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
When I was five years old I picked up the best habit I’ve got, from my mother: hand written correspondence. She loved writing cards and, as it is said, children do what we do, not what we say.
That was 36 years ago, when puppy and butterfly stickers were as much a part of the cards I wrote as words were. In the decades since, I’ve accepted that letter writing is an art, a powerful art, and one that has benefited my life in profound ways.
Here are the top three reasons why letter writing is powerful.
ONE: It makes relationships stronger.
Relationships are the core of life, and letter writing is an art of relationship.
When you’re struggling or just feeling down in life, you depend on relationships to help bring you back up. When you’ve got something to celebrate, you want to share it with people who’ll be genuinely happy to hear the news.
Relationships are what makes life rich. Though popular culture defines intimacy as solely for romance, intimacy is actually the sharing of human experience. Think of it as “into-me-see.” When you share your human experience with someone, however tender it might be, you invest in relationship. Your life becomes richer and so does the life of the person you’ve shared it with.
Your handwritten letter is a gift for the whoever you send it to. It feels like a real treasure. Totally different than a piece of junk mail with pizza ads and carpet cleaning coupons. When you invest in someone — a friend, family member, peer, mentor, God/Spirit/Source, a neighbor, or even yourself — by taking the time to write to them by hand, you feed the thing that matters most in life: relationships.
TWO: It makes you more present.
Look to the wisest among us; the quality of their presence makes them Jedi. Still, attentive, grounded, mindful, awake… present. Right. Here. Now. Where all the power is.
You’ve met people like this, right? Maybe they’ve been meditating for 26 years. Maybe they almost died twice. Either way, they are present.
Especially when most of us walk around tethered to our “smartphones,” we could use a heavy dose of mindfulness training, don’t you think? Well the good news is that small steps are often big steps, and letter writing is a powerful act of presence.
Who do you want to write to? Not tomorrow, not next Tuesday. Right now. What do you want to share about your day, your dreams or your doubts? Not in 2033. Now. What is true for you, right now?
I bet you can type pretty fast, but handwritten letters take time. They slow life down, so you can sit in the present moment, where you are, with your stress or daze or disappointment. Right now. Both journaling and letter writing can be therapeutic, and handwritten correspondence can be a blend of both.
THREE: For pleasure.
For you. Mmmm, that pen feels good on that paper. The way its ink settles into the page, the way it rolls like liquid or sticks to twist my cursive t’s into the next sentence. Letter writing is tactile. It offers sensual pleasure that isn’t found on the screen.
For who you write to. When you find a paper envelope with your name handwritten on the front, doesn’t it feel good? People tell me it feels very, very good. Somebody loves you and they wrote you a letter, for cryin’ out loud.
For the postpeople. Once I’ve placed an enveloped in the mailbox, raised the red flag for Ruben the mailman, and turned back toward the house, I have dipped my day in pleasure — and perhaps his, too. Day in, day out, our mailwomen and men walk rain or shine to hand deliver our mail to us. And it’s cheap: 47 cents a letter as I write. Isn’t it nice to think your envelope, addressed by hand, could make their day just a little sweeter?
Delight in the mail box. Less junk mail, more love mail.
Be part of the revolution. Join us for a fall 2016 in-person letter writing workshop in Northern California, led by Leaning into Light Founder Jessica Rios, whose lifelong art is letter writing. Or sign up for our recorded 30-minute phone workshop anytime.
In recent months I’ve wondered about the relationship between how a woman cherishes and tends to her home, and how we value women as a society. Could it be that there is a noteworthy correlation between the undervaluing of women, and the undervalued art of tending to the beauty and order of a home? And could it be that when women stand up for the value of home-tending, we move humanity forward in its return to being a woman-honoring species?
(Who’s chuckling about the obviousness here…?)
At this point, I’ve begun to stand firmly for the value of what I do in and for my home. What I do — as with many other women and mothers — is constant. Beautifying through placement, flow and seasonal rhythms. Picking up, cleaning, endlessly returning the space to order since life — and the material things in a home — are in constant motion.
Sure, nice idea. But how do I really "stand for" the value of this?
Many ways. By naming what I do, out loud, taking it out of the shadow and into the light of day. With self acknowledgement. By counting it, quantifiably, as a contribution to what holds up our family physically, mentally, emotionally.
Yet it hasn’t always been this way.
When I was a teenage girl, my bedroom was cluttered. In college, my dorm room was too. Those were small spaces to contain all the immensity that is a Woman Child, as my dear, now-deceased Uncle Cheo used to call me.
Sometime in my twenties, home became more like an altar than a place for a bed, lamp and shower. A place to hold my big, powerful emotions and weary head. A place where the rigor and richness of living an authentic life could relax for the night. What would it feel like if my desk was an altar to writing? My bathroom, a sacred and small personal spa for refilling my well after days spent out in the noisy world? How many plants do I need to help my space feel like part of the Earth, rather than a closed-off and insulated cave? Are my eyes still wanting what’s placed on this windowsill, or shall I wipe its white paint clean and place new items here to sit for a while?
At some point I fell madly in love with my home.
Each time I’d move to a new home or apartment, home became a canvas for my art, a way to express my sense of beauty in space.
Today it’s that way still. Creating space at home is a passion of mine as it is for many other women.
Except I don’t live alone anymore. Home is shared with my husband and our 3-year-old daughter, and it isn’t necessarily their vision for home to be, in large part, a sort of altar.
That’s OK. Living together harmoniously is one of great challenges of committed relationship. Can I surrender my desire for him to put away his water glass every night rather than leaving it stranded somewhere in the house? Can he forgive my constant fluttering, never-sit-down-ness, my incessant need to create beauty and order rather than just relaxing with him on the couch? Can we find a way to share the roles that help make our house a serene and tasteful place to be?
Sure. Usually. And getting there is a terrific exercise in communication, acceptance and respect. One that grows us. One that makes us more of an “us” rather than just a he and a me.
A few of my close girlfriends share the kind of passion I feel for my home. We don’t sit until we tend to our own inner sense of what this outer space ought to feel like. We don’t take “relax” for an answer if the tug to tend to our space is the truest one we feel. We will relax when our Goddess Caves are ready to hold us exquisitely as we relax. We will relax when our art has been lived, when our homes have been loved, the way we were born to storm them into spatial artistry.
It’s not a hobby to tend to our homes this way. It’s part of who we are.
When I was pregnant, some girlfriends wondered how I’d do it with a little one around. “You’ll have to let go,” they would say. “I sure did.”
It did make me wonder. Would I become someone super different from who I was now, like, Wow, I don’t even care if my bathroom floor has hair on it now that I’m a mom!
Heck, no. I didn’t think so, and it definitely isn’t so. Have I let go 5%, allowing a little more dust on the edge of the floor than I used to allow? Yes. But does my home still feel like a tended-to sanctuary, where beauty and order are high priorities, and delight greets my eyes on every square foot of floor and wall space? Yes. Because this is me living my truth — not someone else’s.
“The dishes can wait!”
Yes, perhaps if your child needs your attention badly and you’ve been away all day. My dishes don’t wait. Not if washing them honors my truth in that moment. Warm soapy water and a spacious sink to wash dishes is a fortune that I indulge in, one that bathes my mothering hands in frothy spa suds and light, kissed by the sun from the window.
“Come on, relax, are you going to vacuum again?”
Hell yes I am. These feet hold my body all day long, moving many miles from here to there, carrying a 40lb. child, picking up after her and us, bringing in the mail and the CSA box, raising and lowering the swing, trimming raspberry bushes, picking up dog poo, and 4,000 things more. These feet deserve the love of a floor that’s clean to carry them, a floor not coated in dog hair and snack crumbs. These eyes like to see a sensuously pleasing carpet, free of the day’s haste and droppings. Tended to.
It must be about the tipi.
Somewhere in my memory, the ancient kind of memory, I can hear my soul sister Shirley sweeping in her tipi across the meadow. Carrying our brooms, singing into the nighttime sky, candles whisking warmth into the moon. I hear her joy; it sounds like mine.
The Bible says a woman’s place is in the home. I’m not Christian. A woman’s place is in the home when she wants it to be. And if she wants it to be at a job outside the home 10 or 40 or 80 hours a week, then that is a woman’s place. No book or nobody other than each woman herself knows where that woman’s place is. A woman’s place, moment to moment, is wherever her body and soul blend most rivetingly with this delectable planet. Apple farm, corporate boardroom, her own bathtub. She chooses where that is.
Mothers hold up the world.
We’ve all come from mothers. Life comes from Mother. Without daring to articulate all that we hold quite yet, I have noticed that women have a capacity to carry an enormous amount of responsibilities, visions, lenses, and landscapes — an exhaustive, complex and largely unrecognized array of what life needs.
If we’re carrying so much for our families — with parenting, our jobs or businesses, the social calendar, the home and yard and community, family dreams and relationships, emotional needs, and perhaps even refueling our own tanks too — why shouldn’t our homes play a big role in carrying us?
They do. So can we give ourselves permission to tend to them as wholly as we long to?
When a woman tends to her home like an altar, she sees in it the golden cave of the goddess. Like a mirror for her exquisite soul, she tends to that which holds her, because she knows how much she holds. She knows her worth. She stands for it.
Years ago I felt a bit concerned I cared too much about the sanctuary of my home. Listening to the bigger voice in me, I kept tending to home as a sanctuary of beauty, order and light. Chaos erupts, messes and spills, I embrace it, and then just like I breathe, my body moves in a dance of bringing it all back to clear, grounded, still. Now I see how masterfully this sense of space, this way of home, holds me. This is why I tend to it so devotedly. As it holds me, I can then hold my child and all of my life more completely.
Women, all of us, can either honor this tending to home as part of all we hold — and with our voices and actions, value it, not letting it be overlooked or belittled — or we can devalue it in a chorus with a culture that sess women as inferior. Since when did She Who Carries and Births New Life become less than a marvel worthy of utmost care?
It’s not about what anyone else sees or thinks. This is my tipi. My reflection of self care, in space. I will sing and I will sweep.
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.