Evelyn Muhlhan - another homebirth midwife bites the dust?

[Anonymous]

Back to the subject at hand, what are the complaints? I am a big supporter of safe homebirth with a CNM so I am curious.

[Anonymous]

Anonymous wrote:If Evelyn wanted to put more details out there for the public, she would have done so herself. I just don't see the point in gossiping about the situation when she's already made public the basic info about her situation.

If you want more details, call her yourself. Don't ask around anonymously on a public message board.

It's not gossiping. A peer institution has suspended her license. That is serious business. This happens to other professionals, in medicine and law, to name a few. Why would you think it was a private matter? The public has a right to know.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes because OBs aren't concerned about women's reproductive rights. Got it now.

There's more to reproductive rights and choice than whatever wan grey meaning you're giving it.

Consider that for those OBs who would have all women give birth in the hospital, with all the rules and regs that frequently follow whether or not they are evidence based or in the patients' best interest, are, in fact, acting against choice in birth.

and you know this because you went to med school and completed a multi-year residency in Ob & Gyn and have seen most of all complications that can happen?

Because I can read and I have read studies that say, for example, that if a laboring woman desires to eat that allowing her to do so improves outcomes. I think the average OB knows this and I think that in a less litigious world they'd allow this for 97% of women. Insurance and hospital policy dictate otherwise.

And you just outlined the biggest OB/midwifery dichotomy yourself: far and away the vast majority of births do not have complications, and while complications can arise in any labor and birth, they can usually be identified by a well trained midwife who is then equipped to deal with them or can transfer. I think if hospital births were more humane with fewer rules (you must have a hep lock, you may not eat or drink, you must be monitored this many minutes of every hour, you must have the baby within x many hours, etc) I would actively advocate against home births. But once you have been admitted in most hospitals, you will be following hospital protocol, whether or not your situation dictates it. Until then, though, I will advocate for women to have the home birth option.

Can a mud wife stitch up a cervix, stop bleeding or operate on a distressed baby, what about a premie

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes because OBs aren't concerned about women's reproductive rights. Got it now.

There's more to reproductive rights and choice than whatever wan grey meaning you're giving it.

Consider that for those OBs who would have all women give birth in the hospital, with all the rules and regs that frequently follow whether or not they are evidence based or in the patients' best interest, are, in fact, acting against choice in birth.

and you know this because you went to med school and completed a multi-year residency in Ob & Gyn and have seen most of all complications that can happen?

Because I can read and I have read studies that say, for example, that if a laboring woman desires to eat that allowing her to do so improves outcomes. I think the average OB knows this and I think that in a less litigious world they'd allow this for 97% of women. Insurance and hospital policy dictate otherwise.

And you just outlined the biggest OB/midwifery dichotomy yourself: far and away the vast majority of births do not have complications, and while complications can arise in any labor and birth, they can usually be identified by a well trained midwife who is then equipped to deal with them or can transfer. I think if hospital births were more humane with fewer rules (you must have a hep lock, you may not eat or drink, you must be monitored this many minutes of every hour, you must have the baby within x many hours, etc) I would actively advocate against home births. But once you have been admitted in most hospitals, you will be following hospital protocol, whether or not your situation dictates it. Until then, though, I will advocate for women to have the home birth option.

Can a mud wife stitch up a cervix, stop bleeding or operate on a distressed baby, what about a premie

I hope "mud wife" was an auto correct error.

It varies from state to state, but generally midwives can do stitches (do you mean perineal tears? I don't think i've heard of a torn cervix), stop bleeding, as well as identify small bleeds before they become all out hemorrhages, resuscitate newborns, and home birth midwives won't catch babies born before x many weeks, usually 36, i.e., term. Midwives are very clear - they are there to serve the large majority of women who are healthy, have taken good care of themselves, and have healthy pregnancies. OBs are not bad people - they just shouldn't have as much to do with normal births, at least not in the current medical climate.

[Anonymous]

Do doctors stitch cerivxes??????

[Anonymous]

Oh, no, is Dr. Amy a permanent fixture on this page? We'll never have a normal conversation again.

[Anonymous]

I just read the link, and I am curious to learn more as the facts come out. As a mother looking forward to her third homebirth, what concerns me is that the complaints all came from doctors at hospitals to which homebirthing women transferred.

A good midwife will transfer when indicated. That is providing excellent care. In fact, that is a huge part of what I pay my midwife to do: watch and let me know if everything is going well or if we need additional help.

I hate potentially having to weigh the derision and the professional ramifications lurking at the hospital in the back of my mind if we need to discuss transfer. I want to think I would not hesitate for the sake of my baby's life, but knowing doctors are waiting to make my life, and my midwife's life, miserable for doing the RESPONSIBLE thing is always there.

A very close friend did not transfer during active labor, but during early labor due to suddenly passing a clot. The care she received was subpar and delayed because the staff and doctors took so much time yelling at her for having even thought of homebirth. She had brought her complete prenatal records with her, and the doctor would not even touch them, saying they were worthless and beneath him. After hours of tests and monitoring overnight, they sent her home because there was "nothing wrong with her"--after they had said she should be brought up on charges for putting her baby in danger!

She made the informed decision to deliver in the hospital, just in case something new came up, and when she presented as an already registered maternity patient, she was treated well. The birth was quick and uneventful.

I am in Virginia, but I will watch this situation closely to see if it contributes to a chilling effect on women's ability to transfer.

I don't understand how women can choose to abort even up to the partial delivery of her full-term baby, but OBs flip out over mothers letting their bodies work under the watchful eye of medical professionals out of hospital settings. Where's the logic?

[Anonymous]

The doctors treat the conditions.

Nurses care for patients.

That's the big difference.

[Anonymous]

Anonymous wrote:I just read the link, and I am curious to learn more as the facts come out. As a mother looking forward to her third homebirth, what concerns me is that the complaints all came from doctors at hospitals to which homebirthing women transferred.

A good midwife will transfer when indicated. That is providing excellent care. In fact, that is a huge part of what I pay my midwife to do: watch and let me know if everything is going well or if we need additional help.

I hate potentially having to weigh the derision and the professional ramifications lurking at the hospital in the back of my mind if we need to discuss transfer. I want to think I would not hesitate for the sake of my baby's life, but knowing doctors are waiting to make my life, and my midwife's life, miserable for doing the RESPONSIBLE thing is always there.

A very close friend did not transfer during active labor, but during early labor due to suddenly passing a clot. The care she received was subpar and delayed because the staff and doctors took so much time yelling at her for having even thought of homebirth. She had brought her complete prenatal records with her, and the doctor would not even touch them, saying they were worthless and beneath him. After hours of tests and monitoring overnight, they sent her home because there was "nothing wrong with her"--after they had said she should be brought up on charges for putting her baby in danger!

She made the informed decision to deliver in the hospital, just in case something new came up, and when she presented as an already registered maternity patient, she was treated well. The birth was quick and uneventful.

I am in Virginia, but I will watch this situation closely to see if it contributes to a chilling effect on women's ability to transfer.

I don't understand how women can choose to abort even up to the partial delivery of her full-term baby, but OBs flip out over mothers letting their bodies work under the watchful eye of medical professionals out of hospital settings. Where's the logic?

Jesus, lady. If you were half as informed about the rarity and reasons for dilation and extraction as apparently are about homebirth, I would have thought you were pretty rational. But you had to steer the convo onto the third rail. Grr.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes because OBs aren't concerned about women's reproductive rights. Got it now.

There's more to reproductive rights and choice than whatever wan grey meaning you're giving it.

Consider that for those OBs who would have all women give birth in the hospital, with all the rules and regs that frequently follow whether or not they are evidence based or in the patients' best interest, are, in fact, acting against choice in birth.

and you know this because you went to med school and completed a multi-year residency in Ob & Gyn and have seen most of all complications that can happen?

Because I can read and I have read studies that say, for example, that if a laboring woman desires to eat that allowing her to do so improves outcomes. I think the average OB knows this and I think that in a less litigious world they'd allow this for 97% of women. Insurance and hospital policy dictate otherwise.

And you just outlined the biggest OB/midwifery dichotomy yourself: far and away the vast majority of births do not have complications, and while complications can arise in any labor and birth, they can usually be identified by a well trained midwife who is then equipped to deal with them or can transfer. I think if hospital births were more humane with fewer rules (you must have a hep lock, you may not eat or drink, you must be monitored this many minutes of every hour, you must have the baby within x many hours, etc) I would actively advocate against home births. But once you have been admitted in most hospitals, you will be following hospital protocol, whether or not your situation dictates it. Until then, though, I will advocate for women to have the home birth option.

Can a mud wife stitch up a cervix, stop bleeding or operate on a distressed baby, what about a premie

What about a preemie?

Evelyn attended my daughter's birth. My partner and I had planned a home birth. Our daughter had other plans, and was born at 34 weeks.

Evelyn called me back promptly when I was freaking out that I thought my water had broken. She told me to go to the hospital IMMEDIATELY. Upon examination, I was told that a completely natural birth was out of the question, and a home birth would not be happening. I was on bed rest for about a week, in the hospital.

Evelyn was fully supportive of both my partner and my best friend there in the room with me (while the hospital was NOT cool with anyone but the father), doing Reiki and energy work while I dealt with contractions (hospital staff is asking "what's the deal with all the pretty rocks you guys have?").

She understood our wishes for as little intervention as possible, but advised us that we needed several medical interventions to save both my own life, and our daughter's. She even made the suggestion (GASP!) that to avoid a C-section, I should strongly consider some kind of pain management. I'm glad I took her advice- I pushed out a feisty little 4lb 9oz baby in less than seven minutes.

Evelyn helped me balance my desires with what was best for a healthy mommy and baby. When I was uncomfortable with how the hospital staff bullied me, Evelyn kindly stood up for me.

During the month baby was in the hospital, hospital staff discouraged breastfeeding on demand for NICU babies. Lorrie Leigh (one of the other midwives at ABC) came to the rescue. As a mother of a NICU graduate herself, she came to the hospital twice to give me practical as well as spiritual support, out of the goodness of her heart, on her own time. Without Lorrie's help and encouragement early on, I'd likely not have stuck it out with nursing my daughter.

I highly doubt I'd have EVER received that kind of encouragement and support at any standard OBGYN facility.

While I'm not fully aware of the facts surrounding Evelyn's suspended license, I can at least offer my personal experience with "What about a preemie?"

In addition, my daughter ended up with lead poisoning, and it was Evelyn who made sure we received the EPA lead paint pamphlets that our landlord never provided as required by federal law. Evelyn was the FIRST medical professional to make the suggestion that in a healthy, active 20-something living in a pre- Civil War home, lead paint could very likely have contributed to her preterm birth. Had it not been for Evelyn, our daughter would have been exposed to lead for far longer, and the complications to my daughter's health would have been far worse. One of the other fabulous women at the office, Wendy, gave us all sorts of links, brochures, legal advice hotlines, etc about lead exposure before our blood work left the office.

If anyone from Evelyn's office stumbles upon this, you know who I am, and I'd love for you to get in touch with me or my partner about any numbers I can call or letters I can write saying that Evelyn SAVED MY LIFE.

[Anonymous]

I understand that there were several complaints against her from hospitals that she transferred patients to. Not complaints from her patients, mind you, complaints from hospitals that didn't want to deal with a failed home birth. I don't think there were bad outcomes in any of the cases, just transfers so that mothers and babies could get the care they needed at the right time.

I don't know her and never looked into her practice, but want her to be able to present her side of the story and hopefully be able to continue her career, so I did donate to the legal fund. I hope others do as well!

[Anonymous]

FYI...from skeptical OB




Evelyn Muhlhan, CNM was suspended by the Maryland Board of Nursing on October 7. According to the story in the Catonsville Patch:
The Maryland Board of Nursing has suspended the license of Catonsville-based midwife Evelyn D. Muhlhan, citing multiple complaints in recent years alleging she performed home births without a physician backup or an approved medical plan.
It seems that Muhlhan was too busy trusting birth to pay attention to the standards of practice. The suspension order is chilling reading, recounting as it does the various complaints made against Mulhan:

Case #1 (baby requiring expert resucitation):
On or about July 16, 2008, the Board received a complaint regarding Respondent from MD l, a neonatologist at Hospital-A.

According to the complaint, on June 7, 2008, Respondent performed a vaginal home delivery and the patient ("Patient A") was reported to have experienced a pregnancy with contraindications for a home vaginal delivery, including, a previous c-section, Factor V Leiden deficiency and maternal obesity...

On arrival at Hospital A, the baby was described as cyanotic and apneic with no respiratory effort and was intubated and admitted to the NICU. with diagnoses of respiratory distress and perinatal depression. The baby was discharged home on June 27, 2008.

When interviewed by the Board's investigator regarding the complaint, Respondent indicated that Collaborating MD-2 was her collaborating physician for home births.

During his interview with the Board's investigator, Collaborating MD-2 was adamant that he does not cover Respondent for home births and that he "never has covered and never will" and has made this clear to Respondent on several occasions.
Patient #2 (baby with hypoxic ischemic encephalopathy and seizure disorder):
On or about April 14,2010, the Board received a complaint from ... Director of Labor and Delivery and ... Director of Gynecology and Obstetrics, at Hospital B. According to the complaint, between March 25th and 26th, 2010, Respondent failed to follow the standard of care in her management of an attempted home birth by:

I. Utilizing Intramuscular Oxytocin to stimulate labor in a term pregnancy;
II. Using fundal pressure in the second stage of labor to attempt to cause descent of
the fetus;
III. Using vaginal chlorhexadrinel6, rather than intravenous penicillin, in labor to treata known group B beta hemolytic strep vaginal carrier to prevent early onset GBS neonatal sepsis;
IV. Misdiagnosing fetal station resulting in an unnecessary episiotomy. The physical exam on admission to Hospital B was a fetus impacted in the vagina at + 1 station which was incompatible with the report that the fetus had been crowning when the episiotomy was performed...

... Patient B delivered a male infant ("Baby B") by LSTCS, with a vertex fetal presentation and occiput posterior ("OP") position at birth. The APGAR scores were 1 at 1 minute and 5 at 5 minutes and cord/Initial blood gas was ph 7.1; pC02 63; p02 10; BE -13. Baby B was limp and cyanotic on delivery with nuchal cord x 1, required PPV for 3 minutes before being transitioned to CPAP. Baby B was transported to the NICU on CPAP with diagnoses of Hypoxic Ischemic Encephalopathy and Seizure disorder.

Baby B was transferred to a pediatric rehabilitation hospital on April 21, 2010.
Patient #3 (attempted homebirth of 11 pound baby):
On May 31, 2011, the Board received a complaint from ... Hospital C. The complaint alleged that on January 5,2011, Patient C presented to Hospital C after a failed home delivery by Respondent...

The complaint expressed concerns regarding: an attempted home birth when an estimated fetal weight of 11 lbs. was identified two weeks prior to labor; an attempted home birth with a mother with gestational hypertension; continued assistance of a patient at home with a protracted labor pattern.

...[O]n admission, Patient C was in active labor, dilated at 5 cm, 100% effaced and the fetal vertex was at - 4 station. The fetal heart rate was reassuring and the mother's vital signs were stable. A plan of care was discussed with the patient and a decision was made to proceed with a cesarean section due to arrest of labor and a ultrasound estimated fetal weight of greater than eleven pounds.

On January 6, 2011 at 0147, a live male infant was delivered by primary c-section. APGAR scores were 1 and 8 at 1 and 5 minutes respectively, and the infant weighed 10 lbs and 9.6 ounces.
Patient #4 (attempted VBAC, uterine rupture, intrapartum death):
On or about July 14, 2011, the Board received another complaint from ... Hospital C. The complaint alleged that on July 12, 2011, Patient D presented at Hospital C, after an aborted home birth, with uterine rupture, intra-partum fetal death and a history of a previous c-section...

On arrival at Hospital C, the patient was evaluated in the ER and taken immediately to the OR. Several unsuccessful attempts were made to obtain a fetal heart rate.

On July 12, 2011 , Patient D underwent a low transverse c-section. Operative Findings include: ... male infant in vertex presentation, occiput posterior with a tight nuchal cord. Mother had an area of uterine rupture from the scar from the midline to the right side going down toward the cervix and uterine vessels on the right side. Abundant thick meconium was noted in the patient's abdomen and pelvis with massive bowel edema and erythema, with meconium already stuck onto bowel walls.
Patient #5 (postpartum hemorrhage, attempted manual removal of placenta at home):
On September 8, 2011, the Board received a complaint from the Risk Manager at Hospital C regarding Patient E. According to the complaint, Patient E was admitted to Hospital C on September 7, 2011 after a home delivery and suspected manual extraction of the placenta.

EMS reported that on September 7, 2011 at 22:21 hours he responded to a call of "maternity with complications." Upon arrival, he reported one crew attending to the mother and another attending to the baby. The mother was observed to be lethargic, pale and bleeding from the vaginal area with a blood pressure of 90/50 and heart rate of 158...

... Respondent's assistant (name unknown) stated that that the baby had been born at 9:15pm, the placenta had failed to deliver, Respondent "pulled out the placenta" and at least "some of it had been removed."

The attending physician at Hospital C, documented that Patient E presented with PPH and Retained Placenta and an estimated blood loss at home of 1 liter.

... Patient E underwent a Dilatation and Curettage and Repair of deep 2nd degree perineal laceration with an estimated blood loss of 1500 ml...
The Maryland Board of Nursing suspended Muhlhan's license for, among other things:
Practicing without required physician backup
Attempting high risk deliveries at home.
Use of intramuscular oxytocin to induce labor at home.
Attempted unsuccessful manual removal of placenta at home
Hypoxic ishcemic encephalopathy and seizure in one newborn
Death of the baby during an attempted home VBAC
Mulhan's conduct is completely indefensible, but, you guessed it, homebirth advocates are nonetheless supporting her. According to the website Save Homebirth with Evelyn in Maryland:
There are several problems with the way the Board of Nursing has treated Evelyn. The first, and most severe, is the fact that they suspended her license before proof has been established. One of our rights as an American is that we are deemed innocent until proven guilty. This drastic act does not allow that right to Evelyn. The Board of Nursing has stripped Evelyn of her ability to serve women in any capacity. They did not just suspend her CNM license, they also suspended her Registered Nurse (RN) license, thus completely taking away her ability to work or make a living.

Secondly, none of these complaints came from one of Evelyn’s clients or a client’s family. The complaints were filed by hospital physicians after a client was transported to the hospital. In fact, three of the five complaints came from the same hospital...
Three of the five complaints came from one hospital? Well if that's not a conspiracy, I don't know what is? Just because Muhlhan sent them transports including a woman with a dead baby and ruptured uterus, and another woman with a postpartum hemorrhage during which Muhlhan attempted unsuccessfully to manually remove the placenta at home, they decided to victimize poor Evelyn.

Things are not going so well with the fund raising, however:
Our Goal Is To Raise $20,000. As of 12/01/11 we have raised $1355.00
The Maryland Board of Nursing reprimanded Muhlhan in the strongest possible terms:
... The complaints regarding her practice involve her incompetent, negligent practice during home deliveries resulting in serious complications for the mother and/or death or a poor prognosis for the infant. Her practice shows a blatant disregard for the laws and regulations governing her practice as a CRNM and a reckless disregard for the health, safety and welfare of her pregnant patients. Respondent's practice is a danger to the public health, safety and welfare.
Homebirth leaves babies dead or brain damaged. It is indeed a danger to public health.

[Anonymous]

Good god, PP. That is horrifying.

[Anonymous]

Good god, PP. That is horrifying.

Took the words right out of my mouth. Thanks for posting, PP. I followed the epic thread about the last homebirth midwife disaster with interest, and although I would never think of having a baby while not also in a hospital, one thing I took away from the thread was that CNMs were more trustworthy than lay midwives. I guess not.

I will never understand why it is so important for people to give birth at home, particularly those in the examples above with known complications like group B strep, hypertension, obesity, prior C-section, etc. The terrible outcomes that result are tragedies by the truest definition of the word - that the participants, whether mother, father, midwife but most likely all three - have the tragic flaws of pride, selfishness and overconfidence to rank their "birth story" over the best possible care for their newborns and themselves.

And don't even get me started on this ridiculousness:

There are several problems with the way the Board of Nursing has treated Evelyn. The first, and most severe, is the fact that they suspended her license before proof has been established. One of our rights as an American is that we are deemed innocent until proven guilty. This drastic act does not allow that right to Evelyn. The Board of Nursing has stripped Evelyn of her ability to serve women in any capacity. They did not just suspend her CNM license, they also suspended her Registered Nurse (RN) license, thus completely taking away her ability to work or make a living.

Innocence until guilt is proven is one of our fundamental rights as CITIZENS. Licensed medical professionals are subject to different standards, as they goddamn well should be.

[Anonymous]

This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.