Midwife Cara Muhlhahn, the star of The Business of Being Born, Ricki Lake’s documentary about home births, is being sued by a Manhattan couple who are claiming that it’s her fault that their baby was stillborn. The couple, Catherine and Ricardo McKenzie, decided to have Muhlhahn deliver their child after seeing the documentary. “Initially, they considered using a physician and they went to a different midwife for home birth,” said Richard Reich, a lawyer for the couple. “When they heard about Cara Muhlhahn and all of her expertise and they saw the movie, they decided to have her deliver their baby at home.”
But now Muhlhahn and her aides are being accused of “gross negligence” for failing to refer Catherine McKenzie to a doctor during her three days of labor, despite the fact that the McKenzies’ apartment was less than two blocks from a hospital. Reich claims that Muhlhahn violated state law by “failing to have a written practice agreement with a hospital where a licensed doctor could provide care.”
This is not the first time that Muhlhahn, a self-described “outlaw” midwife, has been accused of negligence, incompetence, or disregard for the health of the mother and child. A New York Magazine profile of Muhlhahn by Andrew Goldman, published last March, showcased Muhlhahn’s disturbing, daredevil tendencies. And although The Business of Being Born, which has done much to legitimize and glamorize the home birth movement, makes Muhlhahn’s care seem infinitely preferable to a sanitized, impersonal, drug-filled hospital birth, Goldman’s profile is much darker.
He recounts the horror stories that didn’t quite make it into the movie’s final cut – like the time Muhlhahn left a woman in labor for 72 hours while she went off to deliver another baby. When Muhlhahn returned, the father (understandably worried about his wife’s health) asked, “How long is too long for a woman to be in labor?” “Never,” Muhlhahn replied. The woman was taken to the hospital and the baby was delivered by C-section. She remembers her reaction to entering the hospital, which surprised her – “It was a feeling of, ‘Oh my God. Here are people in their white lab coats who know what they’re doing, and there’s equipment and medicine here.’ Then I looked over at Cara with her crazy hair and ragtag clothes and I said to myself, ‘What was I thinking?’”
From the limited information available right now (Muhlhahn did not return calls to her office, and so was not quoted in the article), it sounds like Muhlhahn made a serious mistake. And indeed, the NY Mag profile pointed out that in 2003, settled a $950,000 lawsuit over a home birth that left a baby partially paralyzed. Although Muhlhahn’s glamorous “outlaw” midwifery has helped to make the home birth movement more mainstream, something that I think is ultimately very good for birthing generally, she is careless too often, and unwilling to admit that sometimes a hospital is necessary. Her stated goal, to “render birth more poetic than clinical,” sometimes blinds her to the necessity of medical care that she is personally unqualified to provide. And this blindness has resulted several times in tragedy.
It’s important to remember that nightmarish experiences can happen in hospitals too, and that birthing sometimes is a dangerous process – but many hospitals and birthing centers are helping to bridge the divide. Some midwives (Muhlhahn is not one of them) have hospital privileges, allowing them to move their patients to hospitals if the birth is not going smoothly. Muhlhahn also does not have a protocol under which women “risk out” of home birth because of complications like vaginal birth after cesarean section, breech births, diabetes, and twins.
Obstetrician Jacques Moritz, who is an unabashed proponent of the home birth movement, still has reservations about some of Muhlhahn’s practices. “I like her, but there’s some protocols that she has that I just can’t sign off on,” he says. Like the breech babies and vaginal births after Cesarean (VBACs) she says she’s performed at home? “That’s like bragging,” he says. “There’s a lot of stuff I’ve done, too, and said afterward, ‘Wow, I didn’t know I could do that.’ But I wouldn’t want to do it again.”
This particular case was highlighted on a Today show segment last month titled “The Perils of Midwifery”, which resulted in outcry from the home birth movement. The petition against the segment, which you can see (or sign) here, claimed that the show presented a “gross misrepresentation” of midwife-attended home birth. Citing the United States’ high infant mortality rates, the sponsoring organization, Choices in Childbirth, chastisted NBC producers for failing to recognize “an opportunity to discuss the reasons why highly educated, thoughtful and responsible women are choosing a home birth with a qualified midwife as an alternative to a hospital birth- an option that other countries have proven again and again costs less money, necessitates fewer c-sections, and provides better outcomes for mothers and babies than our system.”
So where does this leave us? Certainly one thing we can take away from this is that even though Cara Muhlhahn has made some questionable, and even dangerous decisions, she is not representative of all midwives, and although her presence as a “celebrity midwife” has popularized home birth, her apparent daredevil qualities are now making her something of a liability for less radical home birth proponents. Muhlhahn has had dramatic victories, and tragic defeats. But the spectacle that she has created is distracting from the most central tenets of the home birth movement: that women have a right to give birth how they choose, without drugs if they don’t want them, without a cesarean section if it’s not necessary, and, if it’s safe, in their own homes. There are many other midwives who are trying to provide this, in much safer and less dramatic ways, and they are being hurt by hyperbolic media characterizations, in part brought on by cases like Muhlhahn’s.
What are your birth stories? Have you had experiences with home births or hospital births? And if you haven’t yet had children, how do you want them to be born?
Photo courtesy of The Business of Being Born. Photo by Paulo Netto.