Autopsies don't tell enough, experts say

Possible homicide in babies' deaths hard to determine

August 01, 2007|By Dennis O'Brien and Chris Emery | Dennis O'Brien and Chris Emery,Sun reporters

From examining the remains alone, experts say, there is no clear-cut way to determine whether an Ocean City mother caused the deaths of the four preterm babies found on her property over the past week.

The state medical examiner was conducting autopsies yesterday to determine whether the other three babies discovered last week were stillborn, like the first, or whether they died after birth.

One crucial question is when the babies died. Prosecutors plan to use the case to test a 2005 statute originally designed to extend the definition of murder to include an assault on a woman whose unborn fetus is harmed.

If any of the three bodies still being examined predates the law, prosecution of that case would be questionable.

In all four cases, forensic experts say determining from an autopsy whether a stillborn baby's death is a homicide is no easy task.

"Unless the mother says something incriminating, they're very hard cases to proceed with," said Dr. Michael Baden, a former chief medical examiner for New York City.

Christy L. Freeman was charged with first-degree murder in the death of one of four babies found in and around her modest Ocean City home last week after her boyfriend told paramedics she had passed out in her bathroom.

A stillborn baby just 26 weeks old was found under her bathroom sink Thursday. The remains of two more babies described as "preterm" were found in garbage bags in a bedroom trunk; the remains of another were discovered Friday in a motor home parked in the driveway, police said.

Clues to death

Determining whether a premature birth was an act of nature is a difficult proposition, experts say.

"You would look at the fetus to see if something was malformed. That would give you an inference that the stillbirth was natural because there was something that was making it hard for the baby to survive in the womb," said Dr. Michael Griffith, a forensic pathologist at St. Louis University School of Medicine.

It's possible, but not easy, for a woman to harm an unborn fetus while it is still in the womb, said Dr. Cynthia G. Kaplan, a professor of pathology at New York State University in Stony Brook.

Certain drugs and chemicals could induce a miscarriage, Kaplan said, as could physical trauma.

"If you threw yourself down a flight of steps, the placenta could separate and kill the fetus," she said.

Freeman had bruises on her legs, stomach and forearm when she was found bleeding Thursday, police said.

But Kaplan said she doubted that a woman would intentionally subject herself to such trauma several times. She noted that there are medical reasons for multiple miscarriages, such as damage to the birth canal or viral infections.

"I have to believe they were spontaneous labors in this case," she said.

Kaplan, Baden and other experts emphasized that they have no personal knowledge of Freeman's case.

Generally, they said, one problem for investigators in such cases is that a baby's life can be so easily ended. Adult homicides often leave evidence of a violent death - bruises, knife wounds or bullet holes. But with an infant or a premature baby, there is no need to inflict such obvious wounds.

"Usually it's more difficult to detect, because with an infant it takes less to cause a death," Baden said. "All you have to do is put a hand over the mouth. Suffocation leaves very little behind, very few signs."

Generally, the more decomposed the remains, the harder it is to determine the cause of death and whether the baby was viable, experts say.

One possible clue to whether a baby has survived outside the womb is the presence of air in the lungs. But air can also enter the lungs during postmortem decomposition. So, pathologists look for other signs of life, such as food in the stomach and evidence of healing where the umbilical cord was cut, experts said.

As a result, pathologists often depend on statements from the mother.

"It's very difficult, if not impossible, to tell just from autopsy if the baby was born alive or dead," said Dr. Joseph Prahlow, a professor of forensic pathology at Indiana University School of Medicine. "When I call an infant case a live birth, it's almost always because the mother said it was alive."

Worcester County State's Attorney Joel Todd said he has evidence that Freeman intentionally caused the death of the 26-week-old fetus. The 2005 statute defines a "viable fetus" as one that, based on an attending physician's determination, could survive outside the womb.

Viability generally starts at around 28 weeks, but varies with the health of the baby, experts said. It can start at 20 weeks, and opinions on when it begins can vary from one doctor to the next.

"It is ultimately a medical judgment," said Andrew D. Levy, an adjunct professor at the University of Maryland School of Law. "The prosecution would need a doctor to say there is a reasonable likelihood of the fetuses surviving outside the wombs." That could turn a trial into a battle of expert opinions.

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