On a dreary morning not long ago, Cara Muhlhahn is tooling through Brooklyn in her dented Prius, which she calls her “Mobile On-Call Unit.” Since Muhlhahn is a home-birth midwife, appointments both prenatal and postnatal—and, of course, the big show itself—take place within clients’ homes, and she spends a great deal of her time speeding between boroughs and racking up two grand a year in parking tickets. When a woman goes into labor, “they’re always like, ‘How did you get here so fast?’ ” she says. “Mobile On-Call Unit!”
This morning’s first appointment—or “mommy,” as Muhlhahn refers to her patients—is Kristy Bloom, a 30-year-old preschool teacher who lives in Carroll Gardens. Bloom is a first-time mother, a “primip” in obstetrical parlance, in her 38th week of pregnancy. While Kristy’s husband, Doug, lugs the birthing tub from Muhlhahn’s car up the stairs, Kristy tells me how hiring Muhlhahn was literally a dream realized. In her first weeks of pregnancy, she’d watched the 2008 Ricki Lake–produced low-budget documentary The Business of Being Born. “I cried through the whole movie,” she says. “And then I was in the bathtub and I had this whole vision of the birth and Cara was there. And I came out of the bath and said, ‘Babe, that woman’s going to be our midwife.’ ”
Since participating in The Business of Being Born—or BOBB, as it’s known to the initiated—Muhlhahn has become the most visible proselytizer of the home-birth movement. She just released a memoir called Labor of Love, in which she headily describes her work: “Day after day, I deliver babies, save lives, facilitate and witness near miracles.” She calls her duties as a mouthpiece for the movement her “Moses responsibility.” And she’s hoping to grow her home-birth service to handle the increasing demand in New York, where the numbers are already overburdening the nine home-birth midwives in practice here.
You couldn’t ask for a better home-birth sales pitch than BOBB. The film presents a horrifically plausible portrayal of a hospital childbirth system gone insane, of labor turned into a medical pathology: the continuous fetal heart-rate monitoring that makes it difficult for a mother to get off her back and into a position that actually encourages birth; the fear of lawsuits that compels doctors to perform C-sections on babies experiencing even normal distress during labor; the “failure to progress”—medicalese for laboring in a rentable hospital bed too long—that causes doctors to initiate a chain of “unnecessary interventions” like the artificial-induction hormone pitocin paired with epidural anesthesia, which seem to manufacture their own fetal distress, which in turn produces more C sections. Even obstetricians admit that the shocking rise in C-sections—in 2006, 31 percent of all babies were born this way, up 50 percent from a decade before—has done nothing to improve infant- or maternal-mortality statistics.
BOBB didn’t really break news, but it did introduce the natural-birth argument to a new mainstream audience. “Nobody in Manhattan other than the real crunchy, hair-underneath-the-arm granola types knew anything about home birth,” says Jacques Moritz, a pro-midwifery obstetrician at St. Luke’s-Roosevelt who was featured in the film. “The movie changed everything. I hate to say these things go into fashion, but they do.” More than anything else, BOBB de-radicalized home birth, conflating it with garden-variety natural childbirth and allowing Muhlhahn, largely unchallenged, to argue for its safety. There are only two options when it comes to childbirth, the film seems to say, comparing shots of ecstatic mothers hoisting their babies at home with shots of women under bad hospital light screaming for rescue.
Muhlhahn is offered up as the eminently reasonable alternative to the medical mess, shown in her East Village apartment in the predawn hours, tucking her instruments into a doctor’s bag, looking like the medical pro she is, a dean’s-list graduate from Columbia’s School of Nursing. (She says she had the grades for med school, but revels in her decision to skip eight years of “character-warping educational methods.”) She looks nothing like the hippie-midwife stereotype. “Downright sexy” is how Ricki Lake has described Muhlhahn, a youthful 51-year-old with low-rise jeans and a husky Debra Winger laugh.
She also doesn’t practice like a typical midwife. Personal experience has led her to dismiss many of what she calls the “myths” that are still taught in school as the bedrock of safe practice. The big babies—ten-pounders and more—that most obstetricians are loath to deliver vaginally, because of the risk that their shoulders will get stuck in the birth canal, are nothing more than “fit challenges” to Muhlhahn, necessitating only patience. She regularly does vaginal births after C-section at home, and has even home-delivered the riskiest births, breeches and twins. “She’ll put herself on the line way more than most people, like taking on a birth that’s a little more high risk that most midwives wouldn’t take,” says Abby Epstein, BOBB’s director. “It’s not that she’s a cowboy. It’s because she wants to serve these couples that say, ‘I trust my body. I believe in this process.’ She puts her ass on the line in a huge way every time she kind of steps out of bounds to help somebody. That’s just who she is.”