Popular "Extreme" Midwife Tests The Limits Of Home Birthing

Home births are the hottest trend in baby-making right now, and advocate and practitioner Cara Muhlhahn has never seen so busy, or so harshly criticized, as New York Magazine reports.

For some, the home birth movement is a new idea, brought to them by the 2008 Ricki Lake-produced documentary The Business of Being Born and the resulting buzz. Kristy Bloom, a first time-mother – or "primip" – decided that she wanted Muhlhahn to deliver her baby after seeing her in BOBB:

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.

In contrast, home birth proponents like Muhlhahn lure their patients with the promise of constant care and devotion. Muhlhahn seems to have the kind of bedside manner that makes her patients immediately trust her. She also disparages the hospital-appointed midwifes, claiming that they will not provide the beautiful and natural experience Mulhahn can. Her "home-birth pitch" also includes: no drugs to cloud the experience, no separation for mother and child, no cutting, and the "promise of an unparalleled sense of accomplishment and an indescribable hormonal rush." Muhlhahn believes that home births can create an experience "more poetic than clinical." Perhaps most importantly, home birthers believe that the unbroken contact between mother and child is essential to the bonding process. Natural birth pioneer Michel Odent claims that C sections interrupt the flow of the hormonal cocktail that irreversibly binds a mother to her child. "It's simple," he says, "If monkeys give birth by Cesarean section, the mother is not interested in her baby… So you wonder, what about… the future of humanity?"

However, sometimes home births can go terribly wrong, and when they do, Muhlhahn brings her patients to St. Vincent's, her "backup hospital." Doctors from St. Vincent's refer to it as her "dump." "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," said a former obstetrics resident. This is exactly what happened with Sandra Garcia. Garcia had opted to have a home birth, aided by her husband, a former NYU postpartum nurse, and Muhlhahn, who was shuttling between two births and only available sporadically. Garcia suffered through a hellish 72 hours of labor before she began to question Muhlhahn. Muhlhahn continued to tell her that there was no such thing as "too long" when it came to labor. Fortunately, Garcia did not believe her. She awoke the next day in St. Vincent's after 84 hours of labor with a 103-degree fever. Her baby had to come out by C section, and spent the next five days in the Neonatal Intensive Care Unit.

Author Andrew Goldman ultimately paints Muhlhahn as an ego-driven extremist, who seems to enjoy bragging about all the difficult (and some would say dangerous) births she has aided. Many doctors find Muhlhahn's tactics too extreme, and even some proponents of home birth like Jacques Mortiz think that Muhlhahn in flirting with disaster. "I like her, but there's some protocols that she has that I just can't sign off on," he says. Fortunately for Muhlhahn though, business is booming. With her recently published memoir, and her appearance in BOBB, it looks like Muhlhahn is going to stay the face of the home birth movement for quite some time. Her unwavering trust in the abilities of the female body, and her pitch that promises a poetic version of childbirth, has so far proven stronger than the force of all her critics.

Extreme Birth [New York Magazine]