But labor is an unpredictable thing, and sometimes the experience is more nightmarish than poetic. Muhlhahn’s patient Sandra Garcia was one week overdue when her water finally broke on a Sunday night in early November. She labored that night and through the next day assisted by her husband, Jeff Wise, and her doula, a former NYU postpartum nurse who was now working for Muhlhahn. (Muhlhahn, busy with another labor, appeared only sporadically.)
Monday night, Garcia was approaching 24 hours of labor. Most hospitals insist that a baby be delivered no more than 24 hours after membrane rupture because of the risk of infection, but Muhlhahn isn’t a big clock-watcher. Instead, she takes precautions to avoid infections: “After rupture,” she says, “no routine exams, no baths, no sex.” By 10 p.m., the doula decided that Garcia was about to deliver. So, with candles lit, Garcia got in the birthing tub, which, because of the risk of infection, represents the endgame, the mother’s pushing venue. Except it wasn’t time to push. At Garcia’s insistence, Muhlhahn performed an exam at around 3:30 a.m. and discovered she was only a half-inch dilated. The doula had somehow misjudged her progression. Still, Muhlhahn wasn’t concerned. “There’s no such thing as stalled labor,” they remember her assuring them. “Labor just takes a long time.” With that, she left to deliver another baby.
Late Wednesday afternoon, nearly 72 hours into his wife’s labor, Wise started to freak out. The doula had gone home to rest. It was getting dark. They had no instrument to check the baby’s heart rate. His wife’s face was pallid, her knees and elbows raw from supporting her weight during the contractions. The apartment reeked of vomit and urine from her catheter.
“How long is too long for a woman to be in labor?” Wise demanded to know when Muhlhahn finally returned to the apartment that night. “Never,” Muhlhahn replied flatly. Her philosophy was simple: Trust the wisdom of the body to send the baby out when it’s ready. But she agreed to examine Garcia again. If she hadn’t progressed significantly, they’d go to St. Vincent’s. The results were startling: two centimeters. She had hardly progressed at all.
Garcia crouched on all fours in the back seat of Muhlhahn’s Prius as they drove to the hospital. When they arrived, Garcia was surprised by her reaction to the place she’d been avoiding. “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?’ ” They learned that the baby was facing Garcia’s belly and that this “back labor” was likely why she had felt so much pain and progressed so little.
The next morning, Garcia woke with a 103-degree fever, a sign of infection. An exam showed that after 84 hours of labor, she was still less than five centimeters dilated. The baby had to come out by C-section. Remment Garcia Wise weighed in at eight pounds, eleven ounces, about two pounds more than Muhlhahn had estimated. Rem was whisked away to the Neonatal Intensive Care Unit, where he stayed for five days. It was far worse than any scenario Garcia had sought to avoid with a home birth.
“How do you feel about having a C-section?” Muhlhahn asked the couple at a follow-up appointment to discuss what had happened. It was the first they’d spoken to her since she’d dropped them off at the hospital. Garcia felt the question was barbed with the implication that if she’d only had more patience—tried harder—she could have had a vaginal birth. “I had a plan the whole time,” Muhlhahn told them, “and you just didn’t trust me.”
Muhlhahn calls St. Vincent’s her “backup hospital.” About 10 percent of her patients end up transferring there during labor. But her relationship with the hospital is not exactly formal. “St. Vincent’s is her dump,” says one former obstetrics resident who’s treated Muhlhahn’s transfers. “She could say any hospital is her backup, because no hospital is ever going to deny a woman care. She’d bring her patients in, holding their hands, find out we were going to have to do a section, and then she’s out the door. To me, that’s a dump.” Other doctors on the floor have referred to her transferred patients as “train wrecks.”
There is, of course, a long-standing animosity between doctors and midwives, particularly those who take births out of hospitals. In a 2008 policy statement, the American College of Obstetricians and Gynecologists reiterated its position against home birth: “Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre.” But St. Vincent’s seems to have bridged the divide better than most hospitals. George Mussalli, the chairman of obstetrics and gynecology since 2006, has fostered much goodwill within the midwifery community. Joan Bryson, a veteran home-birth midwife out of Park Slope, and Karen Jefferson and Martine Jean-Baptiste, the home-birth duo that goes by JJB Midwifery, actually have hospital privileges there.