Tori DiVincenzo experienced a traumatic home birth that ended in the death of her daughter. She later discovered that her midwife, Karen Carr, had a history of investigations and disciplinary actions. The case highlights the lack of accountability and inconsistent laws surrounding midwives in the US. Amy Brittain reported
Editor’s note: This story features a video and photos of a deceased baby, which have been included with the parents’ permission. Please be advised that these images may be disturbing to some individuals.
In November 2021, Tori DiVincenzo found herself lying in bed at home, feeling dazed and bleeding. She had endured hours of labor under the guidance of an experienced midwife, only to deliver her baby girl, Sophie Rose DiVincenzo, lifeless and still. In a frantic rush, Sophie was taken to the hospital in an ambulance while first responders attended to the scene at the DiVincenzo’s home in Calvert County, Maryland. The midwife, Karen Carr, and her assistant hurriedly drained the birthing pool, changed the soiled bedsheets, and began cleaning up. DiVincenzo, too weak to stand and completely exposed, refused the blanket offered by paramedics, unable to bear the weight of it. It was then that Carr, a 65-year-old woman with short brown hair, sat on the bed and delivered the devastating news that Sophie had passed away. DiVincenzo later recounted that Carr had expressed her own confusion about how this tragedy had occurred, as just before the birth, she had reported hearing the baby’s heartbeat.
Subsequent investigations would delve into whether Carr had adequately monitored both DiVincenzo and her baby during labor. DiVincenzo would also discover that this was not the first time Carr had faced scrutiny for her work as a midwife. Authorities in multiple states, including the U.S. attorney’s office for the District of Columbia, had previously investigated Carr following other birthing complications. In 2010, Carr pleaded guilty to two felonies in Virginia after a baby died under her care, resulting in a five-day jail sentence and a ban on practicing in the state. In Maryland, where another infant death occurred that same year, a judge ruled that Carr’s decisions during the delivery had dire consequences and imposed a hefty fine.
Despite these incidents, Carr continued to deliver babies, raising serious concerns about the lack of consistent laws and accountability in the field of midwifery. The Washington Post’s investigation revealed that Carr’s career spanned over two decades, and despite numerous attempts by officials in multiple states to prevent her from practicing, their efforts largely failed. The case of Karen Carr underscores a larger issue where expectant parents considering home births struggle to assess a midwife’s track record and make informed decisions about one of the most important events in their lives. The laws governing midwifery practice vary widely across states, making it challenging to hold midwives accountable for any wrongdoing. Furthermore, the credentialing body for certified professional midwives, the North American Registry of Midwives (NARM), investigates complaints against midwives only with the mother’s consent. Lawsuits are also infrequently pursued, as malpractice insurance is often not required for midwives.
While home births account for only 1.4 percent of all births in the United States, there has been a 35 percent increase in home births over the past five years, while hospital births have slightly declined. This trend is not limited to one demographic group, as both white and non-white individuals are increasingly choosing home births. The reasons for opting for home births vary, with some women seeking empowerment and greater control over their bodies, while others aim to avoid medical interventions. The COVID-19 pandemic has also contributed to a growing distrust of hospitals and doctors.
Certified professional midwives, like Carr, attend the majority of home births in the country. These midwives typically have no hospital privileges and learn through apprenticeships. Many believe that childbirth is a natural process that requires minimal medical intervention. However, a Post analysis of CDC data over five years revealed that full-term infants born at home under the care of midwives are more than twice as likely to die compared to those delivered in hospitals by any provider.
The inconsistent laws surrounding midwifery practice further complicate matters. While 36 states and D.C. have laws allowing certified professional midwives to seek licensure, the regulations vary significantly. Some states prohibit midwives from attending riskier births, such as breech or twin births, while others have no such restrictions. Requirements for monitoring fetal heart rate during labor also differ among states. Additionally, the medications midwives are permitted to administer vary depending on the state.
When something goes wrong during a home birth, parents often find themselves with limited recourse. State laws often lack clarity regarding a midwife’s obligations, making it difficult for prosecutors to pursue administrative or criminal cases. NARM, the credentialing body for midwives, only investigates complaints with the mother’s consent. Lawsuits are rare due to the absence of malpractice insurance requirements for midwives.
Determining the extent of Carr’s career’s impact on the broader issue of accountability among certified professional midwives is challenging. NARM has revoked the credentials of only 10 out of over 4,300 certified midwives in its 30-year history, and Carr is not among them. The accessibility of complaints against midwives also varies across states, with some making them easily accessible to the public, while others require records requests. Additionally, changes in laws over time can make past allegations difficult to obtain from licensing agencies.
Tori DiVincenzo, who had struggled with infertility for eight years before becoming pregnant, initially trusted Carr when she discovered her through a nurse midwife’s recommendation. Carr’s website stated that she was licensed and had attended over 1,700 births. The DiVincenzos paid $4,200 for Carr’s services, with most of the fee covered by insurance. However, as DiVincenzo delved deeper into Carr’s history and pieced together the events surrounding Sophie’s death, she became convinced that her daughter’s passing could have been prevented. She compiled a timeline titled “Sophie’s Story,” accompanied by a photo of her baby girl wrapped in a knitted blanket. DiVincenzo submitted this document to the Maryland Board of Nursing, hoping they would investigate her complaint and ensure Carr never practiced again.
The case of Karen Carr highlights the urgent need for consistent laws and greater accountability in the field of midwifery. Erin Ryan, a certified professional midwife in Vermont, emphasizes that the issue extends beyond Carr and represents a systemic problem. Integrating midwives into the healthcare system would establish agreed-upon standards of practice. As expectant parents increasingly opt for home births, it becomes crucial to provide them with the necessary information and safeguards to make informed decisions about their birthing experience..