Labor of Love: A Midwife's Memoir

In the world of midwifery, it's "The Calling," that inner voice that guides some women to the profession and life they're meant to lead.

For Cara Muhlhahn, that meant helping women deliver their babies naturally, without drugs and in their home -- often in the bathtub. Muhlhahn gained fame as one of the profiled midwives in the Ricky Lake-produced documentary The Business of Being Born. In Labor of Love: A Midwife's Memoir (Kaplan, 272pg, 2009), Muhlhahn describes her personal journey more fully. She goes from birth, or "fore-life" as she calls it, through a post high school trip through Europe and North Africa, a midwife apprenticeship, nursing school at Columbia and eventually to her own home birth practice in New York City.

While billed as a memoir, this book is also equal parts anti-hospital polemic and propaganda for the home birth movement. Muhlhahn's disdain of the medical establishment is evident throughout the book. She rails against most interventions -- forceps, vacuum extraction, C-section and episiotomy -- despite experiencing the agony of a torn perineum during the birth of her son. For Muhlhahn these techniques, as well as epidurals and other pain management (delivered by the "Candyman"), exist only for the convenience of doctors and the bottom lines of hospitals. Home birth, in her view, is a natural process that empowers women and should be allowed to proceed on its own, at its own pace. There is little mention of the babies involved.

It was during her sojourn through Morocco that Muhlhahn heard the Calling. While living in a cave with a local family, she watched helplessly as a young girl died for lack of medical attention. This ignited a personal resolve never again to be in a situation where she was unable to provide critical care.

After two years as a midwife apprentice in Oregon and Southern Texas, Muhlhahn embarked on an apprenticeship of another kind. She joined The Moonies -- a religious cult -- and spent an additional two years as one of those people seen trolling for donations in airports with tambourines, bad haircuts and perpetual smiles. Only after being forcibly deprogrammed by her parents did she rejoin society.

Passing on medical school, which she considered "character warping" and as having a socialization process akin to the cult she'd just left. Muhlhahn opted for nursing instead. Fulfilling prerequisites at CUNY, she attended Columbia University where she graduated with honors.

Shortly after graduation, her life was nearly derailed by an unintended pregnancy. She anguished over the choice of keeping a child she wanted versus a career she equally desired. A bit of that character warping might have helped here. After her decision was preempted by a miscarriage, she saved the embryo in her refrigerator until the odor of its decomposition helped her to let go.

Working for several years as a midwife at a number of New York City hospitals, Muhlhahn became increasingly disenchanted with the hierarchical and clinical nature of modern obstetrics. In 1996, she opened a private midwifery practice, specializing in home births, in her East Village apartment.

For Muhlhahn, birth is a transformative and poetic experience for the mother. But perhaps she forgets that it is first and foremost a transformative experience for the child and that the purpose of birth is to produce a live, healthy baby, not to "empower" women. Her arguments for the safety of home birth stem entirely from her own experience. Many of her patients had uneventful home deliveries but there were a lot of close calls. She breathlessly describes rushed trips to the hospital for births gone awry, none fortunately resulting in serious injury or death.

Some numbers would help a lot here. There is nary a statistic or reference in the entire book, only argument by anecdote. Her case could have been better presented. There are, after all, plenty of studies showing that, under ideal circumstances, home births are as safe or only slightly more dangerous than hospital births -- although no safer.

Statistics, as the mathematician Aaron Levenstein said, are like a bikini in that what they reveal is suggestive, but what they conceal is vital. The existing statistics certainly "reveal" that home births are safe, but what are concealed are the experiences of the individuals involved. The guilt and grief over a dead child will last a lifetime. There is little comfort in knowing that statistically one did the right thing. Birthing centers are fully capable of allowing all the empowerment a women desires and, unlike one's home, the best of modern medicine, should it be required. While a woman should always have the choice to bear a child and how to bear it, not all choices are wise simply because they are available.

Muhlhahn tells a tale of a life lived her own way and on her own terms. She is an intelligent and persuasive woman, although ideologically rigid. In many ways, she's a product of the Me Generation era of the 1970s, with its emphasis on personal fulfillment over all else. Throughout her life, Muhlhahn lurched from one fringe belief system to another -- beginning with the Moonies and transitioning to Jungian psychology -- before settling on home birthing. She waxes on about women's empowerment, yet mentions babies' welfare only in passing. In the end she is preaching to the choir. Those who feel that modern medicine obstructs birth, rather than abets it, will find her story inspiring. For the women who choose to have their babies in a medical facility, she'll probably come across as a kook.

Comments

[jaxieb]

Quite a different review here:
http://mothering.com/sections/book_reviews/book_reviews.html

[ParticleNoun]

(continuted)

However, I will tell you that the experience of being with Cara both in the months leading up to the birth, and during the birth, were astounding. She is an amazing practitioner, and although the birth ends up being the most tragic events of our lives, when I'm able, at times, to step to the side and view the process up to that point, I see that it was amazing, and yes, empowering. Much much more so than our first child's birth in the Hospital, which was mired in interns treating my wife like an object, constant interventions, alarms, commands, and eventually a C section.

In any event, I can completely understand that some people would not choose a home birth. However, the choice should remain for those that do.

I have every reason, emotionally, to be a strong advocate against Homebirth, but I find myself to be quite the opposite.

[ParticleNoun]

HuffPost's Pick

Well, I guess in a way I'm more well placed to comment on this than many, as my wife and I are featured in this book. Our child, Lilah Mae, was the only child Cara ever lost in a home birth. She details this in the book. Of course, the experience for us was incredibly painful, but we do not blame Cara in the least, and still completely support home birth. I suppose it would be natural for my wife and I to blame Cara, and she even invited us to do so in an effort, I think, to give our grief something to focus on. But the simple fact was, she was not at all to blame. After speaking with many in the profession, who afterward opened up to us about infant mortality, it became clear that horrible things happen in hospitals all the time, and that there is absolutely no guarantee that being in a hospital will prevent a child's death.

I think Homebirth should be an accepted option in the spectrum of birthing choices for women. I wouldn't ever desire to pressure someone into it. In my view, it has to be a choice one comes to wholly on one's own.

[swedish123]

Cara will be at McNally Jackson Books tonight at 7 p.m. for a panel discussion on home birth.

According to the NYT, it is free and open to the public.

http://www.nytimes.com/2009/01/02/arts/02spare.html

[saami]

Beware of those who are so rigid and so self righteous. I have had 5 babies all by natural child birth and all in hospitals. My children were born in a facility where if there was a problem it could be dealt with immediately and they would be safe. Not all pregnancies nor labors nor births are normal and uneventful. I would rather be safe than sorry.

[Shotgun Mary]

While I applaud your effort at a balanced review of this book, your discomfort with Muhlhan's position is apparent. To argue that the only purpose to birth is to produce a healthy child, not empower women, misses the point. It's that attitude which has turned women away from the modern medical model of maternity care. We are not treated as people by the medical community. Birth is an infant extraction. Arguing that the baby is the only person that matters in the birth process is no better than arguing that the mother is the only important party. There has to be a middle ground where babies are protected through technological advancements and mothers are respected instead of bullied into unneccesary and painful interventions that can put a low risk mother AND her child at risk for dangerous complications. It would be wonderful if there was a free standing birth center within close distance of every community but sadly thats not the case. At 7 months pregnant my only choices are a hospital with an exceptionally high c-section rate or a home birth. I have chosen the home birth because I think it represents the best choice. However, if I had a birth center near by I likely would have chosen it instead. Until we can address the problems of the modern health care system mothers will be forced to choose between risking her life and the life of her child's in a hospital or encountering different risks at home.