RICHMOND, VIRGINIA: Karen Carr, a home birth midwife who was jailed for five days following a baby's death, is being investigated further after being linked to two other fatal incidents.

The former sheet metal mechanic has reportedly been investigated by authorities three times following the deaths of three different babies since 2010.

The midwife was charged with child endangerment in Virginia, fined $30,000 for practicing without a license in Maryland and exonerated after a DC investigation.

But despite the conviction and fine, Carr is still licensed to practice as a midwife in Maryland and Delaware due to a "patchwork" of inconsistent state laws across the country, according to a report by the Washington Post.

There are only 36 states that have licensing legislation for midwives, but the regulations that govern their practice differ widely.

Only 1.4% of the 3.6 million infants born in the US each year are delivered at home, but according to a study by The Post, the risk of death for a full-term baby giving birth at home with a midwife is double that of a baby delivered in a hospital.

When was Karen Carr first arrested?

Carr worked out of her two homes, one in Baltimore and the other in Mechanicsville, Maryland, in 2010 when her work drew concern at a local hospital.

In May 2010, Harold Lee, then the chief of staff at St Mary’s Hospital in Leonardtown, Maryland, reportedly wrote a complaint to the state Board of Physicians, stating, “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,” the complaint continued, according to Daily Mail.

At that time, she was reportedly approached by a couple whose baby was in the breech position. Due to the significant danger of difficulties, such infants are usually delivered via C-section in a hospital; however, the couple apparently had hospital anxiety and decided they still wanted a home birth.

When the couple met Carr, she allegedly claimed to them she had no trouble giving birth at home and had delivered more than 40 breech infants.

Despite Carr's alleged admission that she lacked a Virginia work license, the couple hired her to assist with the birth. But tragically, a fatal mishap took place during the delivery of 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 an unconscious state, but it was too late and the couple agreed to remove his life support.

The baby’s death was investigated by the Virginia Department of Health Professions and Carr also was interviewed as a part of it.

Just a few days later, paramedics were called to attend another home birth that Carr was overseeing in Maryland. The twin infant was apparently having respiratory difficulties, but Carr allegedly said everything was alright, and the baby died in the hospital.

At the time, The Children's National Hospital staff discovered that they had treated three babies born under Carr's care who had then died. Then, a conference of authorities from DC, Virginia, and Maryland was apparently called by the US attorney's office in late November 2010 to discuss Carr’s work.

They allegedly attempted to bring charges across state lines but were unsuccessful. Child homicide prosecutor Cynthia Wright subsequently told The Post that it is "very difficult" to bring charges against midwives because "a midwife who loses a child in one jurisdiction will often move to another."

Eventually, an Alexandria grand jury indicted Carr in 2011 on six felony counts pertaining to the Virginia baby's death, including involuntary manslaughter and child abuse.

She entered into a plea agreement, admitting to endangering children and performing an invasive treatment 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 Washington, DC, in 2011, representatives of the Health Department charged Carr with engaging in unlicensed nurse-midwifery practice. However, it was ruled that the District’s law did not apply to lay midwives such as Carr and she remained free to practice.

As for Maryland, the state Board of Physicians allegedly sent Carr an order to "cease and desist" from giving birth, claiming that she was engaging in unlicensed medical practice.

In defense of herself, she said that since midwifery was not medicine, she did not require a license to practice. But the judge refuted her claims and she was found to have created the 'potential for public harm' and fined $30,000.

Her former lawyer Micah Salb told The Post that the judge’s ruling was "grossly improper" and did not prohibit his client from practicing.

“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,” he said.

Why is Karen Carr still delivering babies?

Carr was found guilty of endangering the welfare of children in all three cases; she was imprisoned, fined a total of $33,200, and prohibited from practicing law in Virginia or Maryland.

Following the convictions, she traveled to Haiti and Uganda to work as a volunteer at remote midwifery clinics before trying to make a fresh start back in the US in 2012.

In 2017, she applied for midwifery licenses in Delaware, Wisconsin, and Maryland. She was granted approval in Delaware but refused in Wisconsin, where authorities claimed she presented "an unreasonable risk of harm to the public."

In 2020, she was licensed in Maryland, with the board who approved the license having said, "Since her conviction, the applicant has demonstrated a strong commitment to the profession of midwifery and the safety of mothers and babies."

However, another allegation struck Carr next year when a couple accused her of negligence after a baby died during childbirth while under her care.

The board suspended Carr's license and reportedly said she had been "grossly negligent" and recommended removing her license.

Subsequently, Carr was accused of 21 crimes by state assistant attorney general Denise McKoy, a former pediatric nurse, including neglecting to keep an eye on the mother's and child's health during birth.

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 stated that Carr had attended over 150 births "without any complaints" since obtaining her Maryland license.

Despite her past record and the new allegations, the judge decided that Carr could keep her license.