Catonsville Midwife Being Investigated by Maryland Board of Nursing

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.

Muhlhan, who did not return phone calls seeking comment, runs Alternative Birth Choices, a Catonsville-based practice that provides midwife, doula and OBGYN services to expectant mothers.

According to the company's website, Muhlhan and her team have more than 30 years of experience in home births.

Muhlhan is licensed by the state of Maryland as a certified nurse midwife, which requires completion of a medical degree program. A doula is someone who provides non-medical support to a mother during a birth. 

She received notice of her license being suspended on Oct. 7. The board has given Muhlhan the right to request an "evidentiary hearing" to challenge the board's findings—an administrative process that would permit her to use an attorney to cross examine witnesses, call her own witnesses and present evidence. It is unclear if such a hearing has been scheduled.

Advocates for Muhlhan have started a website to raise money for her legal expenses. The suspension of her license has prevented her from practicing.

Patricia Noble, executive director of the Maryland Board of Nursing, said Friday she could not comment specifically on the case until there is a resolution by the board.

"The Board of Nursing is not against midwives," she said.

According to the order of summary suspension document released to Patch by the board, which details the complaints against her, Muhlhan was performing home births without a collaborating physician or what is called a "collaborative plan" since January 2011, which violates state regulations.

The plan is supposed to be approved by the collaborating physician and the Board of Nursing.

The board states in its document that Muhlhan did not include in her collaborative plan that she was delivering babies in homes. Instead, her plan said the deliveries occurred at her Alternative Birth Choices practice.

Also, when contacted by the nursing board, the collaborating physician on file stated that he was providing collaborative care for her private practice, but not for deliveries at home.

Furthermore, the same physican sent a letter to the board in January of this year that he was no longer Muhlhan's collaborating physician.  

The documents also disclosed several complaints filed with the board in recent years.

• A hospital neonatologist raised concerns in 2008 that Muhlhan performed a vaginal birth at home for a woman who had a prior cesarean section, obesity and other risk factors. The baby was transported to an undisclosed area hospital with complications.

• An area hospital staff member said in May 2010 Muhlhan arrived at the hospital where she did not have privileges after a failed home delivery. The baby delivered was 10 pounds and 9.6 ounces, which is considered a risk factor for a vaginal birth. Several other risk factors were noted.

• Staff at the same hospital in July 2011 said a baby was delivered stillborn and the mother's uterus had ruptured, according to the Board of Nursing document. That happened after a failed home delivery. The mother had also had her previous child by C-section, according to the document.

• Hospital staff from that same hospital reported in September 2011 that an obese mother arrived at the hospital after complications from a home birth. The midwife team had manually removed the placenta at home, according to the document.

Muhlhan was interviewed in the board's offices in August and stated that she had no hospital privileges or collaborative plans, according to the records released by the Board of Nursing. She was also unable to provide accurate medical records because of computer problems, according to the records.

Muhlhan provided records to the board that she had 80 clients from January to September and performed a total of 72 vaginal births. Her uncomplicated vaginal birth rate was 90 percent with a 0 percent maternal mortality and a 1.25 percent infant mortality, according to the calculations Muhlhan presented to the board during the interview.

In Maryland, the infant mortality rate in 2007 was 8 deaths for every 1,000 births, which ranks 42nd in the U.S. The infant mortality rate in the U.S. is 6.8 deaths for every 1,000 births, according to state statistics.

The website developed by Muhlhan's supporters states the Board of Nursing has treated her unfairly because her license was suspended before proof was established. They also pointed out that none of the complaints came from the patients themselves or their families.

"Evelyn is looking forward to her hearing before the Board of Nurses so that she has the chance to present the evidence that will show that not only is she a safe and skilled practitioner, but also that she educates her clients ... " according to the site.

So far supporters have raised $1,300, according to the website.

Home births have been rising in popularity in the nation and in Maryland. According to an article from Maryland Reporter, the number has increased from 291 in 2001 to 409 in 2010. State health officials are also struggling to record them, as details on a birth certificate for a baby delivered outside of a hospital are often vague.

Muhlhan has a hearing before the board at a future date that was not released.