Mansfield, Mo. ? Victoria Kocher helped bring tiny Ethan Criswell into the world in the home of his parents, William and Cheryl Criswell.

Despite Ethan’s diminutive size and physical ailments, Kocher said she saw no reason to call the hospital. “He looked tiny, but what’s my judgment of small?” she said. “He breathed good … I saw no risk.”

Ethan, who authorities said was delivered seven weeks premature, weighed less than 3 pounds and suffered from multiple birth defects, was born March 14. He died seven days later at an area hospital.

Ethan’s parents are charged with involuntary manslaughter. Kocher, who said she served as the family’s labor coach, is charged with child endangerment.

The tragedy throws into focus the decision to give birth at home.

While the vast majority of babies are still born in hospitals, many parents are choosing the home setting where the surroundings are familiar and the costs often lower and choosing licensed midwives to do the delivering.

“She doesn’t brush you off and rush you in and out like doctors,” said Stephanie Goodman of Dadeville, describing the midwife who helped deliver her daughter, Alexis.

Kocher is not a licensed midwife. She says she never told the Criswells that she was. “I always made it clear I was in the position of a labor coach,” said Kocher, who said she never charged the Criswells for her services.

The Criswells, through their lawyer, tell a different story. “She represented herself as a licensed practicing midwife,” said attorney Lynn Johnson, who also accused Kocher of lying about her name. “The Criswells knew her as Sharon, not Victoria.”

The Criswells thought they were getting proper prenatal care from Kocher, Johnson said. “She did pelvic exams, kept vital statistic records, prescribed herbal remedies and over-the-counter medications,” Johnson said. “They thought they had retained and were paying for a licensed midwife.”

Kocher denies prescribing any type of medication and said she never implied she was a licensed nurse or a midwife.

“I didn’t do anything but tell her to breathe,” she said, “and tell her when to push and tell her when not to.”

Kocher refused to comment on the allegation she used an alias. According to court documents, she has also used the names Sharon J. Kocher, Vicky J. Newman, Victoria J. King and Victoria J. Smith.

Wright County authorities haven’t gotten caught up in either version of the story of Ethan’s death. They’ve charged all three principals.

Prosecuting Attorney Larry Tyrrell said he believed the Criswells were criminally negligent and “failed to provide medical care, nourishment and liquid to sustain life.”

And the affidavit provided by Mansfield Police Chief Dale McGaw stated Kocher also observed that the child had a clubfoot, was unable to nurse and that the umbilical cord was around his neck during delivery, but did not call for medical help.

Court documents show investigators believe Kocher “created a substantial risk by not advising the parents to seek medical attention for the child.”

Home vs. hospital

It’s been just more than three months since baby Ethan died.

Some people believe the child’s parents aided in his death by not seeking medical treatment. Others believe the parents had a choice of how they wanted to bring their child into the world.

“I feel like it’s every woman’s choice to birth her child the way she wants to birth her child,” said Pat Dennis, a registered nurse at St. John’s Regional Health Center. “If they do experience a bad outcome, they have to live with that.”

While some may dispute the best way to have a child, all agree that a professional caregiver a doctor, doula or a certified nurse-midwife should be directly involved.

A 1998 study from the National Center for Health Statistics and the Centers for Disease Control and Prevention revealed lower mortality rates for infants delivered by certified nurse-midwives than for babies born in hospitals.

“There are definitely segments of the population that like to take control of their own birth,” said Diane Barnes, a certified nurse-midwife and director of WomanCare Inc. in Reeds Spring. “For a normal, healthy woman, being outside of the hospital can be completely safe as long as they have a qualified provider to make sure they’re safe.”

Guilty of being naive

Kocher, a 51-year-old mother of 11, says she isn’t a midwife. And she emphatically denies having told anyone that she was. She’s just, she says, someone who knows how to help mothers-to-be ease through the process.

“I’m just good at making (mothers) comfortable,” she said. “I have a mothering nature.”

Kocher said she has worked for free as a labor coach for the past 10 years, assisting in about 50 births throughout the region. She said she has taken classes on labor and delivery.

Kocher said she met the Criswells through a mutual friend about a month before the baby was born and visited with the family a few times prior to the delivery.

The Criswells wanted Ethan to be born at home, their attorney said, because they had bad experiences with hospitals when their first two children were born.

“These people are not religious fanatics, they’re not anti-medical,” Johnson said. “They were trying to make good decisions as a family.”

Greene County Medical Examiner James Spindler conducted an autopsy on the infant. The affidavit said Spindler wrote to Wright County Coroner Ben Hurtt that “It is my opinion that this child was deprived of basic medical care due to parental negligence.”

Tyrrell said it was wrong for the parents to wait a week before seeking medical help for their child. The prosecutor said it was his duty to be an advocate for the baby. “The little people need somebody to speak up for them, and that’s our job,” he said.

Before the final day of his life, the Criswells didn’t know about all of Ethan’s abnormalities and life-threatening conditions, Johnson said.

Johnson said the Criswells relied solely on Kocher’s advice, and when she wasn’t able to answer their questions regarding Ethan’s failing health the final day, the couple called 911.

“If anything, they’re guilty of being naive and falling for the midwife’s misrepresentation.”

Kocher maintains the Criswells did nothing wrong.

“It was really smooth,” she said of the delivery. “My understanding was that the baby had a brain defect (and probably wouldn’t have lived even if he was born in a hospital). I didn’t see that they did anything wrong.”

The Criswells are scheduled to appear in Wright County Associate Circuit Court Wednesday for a preliminary hearing.

Johnson said her clients were “holding up OK,” but they felt the charges were unwarranted.

“What they did was perfectly legal and the outcome was not good,” Johnson said, “and now they’re charged with manslaughter.”