Sunday, March 29, 2009

Home birth at its most extreme

by Amelia Thomson-DeVeaux

After I watched The Business of Being Born in my women's studies class last semester, I decided to become a birth doula. I'm prone to extreme decisions, but this was also because The Business of Being Born, a documentary about the home birth movement, is one of the most convincing documentaries I've ever seen - it shows off the midwives of New York City as sane and birth-friendly in a healthcare system that is unqualified and unwilling to deliver babies correctly. There's a profile of midwife Cara Muhlhahn (one of the central figures in TBOBB) in New York Magazine which presents her as perhaps a darker figure - one which I don't necessarily agree with, but which is an interesting counterpoint to the film. The article's author, Andrew Goldman, is distinctly dubious about Muhlhahn's methods - and to hear him tell it, she does sound a little crazy.

Goldman writes, "When you ask Muhlhahn’s many happy customers to recount their birth stories, they struggle a bit; you suspect they feel the way an astronaut might attempting to describe space travel to someone who’s never flown in a plane. 'When you get through that transition, and you experience the birth of your child, you get the endorphins, the best bonding experience, I mean, I can’t even explain how meaningful and important and life-changing an event it was,' says Jeannie Gaffigan, who delivered her second child with Muhlhahn." This is the side of Muhlhahn that the documentary presents - a woman who pays attention to her clients, and refuses to let them feel like they're a number or a small part of a larger system. And she has delivered babies under the riskiest of conditions, in dramatic circumstances - like the picture above, which shows her simulating delivering a baby on the roof of a Brooklyn apartment building.

All of this is exciting, and has helped to normalize home birth so that it even seems glamorous. However, there are points at which it's very possible to question Muhlhahn's sanity, and those Goldman is eager to bring up. He recounts the horror stories that didn't quite make it into the movie's final cut - like the time Muhlhahn left a woman in labor for 72 hours while she went off to deliver another baby. When Muhlhahn returned, the father (understandably worried about his wife's health) asked, "How long is too long for a woman to be in labor?” “Never,” Muhlhahn replied. The woman was taken to the hospital and the baby was delivered by C-section. She remembers her reaction to entering the hospital, which surprised her - "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?’"

There are plenty of other stories to make all potential home birth clients cringe, and a few of them ended in tragedy. But there's another side to all this, which obstetrician Jacques Moritz (admittedly, an aficionado of the home birth movement) was quick to point out - "The problem is that we’re talking about the possibility the outcome would be different," he said. “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?'"

Goldman is open about his partisanness in all of this - he and his wife almost opted to go the home birth route, but their baby was born in a hospital, through a cesarean section. But I do wonder how much this has to do with the home birth movement, and how much it's about Muhlhahn as a person. There are many midwives who would never dream of attempting the deliveries that Muhlhahn takes on, and that's perhaps the reason why she's taken on a kind of celebrity in the movement. The fact is that there are many good reasons to have a home birth, but there are also times when it's far safer to have a hospital delivery, and the answer is not as cut-and-dried as the doctors or the makers of TBOBB would like you to believe. And Muhlhahn, in many ways the face of the home birth movement, is definitely controversial (I don't know how I'd feel about delivering my baby on the roof of a New York apartment building, for example). But I do think that Muhlhahn's essential goal, to render childbirth more "poetic than clinical," is a beautiful one. Even if she's personally a little crazy, what Muhlhahn - and her fellow midwives - are attempting is something which is brave, and admirable. But I do have to say, after 72 hours in labor, I would be screaming for the hospital too.

Thanks to Aku for the tip!


At March 30, 2009 at 7:56 AM , Anonymous Anonymous said...

The baby was born in the apartment, not on the roof. And the woman who was in labor for 72 hours requested to go to the hospital and I brought her in. She was still in early labor. Andrew Goldman has done everyone a disservice with his reconstructions of the truth. Cara Muhlhahn

At March 30, 2009 at 8:06 AM , Blogger TommyD said...

I'm a big proponent of having more options in childbirth, but there are number of things that really bother me about the zeal of the homebirth movement.

Documentaries like TBOBB see birth choices in moral terms, with "natural" birth being intrinsically virtuous and "unnatural" births being clinical, male-dominated and generally bad. Some women may choose to give birth at home, and some may choose to give birth at a hospital--with drugs or a scheduled C-section, as the case may be. Neither side should be villainizing the other for exercising legitimate choices.

Furthermore, working in women's health in Africa has shown me just how dangerous childbirth can be. There are no more than 10 obstetricians in Sierra Leone (pop. 6 million), fewer than 20% of births are attended by skilled staff, and most are attended by unskilled "traditional birthing attendants." The result is a maternal death rate of 1,800 per 10,000 births. (Heaven help you if you've got a breech baby!) Women die in childbirth from hemorrhaging, eclampsia, fistula--complications that are quite preventable with trained doctors, proper equipment, and sanitary conditions.

When American women choose to give birth at home with doulas, they do so knowing that they are backed up by a complex, science-based medical system that can take over if anything goes wrong. (The reason the US has a higher maternal mortality rate than other Western countries is that uninsured women receive too little pre-natal and natal care--not too much.) Modern medicine saves women's lives, and we should acknowledge that (while improvable) it is a good thing.

At March 30, 2009 at 5:42 PM , Anonymous Dan said...

I agree with Tommy regarding the benefits of modern medicine. If you really need it, you'll be glad it's there. On the other hand, there are huge benefits to the personal attention you get from a professional midwife (before, during and after the birth).

Where we live (Ontario, Canada) you can choose to have a midwife-attended birth in the hospital. Then you know an obstetrician is available if needed.

I wonder if this sort of arrangement is available in other places.

At October 25, 2009 at 11:16 AM , Anonymous Anonymous said...

yes there are CN midwives practicing in hospitals and outside of hospital with OB backup for emergencies in the US just like in Canada...this is what I am using...a CN midwife in a hospital with a NICU dept there if needed; generally midwives are best for a normal healthy pregnancy and birth with no odd complications...if there is a complication most need to go to an OB if a C Section is needed. That is the main reason for going to an OB for surgical procedures when necessary that cannot be performed by the midwife...otherwise all the tools, medications, gadgets that the OB has the midwife has access to as well. The only thing she cannot do it surgery.


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