z*****9
发帖数: 256 | 1 When a Home Birth Ends in Tragedy, Can the Midwife Go to Jail?
What the case of a Baltimore midwife tells us about midwifery and the law.
By Libby CopelandPosted Monday, May 9, 2011, at 6:47 PM ET
Many midwives involved in home-birth deaths avoid manslaughter chargesLast
week, a midwife named Karen Carr pleaded guilty to two felonies for her role
in a Virginia home birth and was sentenced to a few days in jail and less
than $10,000 in fines and restitution. Considering the punishment she risked
at trial, the plea deal seemed like a wise one: she had been indicted on a
slew of charges, including involuntary manslaughter, after a delivery in
which an Alexandria, Va., client's breech baby got stuck and subsequently
died. Depending on your point of view, Carr is either a compassionate
professional who believes in a pregnant woman's autonomy or an ideologue who
acted as if she was above the law. But what is the law? Is a midwife
criminally liable for a birth that goes wrong? And how often are midwives
actually prosecuted?
PRINTDISCUSSE-MAILRSSRECOMMEND...REPRINTSSINGLE PAGE
FacebookDiggRedditStumbleUponCLOSE
The most serious charge in this case was involuntary manslaughter. Carr, who
is based in Baltimore and has presided over 1,200 births, could have served
up to 10 years if she'd been found guilty on this count—which in Virginia
is defined as unintentional killing resulting from "callous disregard for
human life." Involuntary manslaughter charges are brought for all manner of
crimes in which someone has behaved negligently or recklessly—drunk and
speeding drivers, parents who inadvertently leave their children behind in
hot cars, and, in one Virginia case, a woman who let her three violent pit
bulls run loose until they mauled an 82-year-old woman to death. On rare
occasions, even physicians have been charged with manslaughter; take the
pending case of Michael Jackson's doctor, Conrad Murray.
Chief Deputy Commonwealth Attorney Krista Boucher told me that the decision
to charge Carr with involuntary manslaughter had nothing to do with the fact
that she is a midwife; Boucher said that if a doctor had behaved in the
same way, she would have prosecuted that doctor. Instead, she told me, it
was the totality of Carr's actions that led the state to press criminal
charges. So what were those actions? The facts of the case, as we know them:
The mother was a 43-year-old who wanted to have her first baby at home.
While it's not illegal in Virginia to deliver a breech baby at home, it is
risky; another midwife practice had already turned the mother down for that
reason. During the delivery, the baby's head became trapped for 20 minutes,
according to an account Boucher gave to the Washington Post, and then Carr
and two assistants tried to get his lungs going for 13 minutes before
calling 911. The baby never became conscious and was taken off life support
two days later, the Post reported.
Advertisement
Midwife manslaughter cases are unusual, perhaps in part because moms with
high-risk pregnancies are more likely to deliver in hospitals. I located
just five criminal cases similar to Carr's over the last decade or so, and
they have tended not to be slam dunks. In Pennsylvania in 2009, a midwife
was acquitted of involuntary manslaughter and endangering the welfare of a
child after the death of a breech baby. The judge called her behavior "
abhorrent" but said her acts didn't rise to the legal standard for either
charge. The midwife was instead convicted of practicing midwifery without a
license, and she paid a $100 fine. (Meanwhile, the parents defended her,
saying she honored their wishes not to deliver in a hospital.) In Illinois
in 2000, yet another breech baby died after becoming stuck in the birth
canal. A jury acquitted the presiding midwife of one charge of involuntary
manslaughter and deadlocked on the second. To avoid a retrial, she later
pleaded guilty to reckless conduct, a misdemeanor charge, and was sentenced
to 18 months probation.
Such cases may also be rare because families are often reluctant to press
charges. Take the case of another Virginia midwife who in 1999 was charged
with involuntary manslaughter when a woman in her care died hours after a
home birth. Her defense said it was prepared to pick apart the state's
medical evidence, but the fact that the woman's husband declined to
cooperate with prosecutors may have inclined them to cut a deal. The midwife
ultimately pleaded guilty to several lesser misdemeanor charges.
While midwife manslaughter cases are uncommon, midwives have more frequently
been charged with practicing midwifery without a license. Indeed, this was
another of the charges Carr faced before she cut a deal. Why would a midwife
operate without a license? Typically, it's because she's attending home
births in a state where she can't get a license. Only 27 states currently
offer licensing or formal recognition to certified professional midwives,
the biggest group of midwives trained to perform home births. (The other
main group, certified nurse-midwives, has more advanced credentials and can
operate in all states, yet its members deliver almost exclusively at
hospitals.) In the other 23 states, and in the District of Columbia, a
midwife nationally certified by the North American Registry of Midwives, the
accrediting body for certified professional midwives, is at risk of getting
arrested for delivering a baby. This means that every time Carr delivered
in her home state of Maryland, she was operating outside the law, since she
can't be licensed there.
But Virginia is one of the states that does offer licensing for certified
professional midwives—it's just that Carr, a CPM since 1997, didn't bother
to get licensed there. Her lawyer, Stuart Sears, told me that's because the
state's regulations prevent certified midwives from administering drugs,
such as anti-hemorrhaging medications. "Not just Karen but a lot of midwives
they feel like that's not appropriate," Sears said of the restrictions.
There is 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. Many midwives see this not as a job but as a mission that calls
them to help women deliver the way they have for thousands of years, a
mission that has only grown more essential in the face of hospitals'
astonishingly high Cesarean rates. (Indeed, many midwives say tragedies like
the one in Alexandria are a consequence of the dramatic increase in C-
sections, which pose their own risks to mothers and babies. If more
hospitals permitted women with breech babies to attempt vaginal birth, with
C-sections used only as a last resort, they say, fewer women would face the
choice that Carr's Alexandria client did.) Finally, many midwives are
motivated by personal experience: In 1995, a Baltimore sheet-metal worker
told the Washington City Paper about the trauma of being given a C-section
when it was discovered during labor that her first baby was in a breech
position. She "felt violated and powerless," the City Paper reported in a
long story on midwives, "and vowed never again to give birth in a hospital."
The woman was Karen Carr, and it was this event that caused her to begin
training as a midwife.
Will Carr's prosecution have a chilling effect on other midwives,
discouraging them from taking on risky home births, or from practicing at
all? It seems unlikely. For one thing, the recent rise in home births
suggests that momentum is on their side: Midwives point to the fact that
demand for home deliveries, while still modest, is increasing. Such
deliveries rose from 0.59 percent of all American births in 2006 to 0.67 two
years later, according to the CDC. (That's 28,357 home births in 2008. Only
a small number of those were of the oh-no-the-baby's-coming-too-fast-to-get
-to-the-hospital variety; the rest are planned home births.)
Besides, says Carr's lawyer, "I don't know that the midwife community is
especially prone to chilling." |
|
