In March 2013 our daughter Helena Beam was born in our Chico, California bedroom. We were very pleased with how our homebirth midwife, Dena Moes RN, showed up both during my pregnancy and our 7-hour labor. She also responded exquisitely when, two hours after our daughter was born, Dena noticed she wasn’t breathing right and called 911 without hesitation.
Since then, I’ve become aware of some intense and unfortunate challenges facing Dena and other homebirth midwives. I interviewed her to learn about what’s transpired and what it may mean for homebirths – and holistic parenting – into the future. -- Jessica Rios
Jessica Rios: In your profession, have you always been a "homebirth midwife?" How did you get into midwifery?
Dena Moes: No, I haven’t always been. I didn’t even know what a midwife was until I was 23. I have a degree in Literature from Yale, and I was living in New York City when a friend gave me the book Spiritual Midwifery by Ina May Gaskin. I read it and thought, ‘Oh my God, I am supposed to be a midwife.’
So I left the city for a week to go to a yoga ashram in upstate New York. I had been writing a lot about the midwife possibility, and on my last day at the ashram it happened to be Mother’s Day.
Some moms came up from the city to do a special Mother’s Day sweat lodge, and I helped carry rocks. Some women were walking toward me huffing and puffing as they carried rocks.
At one point I said to one of them, “You’re almost there!” and she turned to me and said, “Wow, you sounded just like my midwife when you said that!” It turns out she was the President of the International Cesarean Awareness Network. She turned me on to Certified Nurse Midwives and got me a gig volunteering at a big public hospital. Later I returned to North Central Bronx Hospital as a student midwife, and got to work with birthing families who were immigrants from all over the world.
There are two routes to becoming a midwife. One is as a nurse midwife, and one is as a non-nurse midwife, known as a licensed or lay midwife. A Nurse Midwife is a Registered Nurse (RN) and also holds a Masters degree in Midwifery.
I really enjoyed training in a hospital because I got to see a lot of situations in a very short period of time. I worked both as a Labor and Delivery Nurse and as a hospital midwife, and before that, as a student, I lived in an Amish farm house for a summer and attended 25 Amish homebirths while interning with a midwife who took care of Amish families.
When my husband and I moved to Chico, the community needed another homebirth midwife. It felt like just the right time to put down roots and open the practice I had dreamed of. So I did. That was 2005.
JR: How has it benefited your clients to be a RN too?
DM: For my clients it’s been really valuable to have both the education and the work experience I brought to homebirth. A lot of them have been comforted not just by the fact that I’m a RN but that my degree is from Yale, an Ivy League college. By the time I started my homebirth practice, I had worked in several large Medi-Cal clinics providing gynecologic care and family planning. I had worked as a Labor and Delivery Nurse, some nights getting to assist with as many as four births in one shift.
When you work in a hospital, you take care of everyone who comes through the door. Having seen complications in the hospital, I genuinely knew when things were progressing normally and when they weren’t. I feel this is an asset – the education and training of certified nurse midwives – to have a wider breadth of experience. There’s a certain clinical competency there.
JR: What started happening in 2010 when your license was being threatened for revoking?
DM: I’ll share some background first. When I opened my practice in 2005, I approached several OB-GYN doctors in my community who I’d heard were the most open minded or progressive, and asked if they would provide support to my homebirth practice in the form of consultations and collaborations, which is always the ideal... that midwives work in collaboration with other health care providers. That way, if there is a transport [from home to hospital], it’s smooth.
I received a very negative response. No one agreed to work with me and I was told by the medical community that homebirth was not welcome here. I had a choice. Should I say “forget it” and go get a job as a gynecologist, or do what I always wanted to do?
So I asked homebirth midwives all over the state, and what I found was that nobody had a collaborative doctor in their community except in the case of Los Angeles midwives working with a MD named Dr. Stuart Fishbein.
I called the Board of Nursing and asked about the legal requirement for supervision of nurse midwives, which by the way is only required in six U.S. states now. The other 44 have dispensed with that requirement because it just doesn’t make sense. If midwives are required to have a supervising physician but no physicians are willing because they see us as a threat to their sense of authority, and as competition... they’re not necessarily going to jump at the opportunity to work with us!
This year there’s a bill in the CA Legislature (AB 1306) trying to remove the physician supervision requirement. This law would help fix some of the brokenness around midwifery in the state of California. Basically during the years I was in practice as a homebirth midwife, the requirement was that I have a physician available to call by phone and consult with, if I had a client with a medical concern or question I couldn’t address.
It was Dr. Stuart Fishbein in L.A. who agreed to do that for me. Over the years I would call him when I needed help from a MD.
Meanwhile some obstetricians in my local community wrote a letter of complaint about me to the Board of Nursing, their main concern being that I wasn’t working with a local physician. A six-year investigation began at that time. I got a letter from the Board of Nursing, and this all finally ended in February 2016.
Once a year during that period, I heard from them about the investigation. Really I thought the concern would be dismissed without merit. The letter complained about four women who had been transported -- all with healthy babies and good outcomes -- and two of them weren’t even my clients! I’d never even met them. It seemed capricious. I thought, ‘This is just harassment. It’s not even accurate.’ I thought for sure it would all be fine.
For a couple years, I really wasn’t concerned. I actually thought the Board of Nursing would somehow be on my side and see this inaccuracy that they would see through this misunderstanding. Then in 2012 a nurse midwife friend told me, “You’ve got to get a lawyer. This is serious.” I hired a lawyer. The Board of Nursing called me to Sacramento for an interview and my lawyer was Skyped in. The woman investigator grilled me about the two actual clients. The clients in question were VBACs [vaginal birth after cesarean].
Prior to 2005, VBACs had been happening regularly in local hospitals. In 2005 when I opened my practice there was a sudden ban on VBACs in all the hospitals in my county. A group of obstetricians got together and recommended banning VBACs in any hospital without 24-hour in-house anesthesia...
I won’t get into the shenanigans, but it happened. What that meant was that all the women using these hospitals, who’d already had a cesarean labor, had no choice but to birth via cesarean. VBAC wasn’t an option. Many women were forced to have unnecessary, repeat C-sections.
Midwives tend to assist VBACs when the hospitals won’t. This is what ended up being seen as a breach of my practice, even though there were no Board of Nursing regulations specifically about VBACs. So I followed the guidelines of the licensed/lay midwives, who are regulated by the California Medical Board instead of the Board of Nursing. I thought if I followed their guidelines, I would be covered.
Already though, there was a major red flag on my mind.
The medical investigator who interviewed me for three hours and was going to have to make a nuanced analysis, had not known what labor was. During my interview she asked me, “What do you mean, labor?” She said she had never had an obstetrics case, and that specific medical background was not necessary for her job description. That’s when I knew the scales of justice were not going to be very well balanced.
Since around 2010, nine of the 30 certified nurse midwives practicing homebirth in California are or have been under investigation. I’m in great company! (Laughs.)
After my interview with the investigator, I didn’t hear from them for two years. During that time, I took a 9-month trip backpacking around India with my husband and daughters. Toward the end of our trip, I heard that I was formally charged by the Board of Nursing. A year later, I settled for my RN license to have a 3-year probation period, and that has meant closing my homebirth practice. For now.
JR: That sounds devastating.
DM: I’ve definitely had to grieve. This is how I’ve been supporting my family for the past 12 years. My oldest daughter is about to apply for colleges. It’s been a big transition.
JR: Is there a silver lining?
DM: Yes. When we came back from our yearlong trip in India and Nepal, I knew I wanted to write a book about our family adventures, and a memoir about being a midwife. In the last few months since I closed my practice, I have been able to finish my 350 page memoir. I'm currently shopping it to agents with a vision of having it published in the next few years. Now I have a midwife website and an author’s website!
JR: What does this say for women in general?
DM: Here in the U.S., there is still a witch hunt against midwives. We threaten the paradigm. And, homebirth is not going away. Homebirth is a consumer driven movement. It’s not like I put up billboards: “Come try a homebirth!” Women came and found me because it’s what they wanted.
Interestingly, I heard through the mom community that the same doctor who spearheaded the letter to the Board about me has started attending VBACs in the hospital again in the last couple years, and has actually told one pregnant woman that they had to start attending VBACs again because of the pressure put on them by the homebirth midwives. Meaning, women were saying to them, “Well if you won’t give me a VBAC, I’ll just go and have a homebirth.” Women will ask for what they want. It’s not up to the medical profession to tell them no. Pregnant women have rights.
If people want to help the situation, get involved in passing the California bill and fixing the broken laws, making it easier to practice homebirth in California. A step for midwives anywhere is a step for midwives everywhere.
JR: What would you say to women in the United States who want to give birth at home?
DM: Women are perfectly designed to give birth. Just like you get the baby in, you can get the baby out. Look at all the people in the world! Everyone came from a mother. It works. Definitely find a midwife. There are probably more midwives now than ever.
The most important thing is to find a midwife you feel comfortable with, who you can trust, you feel heard, you feel empathy. And also does she have training and experience? How long has she been doing it? Talk with other moms in your community. Most everyone has found my practice from other mothers. Homebirth in the United States is on the rise. It has been steadily increasing for the last decade.
JR: Thank you for your work, and your time.
Dena’s Recommended Reading
• Spiritual Midwifery by Ina May Gaskin
• Birthing from Within by Pam England
• Breastfeeding Made Simple by Kathleen Kendall-Tackett & Nancy Mohrbacher
• The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Baby by Dr. Sears
• You Are Your Child’s First Teacher by Rahima Baldwin Dancy
Our free recording for December is a 43-min interview On Privilege, with Griffo Distillery's co-founder and Director, Jenny Daly Griffo. You can listen to it here.
Jessica Rios, Founder of Leaning into Light, is a mother, coach, lifelong letter writer, and eternal fan of Mr. (Fred) Rogers. This deeply personal blog and our free recorded conversations are devoted to one of her greatest passions: illuminating the beauty of the human spirit.