44 Years of Midwifery, Across the Full Landscape of Birth

Throughout my career, I have worked alongside highly skilled physicians and midwives who generously shared their knowledge and experience.

I have also practiced in circumstances where something was being missed and the mother or newborn needed someone to recognize it, respond, advocate, or begin emergency care.

I have worked in hospitals without neonatal intensive care when a newborn required additional support. I have initiated emergency care while arranging transfer to a higher level of care. I have practiced where consultation was readily available and where distance and limited resources made early recognition especially important.

And I have spent decades supporting physiological labor and birth—watching what happens when birth is given the time, environment, and support to unfold on its own.

These experiences belong together.

They taught me the importance of recognizing normal physiology, understanding medical risk, appreciating what interventions can accomplish, understanding what they can change, and knowing that context matters when weighing one course against another.

Over four decades, I have watched maternity care change.

Recommendations change. Technologies change. Available interventions change. The language surrounding risk changes.

The underlying work of understanding an individual woman’s circumstances remains deeply contextual.

Sometimes the important question is what could happen if an intervention is delayed.

Sometimes it is what changes when an intervention is undertaken.

Sometimes it is whether additional information, monitoring, time, consultation, or another management pathway changes the decision.

And sometimes the most important realization is simply that a woman did not yet understand the decision she was being asked to make.

That is where much of my work now lives.

“OG Midwife” reflects a career spent close to birth in many of its forms: physiological and medical, straightforward and complicated, well-resourced and resource-limited.

After 44 years, I have accumulated something different from a collection of answers.

I have accumulated context.

I have seen enough variation to know why apparently similar situations may require very different thinking—and why a diagnosis or recommendation rarely tells the whole story by itself.

Today, I use that experience primarily through education: helping women slow a complicated question down, understand its parts, identify what they know and what remains uncertain, and prepare themselves to participate more fully in conversations and decisions about their care.

Women often reach me after being given a diagnosis, recommendation, intervention, deadline, or description of themselves as “high risk.”

They may already have researched extensively. They may have conflicting information. They may know exactly what they want but need to understand the medical considerations around it. Or they may simply know that something still does not make sense.

The consultation begins there.

We can examine the medical context, available evidence, physiological considerations, potential benefits and risks, timing, alternatives, personal priorities, and the questions that deserve further discussion with the healthcare team.

The purpose is education and understanding.

Because after all these years, one principle has become increasingly important to me: