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Still no answers about a mysterious cluster of rare birth defects in central Washington, but the anxiety is growing and so is the criticism about the way the state is handling the investigation.

Could it be the nitrates in the well water that have built up for decades?

In about 22 percent of wells we test, earlier studies have shown maybe 15 percent there is contamination with nitrates in people s drinking water in their wells, said Dennis McLerran, EPA regional administrator.

Or could it be pesticides or something else?

Nurse Sara Barron was the first to report a spike in cases of a fatal birth defect called anencephaly, babies born with parts of their skull and brain missing

Three in a couple month period of time, that's unheard of. They are such tragic, terrible outcomes, said Barron.

The state health department found that in three counties over a three year period, there were 23 cases of anencephaly. That's four times the national average.

We have not found an answer and that's the very frustrating part because it's such a devastating diagnosis for a woman to have, said Many Stahre, PhD, epidemiologist.

Yet the state hasn't interviewed any of the families involved. Andrea Jackman's daughter was born with spina bifida, another type of neural birth defect.

Nobody's asked me anything, said Jackman.

So how did the state do its investigation?

We looked at all the information that was included in their medical records, said Stahre.

Information like prescription drugs and other medical conditions, but medical records don't track folic acid deficiency in the diet or pesticide exposure, two risk factors for this type of birth defect.

So why not just ask these mothers?

We have to weigh that heavily. This is a devastating diagnosis and we know for a lot of these women, they had to make some hard choices.

Andrea calls that attitude condescending and paternalistic, not to mention harmful.

Anything that could help another mother to not go through what I went through, I would have been fine with it, said Jackman.

Federal and state health officials are continuing the investigation and may interview families in the future.

As we still monitor cases for 2013, we're considering just about everything at this point, said Stahre.

There's got to be something. It could even be the smallest thing. Not knowing is scary, said Jackman.

The CDC says the cluster could also be just a coincidence. A follow up report is due out in the spring.

Related links:

CDC: More information on preventing birth defects

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