Tori's Blog

Cara Muhlhahn

Monday, March 30th, 2009

There has been a great deal of discussion during this last week regarding Cara Muhlhahn, the midwife portrayed in Ricki Lake’s film, The Business of Being Born. The article does a very good job of outlining several different aspects of her practice. Ms. Muhlhahn has birthed many hundreds of healthy babies and appears to be well thought of by the majority of her clients. She has also settled a “just under a million dollar” malpractice suit stemming from a baby damaged during birth and has had a baby die under her care.

She prides herself in not having dedicated physician or hospital back up because she doesn’t want to be constrained by the directives those relationships would entail. She blatantly exceeds her scope of practice and offhandedly discusses her work with women who clearly do not fall under the “low-risk” category – twins, VBAC (vaginal birth after cesarean) and breech birth. It is almost as though she considers a potentially difficult birth to be a challenge of sorts. She appears to hold herself separate from professional accountability.

I have watched The Business of Being Born several times and during one birth, Cara Mulhullan delivers a baby in a tub without the use of gloves, a basic and vital aspect of infection prevention and protection for both the mother and the care-provider. She lightly refers to herself as a renegade. Yet, she appears to be celebrated as the panacea of homebirth practitioners.

This should be, to any rational person, frightening at the very least. In countries that actively practice home-birth, these are all situations in which a woman would not be considered to be a candidate for safely giving birth at home. These are circumstances that a woman planning to give birth in a birth center or with a nurse-midwife here in the U.S., would be under the care of an obstetrician in a hospital. It is completely logical, ethical and absolutely essential to ask “whose best interests are at hand with this sort of sense of self”. As Ms. Mulhullan and other home birth midwives enjoy the increase in their practices due to Ms. Lake’s film, I can only hope that they fully acknowledges that their skills are limited, as are all practitioners based on their level of knowledge, training, and experience.

I know, have worked with and fully respect several, amazing, home-birth midwives. Every one of them has a physician back them up in case of an emergency or complication (both can and do happen with “low-risk” moms) and they are very clear about their criteria for a birth at home. If it were true that the process of birth could always be “trusted”, half a million women around the world would not die each year from a likely preventable pregnancy or birth related complication. Birth is not merely an “experience” – the health, the very lives, of two (or more) people are in the hands of the practitioner. Let’s not ever forget that.

Your Comments

  1. Hello Tori,
    It seems that you’ve done research on Cara Muhlhahn’s practice, and I’m glad you watched the Business of Being Born. However, your argument that Cara puts her clients’ lives in danger by being a “renegade” seems unsupported by the facts. As you say in your article, Cara has attended “many hundreds” of births and has lost only one baby. According to the CIA World Fact Book and the United Nations Population Division, the United States has an infant mortality rate of 6.3 per 1000 live births. This means a death every 159 births. Taking into account the fact that the home birth rate in the US is less than 1%, most of these babies are lost in hospitals. Comparing the rates, it’s plain that Cara’s infant mortality rate is lower than that of hospitals and doctors. Her “renegade” methods seem to be doing far more good than harm.

    • Unfortunately, Cara Muhlhahn has had more than one infant who was damaged during a birth and has been the focus of more than one lawsuit. This is highly significant with a practitioner who throughout her practice has delivered a relatively small number of infants.

      I respectfully need to point out that the United States infant mortality rate is not soley infants who die during childbirth. It includes all infants born after 20 weeks as well as all children who die under one year of age. The inclusion of pre-term birth and infants under one year of age is a significant factor in all of the countries’ statistics.

      These figures do not have any true relationship with the mortality rates specific to term healthy infants born either at home or in a hospital.

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