Catonsville Midwife Awaits Final Hearing on License

A well-known Catonsville midwife is awaiting a final ruling from the Maryland Board of Nursing to find out if her license to practice in Maryland will be revoked.

Patricia Noble, executive director of the Board of Nursing, said the board has not made a final ruling but said the date of midwife Evelyn Muhlhan's hearing is not public.

Muhlhan's license by the Board of Nursing in October after several complaints were filed with the board. Her supporters have argued that none of the complaints were made by clients but instead by health professionals. The original investigation document is attached to this article.

Muhlhan runs Alternative Birth Choices, a Catonsville-based practice that provides midwife, doula and OBGYN services to expectant mothers. She has been performing home births for 30 years.

The investigation by the board comes as home births are on the rise in Maryland and also at a time when several advocacy groups are pushing for expansion in the number of midwives licensed to provide home births in the state.

According to an article from Maryland Reporter, the number has increased from 291 in 2001 to 409 in 2010.

The state Department of Mental Health and Hygiene said that despite the increase, home births still account for less than 1 percent of births in Maryland.

The department has issued a joint statement on planned home births in Maryland endorsing the following practices:

• A pregnant woman considering a home birth should consult with a licensed physician or certified nurse midwife to determine if she is a good candidate for home birth.
• All planned home births should be attended by a licensed physician or a license certified nurse midwife.
• It is illegal for a physician or midwife to practice without a license in Maryland.

The Board of Nursing has 208 licensed certified nurse midwives in Maryland out of more than 300,000 licenses in Maryland, Noble said.

At least one home birth advocacy group is advocating for another level of midwifery to be made legal in Maryland.

Maryland Families for Safe Birth is advocating for the approval of a certified professional midwife, which is a type of certification in many other states.

President Jeremy Galvan declined to comment specifically on Muhlhan's case. He said there is a need for midwives who do homebirths in Maryland.

"As many as 50 women who planned to have a home birth now have to make alternative arrangements last minute," he said, with the suspension of her license.

While the number of certified nurse midwives is high, the number who will perform a birth at home is much smaller, Galvan said.

"Clearly the nurse midwives are not interested in providing home birth services," he said.

He said his organization is concerned with allowing women more choices in the way births progress that he said they have in hospitals.

In the case of Muhlhan, complaints stemmed from births where there were complications and the mother and baby were delivered to the hospital.

The board said that Muhlhan was not approved to deliver babies outside of her practice and she was also practicing without a backup physician. In the investigation, Muhlhan said that she did not have such a physician, though it is required.

Hospitals need to make an effort to partner more with midwives, Galvan said.

Erin Wright, a certified nurse midwife and chairwoman of the Maryland Chapter of the American College of Nurse-Midwives, is one of those midwives who works in a hospital.

Wright said regulations that require a collaborative plan and a backup plan have only been in place since 2010 and are a marked improvement over previous regulations, which allowed less autonomy for midwives.

Wright practices at the University of Maryland Medical Center and said that 96 percent of nurse midwives nationwide deliver in hospitals.

She said homebirths can be great for families, if the mother is a low-risk candidate. The new regulations allow for a collaborative practice between doctors and midwives, she said.

"I think it's great if women are choosing this and they are appropriate candidates," she said.