Cara MuhlhahnMonday, 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.