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Father's Day: Reflections on My Firstborn's Homebirth as Alignment with Healthcare Reform PDF Print E-mail
Written by John Weeks   

Father's Day: Reflections on My Firstborn's Homebirth as Alignment with What's Needed in Healthcare Reform

Summary: Five days before Father's Day, Morgan Martin, ND, LM, the director of the naturopathic midwifery department at Bastyr University, sent an email to her list of friends of naturopathic midwifery. My two blood children were both born at home, with ND midwives attending. Martin wished to protect natural childbirth as a part of naturopathic medical practice and solicited stories. My question is larger: What might the re-embrace of homebirth mean to our societal effort to reform health care by keeping people out of the sick care system? I recalled something I wrote in 2004, while on sabbatical in Costa Rica, about both my family's experience and thoughts on the role of homebirth midwives in an optimal health care system. I share this story together with information on the campaign with which Martin is engaged. I hope you enjoy their rhythm. Happy Father's Day!
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If indeed we are pursuing
reform by
keeping people out

of the sick care system 

Isn't homebirth a good place
to start?

My good friend and colleague, Morgan Martin, ND, LM (licensed midwife) sent me an email last week. Martin, chair of the Naturopathic Midwifery Department at Bastyr University, was writing to her list to stimulate what she hoped would be an outpouring of support to save homebirth training in the naturopathic profession. My spouse and I had both of our children at home as part of naturopathic maternity care. Martin assisted one of the births. I was on the list.

The Bastyr issue relates to the near unavailability and prohibitive cost of malpractice insurance. An individual midwife might choose to practice without coverage. Harder for an institution to be so exposed.  And why particularly would Bastyr or any other naturopathic medical program invest the tens of thousands of dollars to maintain a practice which, while historically an integral part of many naturopathic practices, is now only selected by a few?

So what we have here may be viewed as a small a story about a small species - naturopathic midwives -  threatened with extinction. We've all grown accustomed to the loss of species, of skill sets, of languages, of cultures. Add one more.

Oddly, the very discussion of homebirth is almost never an integral part of integrative medicine and integrated healthcare discussions. It's been given up, handed over to the institutions at the center of the sick care universe. We rarely ask what whole person maternity care should look like. We talk of optimal
Morgan Martin, ND, LM
health care. But what is the optimal birth experience?

Put differently, if indeed we are pursuing health reform by keeping people out of the sick care system - a theme of the recent Donna Karan integrative medicine event - isn't homebirth a good place to start?

The following is a story I wrote 3 years ago on a writing retreat in the sweet little town of Las Juntas, Costa Rica, while away on a working sabbatical with my family. It's a different mode of writing than typical Integrator fodder, more personal and intimate. Woven in are some reflections about homebirth in Holland.  The nation with the lowest C-sections is also the only developed nation where birth is organized around homebirth by midwives. What is the broader meaning of homebirth for those of us who seek a profound health reform? If my prose bores you, scroll to the bottom for some more from Martin about the situation with naturopathic midwifery.

Dusting off this previously unpublished piece seemed a good way to celebrate the joy of Fatherhood, and to honor Martin's work, and the larger homebirth movement as represented by the Midwives Alliance of North America and, educationally, by the Midwifery Education Accreditation Council.


1.    A Piece of a Birth Story

I sit at our family’s piano with the fresh-born baby, my son, extending out along my right forearm.

He is feeling his first separations, first freedoms, from the womb, then from the body of the mother. he is one room removed from the continuing sounds of where he was born. He feels the slight separation from the chest of the father, that being up there where he looks. He looks to the eyes of me, as I extend him out along a forearm.

Our eyes stay on each other. With the damper pedal down, I touch single notes on the keyboard. He has heard such notes, before, from inside.  Now it is just him and me and the slightest organization of sound into pattern, a few notes, music, his eyes widening in waves of creation, with each single touch of a key.

This is how I met my son as just the two of us for the first time. Here we were no longer surrounded by the celebration of the birth, the two midwives, the two relatives invited in to take part. Here we were just the two of us, and a note and then another, resounding as deep as anything.

2.   House Call of an Obstetrician and His Intern

In the next room were my spouse, post-partum, my Mother the assigned photographer, my sister-in-law who like me was there to assist, plus the two naturopathic midwives who we knew because this was part of my spouse's own professional field.

With them were two who have just arrived after the birth - an obstetrician, and his student doc who was on an OB rotation.

We’d known the doctor before his arrival. He’d served as back-up on my wife’s own midwifery practice, and the practices of the attending naturopathic midwives. He was a fine man, willing to lend himself as support to a homebirth practices which were, in fact, supported by evidence but not by the entire remainder of the universe of obstetricians and big city hospitals in our town. All of the others refused, despite the evidence, to create an open and affirming relationship.

Never mind that lives of are put at risk by their refusal to communicate and relate openly.


“The (experience was the) best,
just the best … but you didn’t
hear it from me.”

Seattle Obstetrician
at his first homebirth

Lured by the laughter on our side of the phone which opened into the birth room, a world removed from the hospital in which the obstetrician received the page, seduced by the sounds of Miles Davis in Miles’ silent way, by the promise of good food and wine, and honoring the desires of colleagues who he respected, the physician broke all protocols. He put his license at risk and agreed to come over to stitch a tear from a too-abrupt birth.

The midwives could have done the stitching but the man was an expert and a colleague. The tear was complicated, a sort which was a rare product of homebirth but a frequent by-product of the haste of hospital delivery. The doctor’s expertise at suturing was well-known, a natural ability made exceptional by practice. He could stitch in his sleep, a good skill in the weird hours of an OB practice.  My wife wanted the obstetrician to do the work. We’d made the call, hoping for a positive response.  

The room was arranged for his arrival. One midwife procured the arm of a desk light from my home-office, and fixed it parallel to the ground, to provide an angle on the subject. We wired a second light for additional clarity, assigned positions, placed the water, the towels, and the tools. I happily accepted my assignment, taking our fresh baby, Lucas, into the next room, to the piano.

The obstetrician went right to work and was done in good time.  All had gone well.

The intern he’d brought was experiencing what was certainly the most surprising moment in a mandatory rotation on his track to a planned neurology practice. He was, in our home at that event, a tourist entering the Andean highlands at festival time, dragged there from workaholism by a significant other without completing the first page of pre-study. he was entering the new culture without even reading on the plane - briefed only by his superior in the car on the way over.

The newborn, 15 years later
Here was something exotic, a birth in a family home on plastic above a rug, in a bedroom of the mother and father, amid the smell of foods fresh cooked, and the festive, sweaty, teary, exultant tribe of this natural healthcare experience. He left excited, accepting the experience like a story which he could one day share when he sat among friend regaling them with tall tales of medicine in foreign lands.

The obstetrician accepted our offer of a plate of food and turned down the offer of wine. He had more work ahead at the hospital. Though he had served as hospital back-up for thousands of homebirths in which midwives were primary, he had never before the combination of trust, collegiality and request to induce him to come out into the neighborhood to stitch up a mother after birth, for which he would ask no fee. Despite providing back-up for many midwives, this was his first immersion in the family experience of homebirth.

On the way out the door, one of the naturopathic midwives, a referring colleague who had numerous times met him on his turf, in the hospital, but never before on hers, in a home, asked him what he thought.

“The best, just the best,” he responded. Then his mouth, I was told, formed into a smile:  “… but you didn’t hear it from me.”

3.   The Midwives of Holland, Where the Practice is a National Treasure

The always nascent homebirth movement in the United States, struggling to find its legs, to set standards, and to gain recognition from Medicaid and other payers, loves to talk about Holland.

My wife and I were both part of this advocacy, she as a practitioner and I, for a time as consultant to, and additional time as volunteer for the Midwifery Association of Washington State and the Seattle Midwifery School.

My wife trained in natural childbirth in Seattle, in England, on the Texas side of the border with Mexico, in India, and in Holland, a planned trip around the world while completing the 50 observations and 50 managements or “catches” which were required in her clinical training.

Midwifery in Holland

The midwives have power.
They are the gatekeepers
for the birth process.
They refer to obstetricians
when homebirth is

The percentage of c-sections
is the lowest in any developed n
ation, at less than a quarter
of the level of that in most US

Costs and complications are
also at a record-setting minimum.

Any hints here for healthcare

The Holland experience proved particularly illuminating. Homebirth and midwifery are viewed as a national treasure there. Midwives are a foundation of the care delivery system. The midwives have power. They are the gatekeepers for the birth process. They refer to obstetricians and for hospital care when homebirth is inappropriate.  Most births are at home, midwife attended. Babies of women who have already had c-sections are routinely delivered at home. The percentage of c-sections is the lowest in any developed nation, at less than a quarter of the level of that in most US cities. Costs and complications are also at a record-setting minimum. Strong relationships between midwives and physicians are promoted as good social policy, smart medicine, and beneficial economically.

The system is a good system to all rational accounts. We wondered that it was not heralded internationally as the best of all possible worlds – which it was. If it wasn't mimicked exactly then it least should be taken as the basis for birth care planning.

Why wasn’t the United States government investing in quality midwifery schools? Why weren’t health care planners insurers and HMOs developing a delivery system which met this rational example? Why weren’t US businesses, so concerned with costs, not enthralled by the direct and indirect savings from this structure of care? 

4.    Attending the Perfect Birth - The Pride of the Dutch Midwife

I found instructive my wife’s description of what I viewed to be the animating energy of this method of creation, this form of assisted entrance into the world. This was the form professional pride took for the most respected of Dutch midwives with whom she worked.

These women – most are women - assigned by the government to specific neighborhoods of the flat country, frequently arrive on bikes. When calls come, they mount their two-wheelers and arrive in time to work with the mother and families. The medium may be the message. Haste is neither their method, nor rapid intervention their predisposition.

Midwifery in Holland #2

The image is left of a midwife,
some few feet away, on her stool,
present, but restricting her
involvement to the necessary.

The birth is the woman’s.  The
midwife is there to reassure,
to guide, to intervene if necessary
 – but to pull back as quickly.

The image with which I was left on hearing of this style of birth was of a midwife, some few feet away, on her stool, present, but restricting her involvement to the necessary. The birth is the woman’s, and her spouse or significant others who she has chosen to have with her. The woman’s job is to labor, to do the work herself, to have the satisfaction of completion, of a job well-done. This is not the midwife’s role. She views herself as a last resort in a chain of social management of birth for which the mother and her relations are a first resort.

The perfect birth is one in which the midwife is hardly needed, physically, where she has helped well-prepare the mother and her team, where, at game time, the coaching is gentle. The midwife is there to reassure, to guide, to intervene if necessary – but to pull back as quickly, when appropriate.

The message to the mother, to the family, and to the child, later, when the story is told, is of a natural process, a difficult, a healthy process. I did it! We did it!  The power is palpable, the empowerment deep, the message of strength in life, of accomplishment runs into every pore. I and we did this, ourselves, together, with little intervention from drugs, from injections, with no invasion of marble corridors, gurneys, breathing devices, strange humans, vacuum suction, without, even, much help from the hands of the professional in whom we placed our trust.

I did it! We did it!

5.     Uhh ... Workaholism Meets the Birthing Clock

Six hours before my first child was born at home, I was in a white-boarding session with the head of national affairs for the national professional association for which I then served as executive director. It was 1992. We were working on some national policy plans for the re-emergence of naturopathic medicine, as an affirmative player in health care policy, in Washington, D.C.

The volunteer head of national affairs for the association, who was both attorney and physician, was in town from Montana for a day. We had tried to set up the meeting three times previously. We were behind on our planning. We believed we needed the meeting.

The newborn, 15 years later, airborne
Although my spouse had the first clear sign
that this was the day while returning from a swim at 10:30 AM, I had chosen to go ahead with the strategizing session. I get no points for sensitivity when this story is re-told among our friends. Then, desgraciadamente, none were too shocked, either.

We worked in the dining area, the piano room, separated from my spouse and our bedroom, the birthing room, by a wall through which a vent, from time to time, passed the noises of a laboring woman, my spouse.

With each half hour we filled more of the walls with potential initiatives, strategic partners, target committees, likely enemies, pitfalls, funding options (few), volunteer personnel (many), organizing strategies and responsibility allocations which would allow this small profession to enter the national arena.

The walls filled with ideas, resource potentials and to-do lists as labor filled my spouse.  She admits now to co-conspiring with me on my denial of the proximity of the birth. She did not wish to discover that she was one of those clients she had experienced as a midwife who, in pain from the early birth pangs, called the midwife to hurry over, or come to the birth center, I think it’s coming, only to find the dilation at 2 centimeters, and stuck there. My spouse wasn’t hurrying to call for help.

In my wife’s telling, I was in altogether another universe, oblivious to what was happening in the next room, the birth pains, happily tossing out ideas for advancing on a professional goal without a thought for what was about to find its way out of her. Finally, between contractions, realizing that the fellow who has the father of the child was going to take every last minute he could for his important business, gathered herself, waddled to the door, and quietly, firmly, let us know that the meeting was over.

My colleague, a female, took down our scratchings toward a future for the profession, rolled them up, and was out the door before the next contraction had passed.

6.   Laboring Alone, Laboring into Marriage

The power of the homebirth experience infused our shared self, formed the bonds which were to hold us tethered when we struggled. The homebirth made of us two a unit, bonded us.

Two hours before my first child was born, and just three before I was to sit with him at the piano, Jeana and I labored together, asymmetrically, not the same for each by any stretch, but wild and powerful for each, in our living room, just the two of us, as we’d planned.

She labored with the child within. At the same time, complicating things, we each labored with our relationship.


She labored with the child within.
At the same time, complicating
things, we each labored with
our relationship.

There we were, in the midst
of a labor, working on our

We were not yet married, not yet sure that we were going to be spending, god willing, si dios quiere, our lives together, not yet sure if we could depend on each other for the long haul. We had called off a marriage ceremony five months before, unable to co-write our vows. These hadn’t been easy months.

In her private hell, she was that wimpy patient who could not stand the pain and called for help at the idea of labor’s cramping. She feared she was the type who, were she in hospital, and given the chance to reach for pain killers, to let something else take the power from her, to diminish herself and her experience, she would. My spouse feared that she would be that woman, and call her colleagues, needy, only to find that she too, was at 2 centimeters, and the birth still many hours, or a day away.

I was not sure of her myself. From a family of four large boned, dark-haired, brown-eyed and outspoken women, powerful each in their worlds, the mother of my child-to-be was a blue-eyed, small-bodied woman who always waited to announce herself. I wasn't sure of her myself.

My uncertainty was reciprocated, as I was to better understand only later. She wasn’t sure that the character who was partnered with her in labor, and yet judging her, was what she wanted to be partnering with either.

That I was not sure of her strength in adversity, with pain, with hardship, with work, aggravated her own self-doubt as she labored.

We had spoken of this. We were working on behaving less judgmentally. Jung’s “shadow” and “anima” as useful tools to separate self from other were there, floating between us, additional birth partners.

There we were, in the midst of a labor, working on our relationship.

7.    Worry Lines and Thumbs to Foreheads

Our favorite tale from a wonderful  and helpful book of birth myths, stories and sayings from around the world, Mama Toto, told of a culture where, to help the laboring woman, everything is opened. Doors and windows are flung open, jars, sashes, screens, all lids removed, all that could hold something in must be opened, opened, to help the child out.

She did not call the midwife,
out of the fear. The labor
came every few minutes, for
hours, for a lifetime, it seemed.

She still did not want to call.
The worry lines kept returning.

I became a less convincing
pillar of strength. I too began
to worry. Maybe I was right.
Maybe the relationship would
never work. How would we raise
the child?

I began to see how her frown furrows on her forehead, between her eyes, would show when her mind closed down, clamped by worries and self-doubt, fear that her ability to withstand the pain would not prevail and allow her to have the child naturally.

With my thumb, I soothed the spot, the point in the forehead, the fount of wisdom, in small rotations, unscrewing the pressure, releasing, easing her being as an open vessel.

Four or five times as she labored through the hours, post-white-boarding, I worked in this way to assist her, to advance our agenda.

She did not call the midwife, out of the fear. The labor came every few minutes, for hours, for a lifetime, it seemed. She still did not want to call. The worry lines kept returning. I became a less convincing pillar of strength. I too began to worry. Maybe I was right. Maybe she couldn’t pull it off. Maybe she hadn’t the strength. Maybe the relationship would never work. How would we raise the child together with this uncertainty?
The worry lines creased my own forehead.

From out of her labor, the woman with whom I had co-habited for two years, with whom I had recently canceled a wedding, reached up. With her thumb, she soothed my own worry lines, and brought me back into the labor with her.

8.   The Birth

She finally asked me to call the midwives at 5:00 PM and then my Mother and her sister, our birth crew. A half-hour later the lead midwife checked her, and found her well-dilated, at 7 centimeters. She had the baby within two hours, on all fours, on the covered rug just beyond our bed.

My Mom captured the whole thing, the battle, the wildness, blood, placenta, all of it that was Lucas' birth. The midwife said it was the loudest birth he could remember. We return to the photos at each of Lucas' birthdays and see all of it there again, first just the head poking out all scrunched up with eyes closed still, an impersonation I do for him, of him who we first saw in his very beginning out here in the light with us.

My Mom
also captured the three of us a few minutes later in the picture that we sent out to friends, the adults with tears, the child swaddled, the new family unit. This was our first picture as a committed couple.

Within three months, we were in fact married, in a small ceremony, in our backyard, under a blossoming pear tree, with my Mother, sister-in-law, and Lucas, our son, with us. We were married by a lawyer friend who had become a judge, at 7:00 AM on a Tuesday morning, for reasons I will not go into here.

What power. What knowing that we’d done something great together. What a chance to, against the gales that threaten, bring in the crops together.

9.   If I am in Charge of Healthcare Planning ...

If I am in charge of the universe of healthcare planning, I want all mothers and their partners to have this experience. Not in the particulars, but in the birth energy, the life force, the can-do, the power to live and love.

If I am in charge of the universe of healthcare planning, I want all mothers and partners to know that birth does not need doctors, nor hospitals, nor machinery, nor much, even, from midwives.

I want them to feel this primary power of self-care, of personal responsibility.


If I am in charge of the universe
of healthcare planning, I want
all mothers and partners to know
that birth does not need doctors,
nor hospitals, nor machinery,
nor much, even, from midwives. 

I want these tracks etched deeply because I want them as foundation for all of our relationship to health and personal responsibility. That here is laid the foundation of good behaviors, and of responsible and empowered management of acute conditions which can be cared for in the home, building their own additions to an expanding complex of self care and community care which is the foundation of a healthcare system.

I want them to pass on this story to their child. This is how it happened. This is what we did together. This is how we did it. This is how you were born to us. This, here, right here, this is where you were born into this world. This is how it’s done.

I want it all demystified. I want the paid help in their places, as helpers not interventionists. I want no golf game or waiting patients or unread journals or research project dictating when and why, but only the rhythm of the time it takes for the baby to be born.

I want the time to be owned by the mother. I want the experience of help to be fused into the father or partner. I want the child to know of the family there.

I want, if I am in charge of the universe of healthcare planning, to have the natural process deeply experienced to give the foundational lesson of the natural processes of the movements of health and disease  -- and to have the experience of this caring professional support and back-up when needed.

I want, whenever possible, as the goal of birth planning, to have deeply implanted the awesome vision of the birth of one’s own child as an experience of self-reliance, of inter-dependence, of comfort that good providers are there, and available, but with the providers in their place, on one side, the self-aggrandizement of technology slapped back into a respectful distance.

I want, if I am in charge of the universe of healthcare planning, natural child birth, in the home if possible, to be the creation story on which the rest of the system not of medicine, but of health, and the care towards health, is built.


Comment:  I hear the protests of many as I re-read this. How about nurse-midwifery, and the move of hospitals toward family-friendly birthing centers? I have only one comment against that: the medium of the hospital remains the message, that birth cannot happen without these institutions, that they are the center of health care. Consider again the theme which Robert Duggan, president of Tai Sophia, expressed in these pages about the recent 10 day forum on healthcare reform organized by Donna Karan. Reforming health care by keeping people out of the sick care system. There is no better way to impart that message. As our remaining small, organic farms are beacons in the resurrection of a healthy food supply, so are our remaining midwives to quality, well-integrated, person-centered health care.

The Bastyr and Naturopathic Midwifery Situation 

The naturopathic midwifery practice is an interesting model an integration of homebirth services into an integrative primary care practice. The practices of licensed naturopathic physicians are based in whole-person, natural health approaches, and typically have enough pharmacy rights to manage most primary care issues. Writes Martin:
"The training of naturopathic doctors specializing in natural childbirth incorporates the scope of practice of direct entry midwives; but in fact, we do not enter that specialty directly. We gain access to the care of normal, healthy women and their normal, health pregnancies via naturopathic medical training, thus greatly expanding the depth of medical and clinical training and the variety of tools available to care for whole families throughout their life times. Though some call us naturopathic midwives, the scope of the naturopathic maternity care provider is more akin to that of a family doctor who attends laboring families in their homes or in birth centers."
As Martin shared with me, the issue being evaluated at Bastyr is that, since other programs are providing midwifery education, does midwifery education need to be a part of naturopathic medical education?
"Both schools that teach this specialty are facing serious challenges maintaining their maternity care training programs due to the unavailability or expense of liability insurance for the institutions. A compelling argument must be made for the continuation of these specialty training programs." 
Another issue has to do with her profession's legislative efforts. Martin urges that "just because the inclusion of maternity care is resisted in state licensure efforts, doesn’t mean naturopathic doctors shouldn’t be trained." She believes that "for emerging professions like naturopathy, loss of scope is unacceptable under any circumstance."

For her, the scope issues are
the profession's domain but the focus of the campaign is on the patient, pregnant woman, newborn and family. She ticks off core values: "Relationship, quality care, educational background, philosophy, continuity of care: these are some of the things that might matter to our clients/patients." She argues for a patient experience which means "having your doctor provide all your family’s health care needs, rather than having to establish a relationship during pregnancy."
In her letter to her colleagues in naturopathic maternity care, Martin suggests a variety of other key points which they might consider if they were to write supportive letter:

  • All physicians are trained in maternity care. Naturopaths are family doctors and should have the option to specialize in maternity care. 
  • The depth of clinical training available in naturopathic maternity care programs is invaluable for clinicians.
  • As holistic practitioners we treat the whole person, family, and community; that should include preconception, maternity and early childhood care.
  • Just because the inclusion of maternity care is resisted in state licensure efforts, doesn’t mean naturopathic doctors shouldn’t be trained.
  • In our highly technocratic medical environment, natural childbirth is an important option for families and we value keeping it available.
  • The majority of our patients are women; many will need reproductive health care, pregnancy or pediatric care. We value ND’s who provide this care.
  • With ND’s focused on wellness, prevention, diet, lifestyle, nontoxic therapeutic modalities, emotional and spiritual health, pregnancy care is an ideal fit.

Martin is also soliciting interest and financial support. She can be reached through Bastyr University:
425-602-3130 or

Final comment: So much in our culture, in medicine, and in the still small naturopathic profession's own journey urges that sloughing off this part of the historic naturopathic practice is a reasonable path. From 1983-1993 I was acutely concerned with the budget-mission pushes and pulls of that profession's significant challenges. The defining nature of these issues was the constant coupling of small budgets with a powerful desire among many in the field to be agents in the transformation of health care as most know it. Both the budgetary and scope battle issues which Martin notes are significant.

Since 1993, my own perch has been in the broader integrative care world. From here, my perspective on the  value of naturopathic maternity care regards the potential contributions and losses to our learning, and our options, from this profession's internal struggles. From this perspective, I feel the potential loss as deeply saddening. Terminating this track of training would be a loss of a somewhat obscure species that can, yet, be a teacher as to all of our efforts to restore health to our shamefully poor and awfully expensive medical system.

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Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
IAYT-Sponsored Series on the Future of Yoga Therapy