone who would allow a midwife who is not fully credentialed to deliver their baby is reckless. It's also appalling that any state providing credentials to midwives would not approve of life-saving drugs or equipment in the event something were to go wrong. Either allow midwives the ability to access what may be needed or don't allow midwifery in the home.
While there is no guarantee the baby could have been saved if the mother had been in the hospital, it's highly unlikely it would not have been. The parent's have to take responsibility here and the midwife shouldn't be practicing in that field any longer.