By Isabel Wilkinson
Cara Muhlhahn’s Alphabet City apartment was filled with women. Some stood around the kitchen counter, munching dried fruit; others cradled babies on the cushy sofas. In the corner, a woman was stretched out on a recliner while her feet were kneaded by a reflexologist.
At first glance, this might have seemed like just a relaxed group of friends. But everyone was pregnant, and it was a waiting room, not a living room. They were all waiting to see Muhlhahn, a local certified nurse midwife whose business has grown substantially as home birth has become more popular in New York. Muhlhahn visits each of her clients at her residence, so it’s a rare occasion for them all to assemble in Muhlhahn’s apartment. The room was buzzing with activity, as women chatted about birthing water tubs and exchanged tips on the challenges of pregnancy and long labor.
At 6 p.m., after the last mother had bundled up and gone out into the cold, Muhlhahn emerged from the back office. She spread out onto the couch, kicking up her black lace-up boots.
“This is lunch,” she said, digging into salad in a brown paper box.
Cara Muhlhahn is at the forefront of a growing trend of at-home births in New York City. According to The Birth Survey — a group dedicated to ensuring public access to information about maternity-care providers and institutions — nearly 10 percent of hospital and at-home births in New York each year are attended by midwives. As more women choose to give birth at home due to dissatisfaction with hospital care, they are turning to midwives — like Muhlhahn, who has delivered more than 700 babies in her 25-year career. While she used to take four to six mothers per month of due date, because of her increased popularity, Muhlhahn now takes on 10 expectant mothers every month.
Meanwhile, cesarean-section rates are growing in New York City. The World Health Organization recommends that numbers of cesarean sections in industrialized nations not exceed 15 percent. Yet Choices in Childbirth, an informational group for childbearing women and their families, estimates that, in 2006, more than 30 percent of U.S. births — and 32 percent of births in New York State — resulted in C-section.
Many of Muhlhahn’s patients choose to deliver at home because of a strong desire to give birth naturally. They expressed a concern about hospital doctors, whom they said offered little individual attention and often pressured women to have a C-section or receive labor-inducing drugs. The release earlier this year of “The Business of Being Born,” a documentary film produced by former talk-show host Ricki Lake, sparked a discussion about hospital delivery in the United States. The film, which shows Lake having her baby at her West Village home, features Muhlhahn. According to many of the women assembled in Muhlhahn’s living room, the film caused them to think more seriously about at-home birth.
“Hospitals are for a problem, for a medical condition,” said Jane Burd, a model and high-end furniture designer from Suffolk, England, who is expecting her first baby with Muhlhahn in January. “Birthing is not a medical condition.”
“It feels like a factory,” Paulina Alenkina said of hospitals. “Home birth is much more stress-free. Once the labor is over, there’s nothing else left to do. You don’t have to go anywhere. There are no papers to sign.”
Muhlhahn’s loyal army of mothers-to-be rave about the individual attention she provides. Irica Berkowitz, 32, a Pilates instructor from the Upper West Side whose second child is due in January, fondly recalled her first birth with Muhlhahn more than three years ago.
“She builds a relationship with you right away,” Berkowitz said, explaining that Muhlhahn accompanied her for a walk along the Hudson River in the rain during her 71-hour labor — which, she said, helped the baby descend the birth canal. “She makes you feel like you’re the only mom she’s taking care of.”
But, of course, Muhlhahn is taking care of other future moms — many of them simultaneously. In this past week alone, she delivered five babies.
“I lived in my car for two days,” she said.
While this schedule may feel like second nature to her now, every birth has its fair share of surprises. One woman’s labor, which began last Sunday, resulted in a transfer to the hospital on Wednesday evening — a decision Cara said was wise, but not necessary — where the woman received a cesarean section. And this Tuesday, when another baby emerged not breathing, Muhlhahn quickly performed a neonatal resuscitation — squeezing air from a small ventilator bag into the baby’s mouth and gently applying cardiac compressions — until the infant began to breathe.
Muhlhahn is a graduate of Columbia University School of Nursing and SUNY Downstate Health Science Center’s Midwifery Education Program. She has practiced as a midwife since obtaining her certificate of nurse-midwifery in 1991. Prior to starting her private practice in 1996, she practiced midwifery at Beth Israel Medical Center and at Maternity Center, Inc., Manhattan’s Birthing Center.
The vast majority of Muhlhahn’s deliveries are personal and proud moments for mothers, as was the case in the birth of Alenkina’s second baby, Jordan. While hospitals use stationary birth monitors to assess a mother’s vital statistics, Muhlhahn used a hand-held Doppler fetal monitor. That gave Alenkina the freedom to move around her Bedford-Stuyvesant apartment — in and out of the bathtub and onto the couch, where Alenkina, a foreign exchange broker, gave birth on a shower curtain and an old sheet.
“Daddy caught him,” Alenkina said. “He cut the umbilical cord.”
Muhlhahn says fathers feel more involved in home delivery than they do in hospital births.
“Dads don’t like to see their women in pain,” she said. “I’m positive that if they play a supportive role, it benefits their bond with the child.”
Despite her busy schedule and constant stream of deliveries, Muhlhahn has managed to write a book, “Labor of Love: A Midwife’s Memoir,” due out in January. The book recounts her colorful past — from vagabonding in the South of France to an eye-opening journey to Morocco — and some of her most harrowing deliveries.
But ultimately, for Muhlhahn, it’s about more than home birth.
“My allegiance is to women and choice,” she said, “and not being sold down the river into circumstances they’re going to regret. That’s my bottom line.”
