Moira Akers was prosecuted and convicted of the murder of a newborn in 2022. She claims to have given birth to a stillborn baby in her home in Columbia, Maryland, in 2018.

Prosecutors doubted Akers’ story, using her online searches for abortion services and lack of prenatal care as evidence of ill intent. But it was a “forensic method” devised in the 17th century that proved key to Akers’ conviction.

The method, known as a “float test,” was designed to determine if a baby was stillborn or born alive by placing the lungs of a deceased fetus in water. If the lungs float, then they are aerated, meaning the baby was breathing and alive prior to their death.

In 2018, former Maryland chief medical examiner Dr. David Fowler signed the autopsy report that, using the float test as proof, determined that Akers’ baby died after Akers asphyxiated it. Fowler also testified in Akers’ trial. Prosecutors used Fowler’s testimony and autopsy report as evidence to convict Akers of second-degree murder in 2022.

Similar to Fowler’s infamous 2021 testimony in the trial of former Minneapolis police officer Derek Chauvin, in which he argued that George Floyd died due to drug intoxication and inhaling fumes from a car tailpipe, Fowler’s citation of the float test in Akers’ case has elicited criticism from the medical community.

Fowler was also the subject of a scathing audit released by the Maryland Attorney General’s office last year, which found that at least 36 cases involving deaths that occurred during police restraint were improperly ruled accidents or left unclassified during his tenure

The float test has been widely discredited as imprecise and lacking methodological rigor.

In the course of our reporting on Akers’ case, we not only reviewed court transcripts and the testimony of physicians and medical experts; we also pressed Fowler’s former office for comment about whether or not the float test was still considered by OCME to be scientifically sound. We received no response. Then, on Tuesday, just prior to publication, Maryland Department of Health spokesman David McCallister disavowed the test.

“The lung float test is not part of OCME’s current routine practice, which reflects evolving scientific evidence, National Association of Medical Examiner (NAME) guidance, and the independent medical judgment of our forensic pathologists,” McCallister wrote in an email.

“When performed historically, the test was only one component of the overall forensic assessment and was interpreted together with the investigative and autopsy findings. How an individual autopsy finding is characterized or used in criminal prosecution is separate from OCME’s medical determination of cause and manner of death.”

McCallister’s disavowal of the float test marks a stunning departure from past practices for determining causes of death in Maryland. Whether the change will affect Akers’ case remains to be seen.

But what hasn’t changed is the fact that Akers was convicted, has served three years in prison, and is facing another prosecution—all while advocates and her lawyers are still fighting against a bureaucracy wedded to Fowler’s past practices.

Akers’ fate remains in legal limbo, but her story reveals how flawed science can have real-life consequences, and how an indifferent bureaucracy can defend the mistakes of the past despite public outcry and scientific pushback in the present.

A Stillbirth or Murder?

Akers’ ordeal began in November of 2018.

According to a statement she gave to police, Akers was watching TV with her daughter when she noticed she was bleeding. The Howard County resident retreated to her upstairs bedroom. There, she gave birth to what she described as a baby that was not breathing, or stillborn.

The mother of two young children told police her husband did not want another child. Finances were tight, and the couple was already struggling to care for both a toddler and an 8-year-old.

“I almost didn’t want to admit to myself that it was [a pregnancy],” she told police.

She hid the possible pregnancy from her family and did not seek prenatal care. “I just didn’t want my family [to know],” Akers said, “a stigma of them knowing that we had even contemplated the abortion part, but knowing that they wouldn’t be happy if we gave up the baby officially for adoption… that’s why I looked into the safe haven stuff.”

The birth itself was a moment of confusion and panic for Akers. When she started bleeding profusely, she thought it was possible the unexpected pregnancy could be the cause. After giving birth in her bathroom, panicked, she placed the baby’s remains in a plastic bag and put the bag in a closet.

Her husband, who had found her bleeding profusely, called an ambulance. According to her lawyer, Akers refrained from discussing the ordeal in front of her two children when EMTs arrived at the house. But when she arrived at the hospital, she told doctors about the stillbirth.

When Akers awoke from surgery, heavily sedated with painkillers and anesthesia, she found Howard County police detectives probing her with questions, which a recording reveals she struggled to answer through the haze of drugs.

Even though the doctors told detectives not to question Akers after her surgery, they did anyway. And prosecutors were able to include statements Akers made during that interview while still heavily sedated and under the influence of multiple drugs, including fentanyl.

“The hospital physicians attending told the police who had arrived at the scene not to speak to her for at least two hours after surgery because she was put under general anesthesia,” Akers’ lawyer, Debra Saltz, told us in an interview.

“So the police, rather than wait two hours, interviewed her. I think it was approximately an hour and 20 minutes later, they began an interview.”

Saltz challenged the admissibility of the interview in court. But presiding Judge McCrone ruled that Akers “sounded okay” after reviewing a recording of the interview.

During Saltz’s cross-examination of lead medical examiner Dr. Nikki Mourtzinos, Mourtzinos made a critical admission: float tests are not performed in a uniform fashion, and the test does not call for a consistent, controlled (i.e. scientific) methodology. “Multiple people do things differently. Some people tie off the lungs, some people would clamp off the lungs and float them in water,” Mourtzinos testified.

Saltz filed motions to toss out the float test results as evidence. But Judge McCrone ruled it admissible, too.

And more unresolved questions about the efficacy of the police and OCME investigations before Akers’ trial remain.

Even though the official OCME autopsy report was not released until four months later, detectives claim Maryland’s Office of the Chief Medical Examiner (OCME) told them Akers’ baby’s death was likely a homicide.

But Saltz says OCME and Howard County detectives had already made up their minds about Akers before their investigation into her ordeal even began in earnest. “It was never going to be about science in this case. It was going to be about a determined outcome, which was going to be homicide, even though it should not have been,” Saltz told us.

Along with the float test results and her post-surgery interview with detectives, prosecutors focused on both Akers’ prior internet searches for abortion providers, as well as her lack of prenatal care, as evidence that she intended to kill her baby.

Again, Akers’ defense argued this evidence was inadmissible due to a state law that prevents drawing criminal inferences from a woman’s behavior during pregnancy. Again, Saltz was overruled. Judge McCrone allowed prosecutors to use Akers’ actions as evidence of later criminal intent.

The chief OCME pathologist who conducted the float test testified in Akers’ trial that the final mechanism of injury was asphyxiation and exposure. However, the autopsy did not find petechial hemorrhaging in the eyes or any trauma around the neck indicating strangulation. The medical examiner argued that the determination of asphyxiation was due to observed inflammation in the pancreas, a less common indicator of strangulation.

But there was also substantive evidence that the baby was stillborn.

The defense offered expert testimony that argued the detection of multiple infections in Akers’ placenta and umbilical cord was indicative of a stillbirth.

“One of the more perplexing aspects regarding the opinions of Drs. Simon and Mourtzinos [the state medical examiners who conducted the autopsy] is that they describe gross and microscopic evidence of chorioamnionitis (inflammation of the placenta and its membranes), and funisitis (an inflammation of the umbilical cord), along with inflammation of the umbilical cord’s arteries and vein,” Gregory J. Davis, a forensic pathologist and professor at the University of Kentucky, wrote in a letter to the court.

The jury convicted Akers of second-degree murder. Judge McCrone sentenced her to 30 years.

New Obstacles for Prosecutors, but the Float Test Remains

In February 2025, after she had served three years in prison, the Maryland Supreme Court granted Akers a new trial. In a 5-2 decision, Justice Brynja M. Booth wrote for the majority:

We hold that the internet searches are irrelevant and that the trial court erred as a matter of law in admitting them. We similarly hold that Ms. Akers’ bare decision to forgo 2 prenatal care was not probative of motive or an intent to kill or harm a live child… In light of our holding on the inadmissibility of the abortion searches, we reverse the judgment of the Appellate Court and remand this case to the circuit court for a new trial.

To win a conviction against Akers during the retrial of the case, prosecutors have to navigate a major evidentiary obstacle now that the Maryland Supreme Court has essentially barred them from using much of the “evidence” used to convict Akers in 2022.

But the float test will still be admissible, and Saltz says prosecutors are likely to use it. Even though Fowler’s former office has publicly repudiated the test, the shadow and influence of Fowler himself still looms large.

“Dr. Fowler had a very large impact on this case and the judge heavily credited his testimony and relied on his testimony to allow in evidence the fetal lung float test,” Saltz told us.

Saltz says the admission by Fowler’s former office that the float test is scientifically unreliable should give prosecutors pause. “I find it hard to believe that the state’s attorney’s office in Howard County would still consider using this outdated test,” she wrote in an email.

“I have always believed that they were motivated by emotion rather than science as they undertook to prosecute my client. I would hope they would dismiss the charges based on this newest information.”

For now, prosecutors are not talking. A spokesman for the Howard County State’s Attorney’s Office said they do not comment on pending cases.

“It is the policy of the Howard County State’s Attorney’s Office not to comment to the media on the facts, evidence, or litigation strategy of a pending case until the matter has concluded,” Yolanda Vazquez wrote in an email.

Akers’ fate will be decided soon; the case is set for trial in November. Saltz says she is prepared to defend Akers, float test or not.

“My client is a very, very strong person. And she always held out hope that this would go her way… she knew that she had a stillborn baby,” Saltz said. “And there are plenty of people—including myself and the actual scientists who can read scientific evidence—who believe her.”

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