The Trial of Karen Carr: Just or a Witch Hunt?

Karen Carr, well-known in Baltimore for her highly successful home-birthing practices, has recently gained new prominence in the media's eye. In June, the unlicensed midwife was put on trial for involuntary manslaughter and child abuse, after the death of a client's child, in September 2010.

THE TRIAL

On September 11th of last year, Karen Carr attempted to deliver the first child of a forty-three year old woman in Alexandria, Virginia. The child was in a breech position (positioned backwards in the womb). This is why a local birthing center had previously told her that it was too risky a situation for her to deliver this child at home. The mother adamantly refused to have her birth hospitalized. She then sought out Carr, who acknowledged that she had performed 40-50 breech births in homes without any problems. Carr warned the mother of the risks involved in breech births. The mother maintained that she wanted a home delivery.

 

Despite Carr’s experience handling breech babies, and the presence of both a birth assistant and a doula, at the delivery - the baby's head became trapped in the birth canal for twenty minutes. He died two days later at: Children's National Medical Center, in Washington, DC.

 

The parents of the child were actually not the ones to press charges. Criminal investigation was initiated by the staff at Children's Hospital, who contacted the Virginia Department of Health Professionals after the boy's death. Krista Boucher, the Chief Deputy Commonwealth's Attorney, in Alexandria, has noted that - though the parents did not seek out prosecutors, they did agree to help, once an investigation was underway. The prosecution claimed that Carr acted “negligently” and that the death could have been prevented. They said that she allowed the baby to remain with his head stuck for twenty minutes and that she did not call for emergency help for thirteen minutes, while she tried to resuscitate the boy.

 

Carr eventually plead guilty to separate counts of child endangerment and to performing an invasive procedure without a license. The original sentencing was: four years in prison, on each count. She had all but five days suspended. Carr was fined $5000 and made to return the $3200 that she had charged the boy's parents.

 

NEGLIGENT OR ATTENTIVE?

 

Instead of writing Karen Carr off as a threat, causing “irreparable harm to the public”, as the DC Department of Health did in January, it is important to recognize her as a midwife who has provided hundreds of women with successful comfortable experiences. An experienced birthing practitioner who took on a risky situation that unfortunately resulted in a tragedy. It is significant to note here, that as of 2009, the United States ranked 29th in the world in infant mortality, with 6.71 deaths per 1,000 live births. About 99% of these births are achieved in hospitals, and yet never is there a charge against a doctor whose delivery ends in death. The hypocrisy in that fact fuels the argument held by advocates for midwifery.

 

One mother, who sought out Carr to help with the delivery of her twins, shared her experience with the Indyreader. She said, “Karen was so different to work with. She listened to me … [and] didn't scare me into doing anything I didn't want to do.”

 

After the hospital's delivery of her first child, this woman began strongly advocating for the women's right to choose their birthing experience. With her first delivery, she felt as though “... everything was ramrodded through and [she] just had to follow.”

 

Despite her efforts to have a vaginal birth, she eventually had a cesarean section for the twins. Though she says, “I didn't feel bad about that C-section like I did with the first one because … it was my decision and I was with my midwife who I trusted.”

 

It was Carr who advised her client to go to the hospital in this scenario. From the sounds of this woman's experience with Carr, she would never refer to the midwife as “negligent” or “threatening.”

 

She says, “We should not be vilifying a woman who has given up more of herself, for far less, so that she can serve women who need and want her. We should be calling to task the fact that doctors are unwilling to back her. We should be questioning why medical training doesn’t include: natural birth, twin birth, breech birth or any other number of birth situations which can present themselves.”

 

MIDWIFERY: AN ALTERNATIVE TO UNNECESSARY SURGICAL INTERVENTION

 

Carr began as a Patient's Advocate at the People's Free Clinic, in Baltimore City, in 1982. After years of apprenticeships, self-study, and passing the NARM (North American Registry of Midwives) exam, Carr became a Certified Professional Midwife (CPM), in 1997. She specializes in twin and breech births and holds a VBAC (vaginal birth after cesarean) success rate greater than 70%. She has worked with more than 700 families and has delivered approximately 1200 babies. Carr has greatly reduced the cesarean rate amongst her clients, with over 96% of them achieving vaginal births.

 

Her resistance to cesarean births has been a defining factor in her career. Carr has intentionally not become licensed as a Certified Nurse Midwife (CNM); instead she contracted independently as a Certified Professional Midwife.1 Carr recently told The Washington Post that she decided against training as a CNM because she thinks doctors too quickly turn to surgery. She did not want to be working under a doctor or a hospital that is mostly “interested in money and power.”

 

There seems to exist a fundamental difference in opinion, on appropriate birthing practices between obstetricians and midwives. As evidenced by the extensive online discourse surrounding this topic - there is a sizable population, who like Carr, believe that the medicalization of birth has resulted in unnecessary surgical intervention and a divergence from the practices that were once in place, to ensure female safety and comfort. What is it that facilitated the current divide?

 

Harriet Smith, a graduate student in Gender and Women's Studies and a local health educator, attributes the divergence to the culture surrounding biotechnology. She believes that, “In a culture that leaps to automatically welcome new medical technology as progress, to choose otherwise seems irrational. A pregnant person who chooses home birth may feel and be perceived as irresponsible by not 'taking advantage' of the 'rewards' of biotechnology. Medical technology is so revered that to be successful without it is considered an anomaly or the rare case.”

 

She describes the acculturation of birth as a medical event as potentially leading to “self-doubt, social scrutiny, and even legal charges of child endangerment.”

 

The problem, according to our first contact, is the medical field's tendency to practice in fear of complications. By doing so, doctors treat all patients as though they need the extra medical care, which in many cases adds unnecessary stress to the patient's body. She claims that this is “...what (doctors) are trained for and that's what they're really good at.”

 

In our contact’s experience, doctors are not trained to facilitate vaginal births. “That's one thing that needs to happen … [we need to] get dialogues going and insist that doctors can't control everything. Because they don't train for everything.”

 

The real question is why do doctors treat vaginal birth as something unsafe? The medical field has reached a point where they treat natural birth as something that must be fixed, which is inherently disrespectful to and untrusting of the female body.

 

A mutually respectful doctor-midwife-mother relationship. This ideal collaboration would enable women to have the freedom to choose how they want to birth and the security of having a range of medical expertise at their disposal. In this case, doctors could handle the situations that require extra medical care, without forcing women with uncomplicated pregnancies into overtreatment. Carr's client was sure to note, that in addition to being present for risks and complications, doctors should be available even if just for a mother's peace of mind. “If she feels better about (seeing a doctor) there's nothing wrong with that, but she should be able to choose...Anyone who chooses not to [take the medical] route should not have to risk their and their baby’s safety to have that choice. Nor should they have to keep it secret or be punished for wanting it…We just can't keep letting more and more choices be taken away, and that's what is happening.”

 

A FEMINIST ANALYSIS

 

Corey Reidy, a local feminist activist, states:

The recent refrain is that Karen Carr is the unfortunate victim of an attack on midwifery by the medical industry. This is entirely true. But it is an utterly monochromatically teensy-tinsy narrow perspective to think that this solely plays out along the lines of Big Business aiming to crush Small Business. The attack on Karen Carr is a modern version of the witch hunts that have played out for centuries upon centuries. Hegemonic powers converge to oppress a group - and sustain their own cast structure of domination. Today’s Western Medical Industry is to a Midwife as a 1600s Religious Bigot is to a Female Herbalist. Today, trials end in character assassinations, colossal fines, and prison terms. Yesterday they ended in drownings, stake-burnings, and lynchings. Different methodologies - same end result. If you make common society mistrust that which is feminine-identified and created - you continue to invalidate that knowledge. You make the dominate knowledge “correct”and you perpetuate a group’s oppression.

 

Feminist theorist: bell hooks, has this wonderful phrase: imperialist white-supremacist capi­talist patriarchy. It signifies that all these oppressive systems are tangled-up together. Parsing them out to explain away a problem does little to illuminate what the hell is actually going on. I would add heterosexism to that list. But, beyond that, all those systems create the foundation for our Western politics.

 

So. if you look at Karen Carr, we see this giant imperialist white-supremacist heterosexist capitalist patriarchy of a beast bellowing towards her swinging a massive baseball bat. That system saw an opportunity to discredit that ancient female knowledge. And it swung hard.

 

Midwifery aims to make women trust their own bodies. It declares that when our laboring bodies give birth, that ability is inherent in us. I mean, honestly, everything in our female bodies is designed to get us knocked-up, carry a child to term, and deliver that small adorable continuation of the human race to the world. Midwifery acknowledges this inherent female-bodied wisdom. A midwife is there to empower the woman giving birth - to guide - to assist - but mostly to acknowledge that the woman’s body knows what it is doing. In female empowerment, the midwife labors with the mother -  it is a collaborative process.

 

Western medicine annuls all of that knowledge.It eradicates the idea that the female body is predisposed with the ability to give birth. Hypermedicalizing birth happens upon a laundry list of reasons, some of it has to do with reaffirming capitalism by requiring that mothers have dollar signs across their realities in order to give birth. It goes back to that idea - that everything in our world operates in some shape or fashion due to the hegemony of imperialist white-supremacist heterosexist capitalist patriarchy.

 

I’m not saying that there isn’t a place for medical science. We absolutely need to respect the advancements we’ve made in our knowedge of the body. Ancient practices, such as midwifery, only make sense in utilization, if they evolve as knowledge grows. But, it’s just plain -- to call upon an ancient word -- tomfoolery -  to pretend that the Western medical world isn’t largely dictated by capitalism (prescription companies, insurance agencies, fear of laawsuits,anyone?). And the way that Western medicine operates now tells the woman that they cannot trust their bodies.The mentality states: the doctor knows how women should give birth. We, as women, don’t know. Their [the doctors] usage of painkillers, the jump at a C-section at the slightest whim, lodging women in rooms with every type of equipment known to humankind -- makes for a birthing experience to be viewed through the lense that of a problem--- that absolutely must be fixed. And the woman doesn’t know how to do anything. Of course. Sure women have been birthing children for millenniums. Pssshhhh. The doctor knows. Science knows. The woman does not.

 

Medical science definitely has its place. Maybe the child in question would’ve lived if the mother had gotten a C-section. Maybe not. I bet the mother wouldn’t have been so adamantly against having a C-section if the ancient practice of midwifery were bred more into a hybrid with medical science--- than the defiant strict segregation that the disciplines exists in today.

 

But, y’know, even then, delivering a new human being into the world of existence is tricky business -- and since I think we’re only beginning to understand birth - we can’t plan for everything. Babies die in hospital births,too. And we don’t decry those doctors for being baby killers. Karen Carr was a practicing well-respected midwife who specialized in delivering complicated births. This is the first time a baby died during birth, and respective sides knew it was a risky birth to begin with. Why don’t doctors go on trial and have their licenses revoked when babies die during hospital sanctioned birth? Because hospital birth is the condoned method, by our imperialist white-supremacist heterosexist capitalist patriarchy. And so, if a baby dies in a hospital, we most likely say it’s a tragedy. If a baby dies at a home birth, we call it neglectful egotistical murder.

 

Karen Carr’s trial was a huge, “See silly female-bodied folks! Your bodies do not have the inherent knowledge of birthing. We must intervene, we the imperialist white-supremacist heterosexist capitalist patriarchy.”

 

Let me try to stop rambling and put this into a nuthsell. Karen Carr’s character assassination was enacted on a stage in order to make women believe that we are lesser than. That we must trust the hegemony. That the hegemony knows what it is best. And we do not. Do not trust our bodies. After all, they are female bodies and therefore hopelessly flawed. Our knowledgs/wisdoms are irrelevant because they are female.

 

As the gender gap becomes more and more narrow. imperialist white-supremacist heterosexist capitalist patriarchy must envision new - more subtle ways- of keeping women from realizing our intense capacity. The “beauty myth”2 is one way of keeping women oppressed.The hypermedicalization of birth is another.

 

BEYOND KAREN CARR

 

In addition to individuals voicing their concerns about this trial, there are several organizations advocating for women's right to choose their birthing experience. ICAN of Baltimore (http://www.icanofbaltimore.org/) seeks to prevent unnecessary cesareans through education, support systems, and the promotion of VBACs.* (footnote: on the site there are links to documents containing the statistics on cesarean and VBAC rates at MD hospitals) In Service to Women (http://www.inservicetowomen.org) works to support midwives who are being prosecuted and mobilize the National Home Birth Community. They have rallied around Karen Carr's case and have been raising funds for Carr's legal expenses.

 

Organizations such as these, are combating the legalized stigma present around midwifery and home births. Presently, there are eleven states3 where practicing as a CPM is illegal. As proven by Karen Carr's case these workers can be arrested and prosecuted if the delivery goes wrong. Consequently, the midwifery field is rapidly shrinking and, as previously noted, birthing procedure has become standardized. What is it that fuels this stigmatization? Is it, as Carr has stated herself, an issue of capitalism? Standardized surgeries generate an incredible revenue for the medical field and do it in a very efficient manner, but they completely disregard what is best for the female body. Deliveries, as they are performed in hospitals, ignore the mother's control over and knowledge of her own body.

 

“A scapegoat of a larger systematic problem,” our first contact describes Karen Carr. It is only through continuing this dialogue that we can tackle the larger problem that is the standardization of birth. Soon-to-be mothers and fathers, (as well as everyone else!) should educate themselves and others on the array of birthing options.

 

As one mother said, “There must be more choice, not less, more openness and trust and less fear.”

 

In order to attain this, we must advocate for the preservation of a mother's choice, and fight against the stigmatization of midwifery!

 

Citations:

“What is Citizens for Midwifery?” http://cfmidwifery.org/whatis/

“Midwifery.” http://en.wikipedia.org/wiki/Midwifery#United_States

“Midwife pleads guilty to felonies in death of Alexandria newborn” May 6 - http://www.washingtonpost.com/local/midwife-pleads-guilty-to-felonies-in-death-of-alexandria-newborn/2011/05/05/AFetRQ2F_story.html

“Midwife Karen Carr, convicted in Alexandria baby's death, is under investigation in MD” May 14 - http://www.washingtonpost.com/local/midwife-karen-carr-convicted-in-alexandria-babys-death-is-under-investigation-in-md/2011/05/11/AFlrp22G_story_3.html

Kluger, Jeffrey. “Doctor Versus Midwives: The Birth War Rages On.” http://www.time.com/time/health/article/0,8599,1898316,00.html

Endnotes: