July 4, 2012
How to Avoid a Homebirth Disaster, Part 2
When I wrote How to Avoid a Home Birth Disaster, I didn’t plan on writing a “Part 2” but the more research I did about Rebecca Fielding’s case, it became obvious that writing a Part 2 would be necessary.
I want to preface my comments by revealing that I’m the granddaughter (3 generations removed) of two 19th century midwives. One delivered babies on a Virginia plantation and the other delivered half of her community until her death in 1936. I have the utmost respect for midwives because it was a midwife from Belize and not my colleagues who taught me the art of delivering my first baby. The record of Evelyn Muhlhan is unfortunately a cautionary tale for pregnant moms who opt to deliver at home.
In the Matter of Evelyn D. Muhlhan, License No. R060032, between July 2008 and September 2011, several complaints were brought before the Maryland Board of Nursing. The law (Code of Maryland Regulations 10.27.05.01(6)states that midwives must have a collaborating physician to cover them documented in a collaborative plan also known as an “Agreement.” Each year the agreement must be updated and submitted to the Board. The Board invoked an emergency suspension for Mulhan’s license for the following reasons:
- On June 7, 2008, she performed a vaginal home delivery on a patient who had a previous c-section, Factor V-Leiden deficiency and maternal obesity. Factor V deficiency predisposes patients to blood clots. The baby had to be brought to the emergency room because it was unresponsive, had meconium and was blue. The patient weighed 295 pounds. A physician was not consulted. Fortunately, the baby lived.
- On April 14, 2010, she used Pitocin in the patient’s muscle although it’s only supposed to be given in the vein. She used an antiseptic solution to treat Group B Strep as opposed to Penicillin which is the standard of care. The patient pushed for 3 hours, Muhlhan did an episiotomy, the baby did not deliver, so she repaired the episiotomy and then sent the patient to the hospital where an emergency c-section was done. The baby was born with brain injuries.
Muhlhan also attempted to deliver an 11-pound baby at home, had a patient who ultimately ruptured her uterus and manually removed another patient’s placenta that ended in a life-threatening postpartum hemorrhage.
So what’s the message? You must, I repeat, you must investigate people in whose hands you place your life. And this applies to physicians as well. Hospitals are imperfect institutions. It is the provider who will and should protect you from those imperfections based on their skill and advocacy. Homebirths will not be for everyone. There are health conditions that simply prevent this from happening.
We are moving towards promoting quality within healthcare as opposed to procedures and money. But we are far from getting there as yet. Each one of us must do our part to protect the integrity of our lives, our babies’ lives and heal our fractured healthcare system.