A midwife’s role in a baby’s death last year has raised new questions about the safety and wisdom of home births. Midwife Karen Carr pleaded guilty last week to two felony charges relating to the death of an infant she delivered in September 2010. The baby was born in the breech position (feet first), and the baby’s head was stuck in the birth canal for nearly 20 minutes before he was freed.

The baby suffered severe brain injury and was finally taken to a hospital, where he died two days later. Carr admitted that her negligence contributed to the baby’s death, and that she was not licensed to practice in the state where she delivered the baby.

Even if Carr, who had 25 years of experience as a midwife, had not been negligent, the nature of home birthing makes breech births very dangerous. Typically a breech birth would not be a life-threatening development in a modern hospital, where doctors would perform a Caesarean section to free the infant.

About five babies out of every 1,000 in the United States are delivered at home, and it is an increasingly popular option for mothers who feel that it’s a safer and more natural setting than a sterile hospital. While most births, both in and out of hospitals, are perfectly safe, a study last year found that babies born at home died at a higher rate than those born at hospitals.

The research, published in the American Journal of Obstetrics & Gynecology and conducted by Dr. Joseph Wax at the Maine Medical Center in Portland, examined nearly 550,000 births. The researcher found “a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital heart defects.”

Many doctors, and the American College of Obstetricians and Gynecologists, recommend against home delivery because it is not as safe as hospital births, for exactly the reason this case highlights. Hospitals have the equipment and trained staff to handle rare but potentially life-threatening emergencies and complications that midwives simply cannot address.

The choice is up to the mother, and of course women have successfully given birth for millennia without the assistance of either modern hospitals or midwives.