Muhlhahn claims that she could have privileges at St. Vincent’s as well, but she prefers not to be encumbered by the hospital’s restrictions. “I actually like legitimacy. I don’t enjoy being an outlaw,” she says. But there are ways in which she has made herself an outlaw of sorts—by not carrying malpractice insurance, for instance. “I think she’s dangerous,” says a member of the obstetrics staff at St. Vincent’s. “You need to be accountable. Something bad is going to happen with her approach to management. Bad things happen to all of us.”
Though it is required by law for every midwife in New York to have one, Muhlhahn also doesn’t have a signed practice agreement with a physician, a document that outlines the parameters of a midwife’s care and the protocols under which a mother would automatically “risk out” of home birth. According to most practice agreements, vaginal births after Cesareans, diabetics, breech babies, twins, and many overdue and oversize babies merit hospital births. Muhlhahn’s website touts studies showing home births to be just as safe as hospital births, but when these kinds of high-risk births are included in statistics, the home-birth perinatal mortality rate jumps to fourteen per thousand versus five per thousand in the hospital, according to a University of Arizona study.
“How long is too long for a woman to be in labor?” the father-to-be asked. “Never,” Muhlhahn replied.
Obstetrician Jacques Moritz is no partisan in any doctor-versus-midwife battle. To the jeers of many of his M.D. colleagues, he hosted a screening of BOBB at St. Luke’s-Roosevelt. His own mother was a midwife, and he has signed practice agreements with twelve midwives who work at the Roosevelt birthing center. He wouldn’t, however, do the same for Muhlhahn. “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.”
“I’m not that comfortable with VBACs at home,” says Muhlhahn, “but I know most can have them fine. Most VBAC mommies know they have less of a chance of giving birth vaginally in a hospital.”
For all her home-birth successes—she has delivered more than 700 babies—Muhlhahn has also had some tragedies. In 2003, she and her former birthing center settled a $950,000 malpractice suit brought by the parents of a child who was injured during delivery. As the baby’s head was crowning, he suffered a shoulder dystocia, when a baby’s shoulders get stuck behind the mother’s pelvis. It was imperative to get the baby out quickly, because he couldn’t breathe in that position. “Cara was crying and saying that she thought she was going to lose the baby,” Yvette Garcia, the boy’s mother, said in a deposition. The child survived, but the cervical nerves in his neck were damaged, rendering his right arm paralyzed, a condition called Erb’s Palsy. According to Garcia’s deposition, when she first brought the boy to the family pediatrician, the doctor took one look at the lame appendage and “knew that the baby was yanked out.” Garcia’s complaint argued that Muhlhahn should have known that the baby would be too large for a vaginal delivery.
In her memoir, Muhlhahn tells the worst story of all: In the summer of 2007, a woman named Lisa was at the end of a particularly long labor. As the head crowned, Muhlhahn noticed the baby’s heartbeat decelerate. She kicked once from inside her mother, and then was still. Muhlhahn got the baby out and began CPR, but couldn’t revive her. “Why had everything I had counted on that had worked for the last twenty years failed?” she writes. “We all had to ask ourselves if this baby would have been alive if indeed she had been born in the hospital.” Moritz says Muhlhahn should go easy on herself; if a clinician hasn’t lost a baby, she just hasn’t done enough births. “The problem is that we’re talking about the possibility the outcome would be different,” he says. “No one who loses a baby in a hospital says, ‘Oh, I wonder if this would have been better if I’d done it at home?’ ”
My wife and I decided not to go with a home birth, not least because Robin’s rheumatologist threatened to drop her as a patient if she chose that route. In Robin’s 39th week, during a routine test at our doctor’s office, the baby’s heartbeat decelerated precipitously. The doctor sent her to NYU to be monitored for a couple of hours, and while she was there, her water broke. The decelerations continued, corresponding to Robin’s contractions; every time she clenched up, you could see the heart rate plunge from 130 beats per minute down to 60 on the monitor, then right back up again. They made V shapes on the tape.