Gross Negligent Homicide: Midwife in Vienna Sentenced to 15 Months Conditional Imprisonment

The judge identified several breaches of duty of care. "You engaged in behavior that should not have been engaged in," he told the 42-year-old. The verdict is not final. The midwife requested time to consider, and the prosecutor waived the right to appeal.

The prosecution held the accused responsible for the death of a girl who died in a hospital five days after birth in September 2023. The accused allegedly neglected "the required duty of action" during a home birth, resulting in the baby's death, according to the indictment. The judge reached the same conclusion after reviewing the evidence. "I acknowledge that you did not act with malicious intent," he stated in the judgment's reasoning to the midwife. She had "the mother's well-being" in mind. However, the failure to perform a cardiotocography (CTG) was a criminal offense attributed to the 42-year-old. Additionally, "the transfer to the hospital occurred too late," the judge criticized.

Accused in Vienna Did Not Confess

The accused denied any alleged misconduct. "For me, the woman was not a high-risk patient," she emphasized. A cesarean section during a previous first birth and the age of the expectant mother - who was 38 years old at the time of pregnancy - were "no reason not to have a home birth" or "not relevant" for the midwife. The woman was "not at the limit of her energy."

The expectant mother approached the midwife in March 2023, who has been practicing her profession since October 2007, has been supervising home births since 2008, and has conducted between 30 and 35 such births annually, totaling around 500. Regarding the specific case, the accused emphasized, repeatedly referring to her master's thesis on home birth at a university of applied sciences during her testimony, that the expectant mother was "well-read" on the subject: "She knew studies and the master's thesis I wrote."

The indictment accused the midwife of not adhering to the provisions of the Midwifery Act and corresponding guidelines when conducting the home birth. It was "neither planned nor executed lege artis." Instead, doctors had advised the mother against a home birth, as risks during the birth process were expected in this specific case. The accused was aware of this expertise and nevertheless did not deviate from the intended home birth, according to the prosecution's allegation.

Complications did indeed arise during the birth. The midwife alerted the emergency doctor - from the prosecution's perspective, however, "the decision to transport to the hospital for medical intervention was neither timely nor appropriate." The delivered child subsequently died from the consequences of oxygen deprivation during birth.

Doctors Had Strongly Advised Against Home Birth

The doctors had strongly advised the pregnant woman against a home birth. Before or during her first delivery in 2020, gestational diabetes had occurred, and there had also been issues with the uterine structure and placenta, necessitating a cesarean section. When asked by the judge if she did not see this as a "warning signal," the accused replied: "Hospitals almost always advise against home births."

The expert in gynecology and obstetrics, Barbara Maier, confirmed the allegations made by the prosecution during the discussion of her report. Although the midwife could not have recognized a placental insufficiency in the mother ex ante, no so-called sugar screening was conducted, even though it was known from the first pregnancy that the mother had developed gestational diabetes. When declining heart tones became noticeable during the birth process, the accused "tolerated the home birth setting for far too long," Maier emphasized.

Expert Witness Implicated Defendant in Vienna

According to the expert, the midwife should have transferred the woman in labor to the hospital more quickly. When she contacted the hospital at 1:45 PM, it took about 45 more minutes for the ambulance to arrive with the expectant mother. After a forceps delivery, which was performed seven minutes after arriving at the hospital, the newborn had to be resuscitated and intubated. Ultimately, the baby could not be saved and died from hypoxia, an insufficient supply of oxygen to the body or individual body parts.

According to the expert, the girl's death could likely have been prevented if delivery had occurred within 20 minutes of recognizing the "emergency situation." The fact that the midwife refrained from monitoring and recording fetal heart activity and maternal labor activity - a so-called cardiotocography (CTG) - was also criticized by Maier as a failure. A CTG responds "very well" to hypoxia, Maier emphasized, addressing the defendant: "You did not recognize the problem with your monitoring." "I doubt that a CTG can detect chronic hypoxia," countered the midwife, who appeared very confident in court.

Regarding her approach to the CTG issue, the midwife stated: "If I feel I need a CTG, the woman is not suitable for a home birth." She also denied having reacted too late to the emergency situation: "Overall, the transfer (to the hospital, note) was swift."

Mother Did Not Blame Midwife

The mother of the deceased baby emphasized as a witness that she did not blame the defendant in retrospect. "It was important to me to give birth at my own pace," she stressed. And further: "Birth is physical. I was not allowed to experience that with my first child." During her first birth in a hospital, the doctors "made many decisions over my head." She experienced "fear-mongering" and "a loss of control over my body." The medications administered to her in the hospital "also affected my child," she explained.

For all these reasons, only a home birth was an option for her during her second pregnancy. It was important to her "to give birth at my own pace," the witness emphasized. She then experienced this: "I was in labor all day. It progressed steadily." When her strength waned and her daughter's heart tones worsened, the midwife transferred her to the hospital: "We drove to the OR at a leisurely pace."

Before the verdict was announced, a confidante of the mother distributed a written statement from the mother to the media present. "She (the midwife, note) is not to blame for the death of our daughter. I would wish for this case to be dismissed and for my family and me to be given the space to mourn and process our fate," the statement read. Five days after the birth of her daughter, it was clear "that her brain did not show enough activity for an independent life without machines. We let our daughter go. We are infinitely sad about this loss."

A reaction to the first-instance, non-final verdict came from the Austrian Midwives' Board (ÖHG), the chamber of Austrian midwives. It will need to be examined whether the woman still meets the requirements for practicing her profession in light of the conviction, it was stated in a release. The Magistrate's Department 40 in Vienna, as the responsible authority, has already initiated proceedings for the provisional prohibition of professional practice. This has not been pursued further in light of the midwife's declaration not to accompany any more home births after a cesarean section until the criminal proceedings are finally concluded. "The ÖHG is responsible for the definitive decision on the continuation of the professional license, which must assess the facts after the final verdict is available," emphasized the Austrian Midwives' Board.

(APA/Red)

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