- Midwife was jailed for child endangerment after a baby in her care died and was fined $30,000 for practicing without a license in another state
- Despite her conviction and numerous other investigations, she is still licensed to practice in two states
- Mothers and babies are at risk due to the ‘patchwork’ of inconsistent state laws governing home births and midwives
A home birth midwife who was jailed for five days following a baby’s death is under renewed scrutiny after being linked to two other fatal incidents.
Karen Carr was jailed for child endangerment in Virginia after a baby in her care died in 2010 and has been investigated following two other deaths, but is still licensed to practice in two states, a report found.
The investigation by The Washington Post revealed how a ‘patchwork’ of inconsistent state laws across the country had allowed Carr to continue practicing despite previous bans and jail time.
Since 2010, Carr has reportedly been investigated by authorities in three different states following three different babies’ deaths.
But despite the conviction and fine, the former sheet metal mechanic is still licensed to practice as a midwife in Maryland and Delaware.
She reportedly once told an investigator who asked why she wasn’t licensed in Virginia: ‘I don’t want a license, I don’t like the rules of a license, you know. I suppose I could get a license but they’d probably take it away from me five minutes after I got it.’
The Post said Carr’s long and ongoing career demonstrates a ‘troubling reality’ where it is difficult for parents choosing a home birth to find out if a midwife is properly certified and safe.
Only 36 states have licensing laws for midwives but the rules that they have to operate under vary widely.
About 3.6 million babies are born in the US every year, of which just 1.4 percent are through home births, but an analysis by The Post found a full-term infant is twice as likely to die during a home birth with a midwife than babies delivered in hospital.
Carr’s former lawyer, Micah Salb, told DailyMail.com The Post’s report is a ‘gross mischaracterization of Karen’s performance as a midwife and her care and aversion to risk’.
‘She has an excellent reputation and an excellent history of success in her work,’ he added.
In 2010, Carr was working out of her two homes, one in Baltimore and the other in Mechanicsville, Md., where many of her clients lived within the Amish community.
Her work drew concern at a local hospital, where Harold Lee, then the chief of staff at St. Mary’s Hospital in Leonardtown, Md., reportedly wrote in a May 2010 complaint to the state Board of Physicians: ‘That none of her patients have died after she’s dumped them at our hospital is plain dumb luck.
‘I hope action can be taken before she kills a mother or baby in our community.’
At this time, she was reportedly approached by a couple whose baby was in the breech position.
Breeched babies are typically delivered by C-section in hospital due to the high risk of complications, but the couple was reportedly nervous about hospitals and decided they still wanted a home birth.
The couple met with Carr who allegedly told them she had delivered more than 40 breech babies and had no problem doing a homebirth.
Carr reportedly told them that she was not licensed to work in Virginia, but they still went ahead with hiring her to help deliver their baby.
The baby’s head got stuck in the birth canal during birth and when he was finally delivered, he wasn’t breathing.
He was taken to hospital in a comatose state, but it was too late and the couple agreed to remove his life support.
The Virginia Department of Health Professions began to investigate his death and interviewed Carr.
A few days later, paramedics were reportedly called to another birth Carr was overseeing, this time in Maryland.
The baby, a twin, was reportedly having trouble breathing but Carr allegedly insisted it was fine and it later died in hospital.
Staff at the Children’s National Hospital reportedly noticed that they had treated three babies born under Carr’s care that had then died.
In late November 2010, the U.S. attorney’s office in D.C. reportedly convened a meeting of officials from DC, Virginia and Maryland to discuss Carr.
They reportedly tried to file inter-state charges but failed, with child homicide prosecutor Cynthia Wright later telling The Post that it is ‘extremely difficult’ to prosecute midwives as ‘oftentimes, if a midwife loses a child in one jurisdiction, they will quickly move to another.’
Instead, the state authorities moved ahead with their own independent investigations.
In 2011, a grand jury in Alexandria indicted Carr on six felony counts, including involuntary manslaughter and child abuse, related to the Virginia baby’s death.
The prosecutor offered Carr a plea deal – so that the baby’s parents would not have to testify – and she pleaded guilty to child endangerment and performing an invasive procedure without a license.
She was sentenced to five days in jail and a $3,200 fine and also agreed to never again practice midwifery in Virginia.
Then in DC, also in 2011, Health Department officials accused Carr of practicing nurse midwifery without a license. But it was ruled that the District’s law did not apply to lay midwives such as Carr and she remained free to practice.
Meanwhile in Maryland, the state Board of Physicians reportedly ordered Carr to ‘cease and desist’ from delivering babies, alleging that she was practicing medicine without a license.
Her defense was that midwifery was not medicine and therefore she did not need a license to practice.
But the judge disagreed, she was found to have created the ‘potential for public harm’ and fined $30,000.
Salb told The Post that the judge’s ruling was ‘grossly improper’ and did not prohibit his client from practicing, saying: ‘It is true that she might have worried that she would be charged again with practicing medicine without a license, but that was nothing new.’
Between the three cases, Carr had been found guilty of child endangerment and jailed, and fined a combined total of $33,200 – and was not meant to practice again in Virginia or Maryland.
The Post said Carr then went to Uganda and Haiti to volunteer at rural midwifery clinics, returning to the US in 2012 to try and start over.
In 2017, she applied for midwifery licenses in Delaware, Wisconsin and Maryland.
She was approved in Delaware and denied in Wisconsin, with officials reportedly saying she posed ‘an unreasonable risk of harm to the public’
Three years later she was given her license in Maryland, with the board writing: ‘Since her conviction, the applicant has demonstrated a strong commitment to the profession of midwifery and the safety of mothers and babies.’
Carr soon launched her website and began taking on new clients, The Post said.
A year later, in 2021, she was accused of negligence by a couple in Maryland whose baby died during childbirth under Carr’s care.
When first responders arrived, EMS staff’s body cameras recorded them asking her questions.
The baby’s parents alleged that Carr had failed to monitor their baby’s heartrate and filed a complaint and the Maryland Board of Nursing.
The board suspended Carr’s license and reportedly said she had been ‘grossly negligent’ and recommended removing her license.
State Assistant Attorney General Denise McKoy, a former pediatric nurse, then reportedly leveled 21 charges against Carr, including that she failed to monitor the health of a mother and baby during labor.
The case did not focus on the baby’s death, but on whether Carr had violated the state’s regulations for midwives.
In her defense, Carr’s attorney, Natalie McSherry, reportedly said that since receiving her Maryland license, Carr had attended more than 150 births ‘without any complaints.’
Despite her past record, and the new allegations, the judge decided that Carr could keep her license.
DailyMail.com contacted Carr for comment.
Her former lawyer, Salb, told DailyMail.com: ‘It is useful to recognize that the Maryland claim against Karen began when several physicians began stridently claiming that Karen Carr posed a grave danger to Maryland families.
‘The facts were irrelevant — in fact, Karen Carr has safely aided in the delivery of over a thousand healthy babies.
‘The Board of Physicians quickly recognized that it could not prevail in a case about the quality of Ms. Carr’s midwifery services, so it explicitly conceded at the start of the case that this case was not about standards of care.
‘This is important because it contradicts the Post’s version that Karen’s work was deficient.
‘Despite that, the Board of Physicians focused in its case against Karen the emotionally-compelling death of the twin baby. Notably, the Board of Physicians was careful to avoid actually ascribing responsibility to Ms. Carr for the infant’s death, even though it hints, suggests, and implies that Karen Carr killed a baby.
‘It is easy to attack the caregiver—whether a doctor, nurse, or midwife—when a baby dies. It is harder to prove that the baby’s death was actually caused by the caregiver.’
OB-GYN and author, Dr Jennifer Lincoln told DailyMail.com: ‘Overall in the US we have a maternal and infant mortality crisis, and people who are pregnant and thinking about where they want to give birth need to be able to make an informed choice whether that is at home or in the hospital.
‘They need to feel that they are safe and going to be looked after, no matter where they give birth.’