By Emanuella Grinberg
OMAHA, Neb. (Court TV) — A self-proclaimed, unlicensed Nebraska midwife has been cleared of wrongdoing for the death of a breech baby she tried to deliver in her parents’ home.
Prosecutors in Omaha claim Angela Hock acted recklessly and negligently from a place of “arrogance” when she tried to deliver the breech baby in her parents’ home instead of sending the mother to the hospital. Emergency medical technicians eventually delivered baby Vera in an ambulance, and she died two days later from a lack of oxygen to the brain. A pathologist opined Vera was stuck in the birth canal without oxygen for 10-12 minutes.
Hock’s defense argued Vera died of complications from childbirth and not because of Hock’s actions. “Childbirth is dangerous” no matter where it takes place, defense lawyer Keith Dornan said in his closing argument Thursday. He accused prosecutors of scapegoating Hock for the actions of others, namely, her parents and medical staff.
“The State didn’t prove [Vera] would have lived but for Angee’s actions,” Dornan said. “The situation that placed her at risk was childbirth.”
Hock opted for a bench trial, which meant Judge Timothy Burns decided her fate instead of a jury.
Judge Burns delivered his not-guilty verdict Friday morning, after taking a day to consider the evidence. The judge said while Hock wasn’t licensed, she had training and experience as a midwife. “At no time did Ms. Hock misrepresent herself,” the judge said.
Hock was free on bail. She left the courtroom surrounded by supporters and her attorneys.
Douglas County Deputy Attorney Amy Jacobsen said in her closing argument Thursday that Hock increased the risk of a tragic outcome when she failed to advise Vera’s parents of the dangers of vaginal breech birth.
Jacobsen reminded the judge of the testimony of the baby’s father, Crayton Noe. He said Hock counseled them on their options for about three minutes after she discovered the baby was breech: go to the hospital or remain at home with Hock since she had training in breech deliveries. The father testified he would have chosen the hospital had he known about the risks of breech birth.
Another witness, the emergency room obstetrician who reported Hock for possible negligence, told authorities Vera’s death was “totally preventable.” Dr. Katherine Lessman softened her position on the stand, saying that while no outcome is guaranteed, Hock’s actions cost Vera critical time that might have saved her life.
“A good midwife would not act like she can handle a breech delivery and spend 2-3 minutes talking to a young, vulnerable mother to make that kind of life-or-death decision,” Jacobsen said.
Hock’s lawyer argued the Noes did their research and considered their options long before Emily Noe went into labor the night of June 14, 2019. Hock attended the birth of their first daughter less than two years earlier, which started in their home and culminated in a c-section in the hospital. That experience and others that Emily Noe described as “bad childhood PTSD in hospitals” led her to seek alternative arrangements after her obstetrician pushed her to have another C-section for her second delivery, Dornan said.
Jacobsen argued Hock exploited Emily Noe’s vulnerability to gain her trust. She reminded the judge of the contract Hock signed with the Noes promising to “provide concrete knowledge, ancient wisdom and current research” so they could make “fully informed choices” on their own. In police interviews after Vera’s death, the grieving mother claimed responsibility for Vera’s death and said she would trust Hock to assist in her next delivery – though she would do it in a hospital.
“You need only listen to the audio to see how much Emily Noe believed in Angee Hock. She liked her, she believed in everything she said to her,” Jacobsen told the judge.
Dornan said other factors may have intervened in the chain of events that would make Hock solely responsible for the outcome, starting with Emily Noe’s decision to stay home after Hock discovered the baby was breech during a vaginal exam.
At that point, another factor could have been Emily Noe’s choice to spend 15 minutes alone in the bathroom after feeling an “urge,” Dornan said. Hock told her it could be a “warning,” but the mother declined Hock’s assistance. When she finally called for help, Hock and a doula found Emily Noe in the bathtub with the baby’s legs hanging from her body, and Hock directed Crayton Noe to call an ambulance.
Dornan pointed out that Dr. Lessman said she would have attempted the same procedures as Hock if she were delivering a breech baby vaginally, including making an incision in the vagina – an episiotomy — to create space for the baby to breathe. By then, firefighters and EMTs were onsite to assist. Both testified that they thought Hock was a professional who appeared to be taking the appropriate steps to deliver Vera.
When the episiotomy failed, it was Hock who directed the firefighters and EMTs to bring the mother to the hospital. Time was of the essence, yet Dornan said construction delays turned what should have been a 9-minute drive to the hospital into a 19-miniute trip, though the state disputes this timeline based. After delivering baby Vera in the ambulance, Dornan argued the EMTs didn’t have the proper tools to start oxygenating the baby — including epinephrine or infant masks — and her “good color” started to turn blue.
The case was closely watched by midwife groups, many of whom feared the case would lead to negative perceptions of their profession. But the prosecutor insisted the case was about Hock alone.
This is not about the state of midwifery law, this is an indictment of one person who chose to put herself out as an expert,” Jacobsen said.
DAY 5 – 12/16/22
- Judge delivers verdict
DAY 4 – 12/15/22
- The judge hears closing arguments:
- Court recesses until 10am, Dec. 16, when the judge is expected to announce his decision.
DAY 3 – 12/14/22
- Douglas County prosecutors rested their case in chief Wednesday morning after calling their last two witnesses. In total, prosecutors called nine witnesses over three days.
- Dr. Robert Bowen, who performed the autopsy on Vera Noe, testified that she died of lack of oxygen to the brain from breech position – specifically, from being stuck in the birth canal for 10-12 minutes with a compromised umbilical cord. She likely reached the point of no return after five minutes without, Bowen opined.
- Bowen didn’t determine the manner of death, saying that’s a legal conclusion for the county attorney, who concluded the death was accidental.
- The judge overruled the defense’s motion to dismiss the charge based on insufficient evidence.
- The defense argued the charges should be dismissed based on insufficient evidence that Vera Noe qualifies as a minor child for the purpose of the offense or that Angela Hock acted negligently since the choice to not go to the hospital sooner was mother Emily Noe’s to make.
- Both sides stipulated that the deceased infant’s mother, Emily Noe, was unavailable to testify due to the traumatic nature of the proceedings.
- In Noe’s absence, the court let Angela Hock’s defense introduce two interviews Noe gave police – one in the hospital while she was grieving her daughter’s loss, the other in her home two days later on June 19, 2019.
- In both interviews, Noe spoke highly of Hock and said she didn’t blame her for her daughter’s death.
- The defense called its own forensic pathologist, Dr. Janice Ophoven, to challenge the findings of the state witnesses Dr. Katherine Lessman and Dr. Robert Bowen concerning cause of death and contributing factors.
- WATCH: NE v. Angela Hock Livestream Day 3
DAY 2 – 12/13/22
- The testimony of Dr. Katherine Lessman, the obstetrician who reported concerns about Angela Hock’s conduct to law enforcement, took up nearly the entire day.
- READ MORE:
- Lessman said in direct that Vera’s death appeared to be preventable but conceded by the end of cross that no outcome is guaranteed in childbirth and that all any physician can do is try to minimize the risk of harm.
- The state also called Omaha Firefighter Matt Carroll, who testified that Hock appeared to be a medical professional who was taking the necessary steps to deliver baby Vera safely.
- WATCH: NE v. Angela Hock Livestream Day 2
DAY 1 – 12/12/22
- The judge hears opening statements:
- Crayton Noe, baby Vera’s father, described how his child’s delivery went horribly wrong when his daughter came out feet first while her head remained lodged in the birth canal depriving her of much-needed oxygen.
- Noe, 29, said they opted for a home birth despite the risks because his wife Emily had PTSD and risked severe anxiety in a hospital setting.
- Defendant Angela Hock helped to deliver their first child Sabra. When Sabra’s labor stalled, Hock advised them to go to a hospital where Sabra was delivered by C-section. While a home birth was unsuccessful, Noe said Hock inspired their trust and confidence and they elected to use Hock again for the birth of their second child Vera.
- The morning after Emily’s water broke, Hock arrived with Miki Hueftle, her Doula, at about 5:00 AM on June 15, 2019. At some point during the night Hock made the determination that the baby was breech, she gave the couple the option to stay home or go to the hospital.
- “She reassured us that she had breech training and attended a course,” Noe said.
- “How long did she talk about that,” asked prosecutor Amy Jacobsen.
- “It was a two to three minute conversation,” he said.
- The labor took a disastrous turn when about an hour after Hock had determined the baby was breech, Emily went to the bathroom and cried out for Hock. The baby had come out feet first. Noe said Hock spent about 15 minutes attempting to deliver the child before asking the Doula to call 911.
- Paramedics arrived to see Emily in distress on all fours, while the baby’s body had emerged except for its head.
- Three firefighters testified that they heard Hock ask for scissors to perform an episiotomy. Brian Strazdas said that they assumed she had medical training and knew what she was doing, but then questioned her qualifications when she did not possess her own birthing instruments. Strazdas said the scissors Hock used to cut Emily’s perineum were designed to cut the clothes off injured victims, not skin and flesh.
- Another firefighter said the episiotomy performed without the benefit of an anesthetic caused Emily to scream in pain.
- “It was a horrific scream, one that I will never forget,” testified one firefighter.
- Despite the ordeal – Noe was steadfast in his belief that Hock meant no harm and repeatedly agreed that Hock supported a successful and safe delivery of their child. When asked if anyone stopped caring for his child, Noe appeared to blame the hospital.
- On cross-examination, defense attorneys suggested that the duty was on the paramedics to make a determination as to whether Hock was qualified to perform an episiotomy. And the defense noted the episiotomy was attempted after the lead paramedic tried inserting his fingers in Emily’s vagina to create space for the baby to breathe. When that was unsuccessful the paramedic had a duty to protect Emily from the episiotomy if he thought she was in any danger. The lead paramedic as well as the firefighters said they thought Hock had medical training.
- The defense also elicited from firefighters that they were mandated to report child abuse, and none of them had reported the alleged abuse of Vera.
- Baby Vera was delivered in the ambulance on her way to the hospital. She died two days later.
- WATCH: NE v. Angela Hock Livestream Day 1
For more Court TV news of the killing Nebraska v. Angela Hock: www.courttv.com/ne-v-angela-hock-midwife-delivery-death-trial/
Court TV’s Grace Wong contributed to this report.