The sun was still rising on a brisk Monday morning in October last year when Sunday Smith, a midwife in New York’s North Country, pulled into the gravel driveway of a small dairy farm, scattering some chickens. She had driven for about ninety minutes, along dark country roads, for a prenatal appointment with Jennifer, who was twenty-nine weeks pregnant with her fourth child. At the front door, an Australian cattle dog named Tickle enthusiastically greeted Smith, followed by Jonathan, Jennifer’s husband. The entire family gathered in the wood-panelled den, with finger paintings on the walls and cartoons flickering on a big television.

Smith took Jennifer’s blood pressure and checked the baby’s heartbeat, using a handheld Doppler fetal monitor. As Smith scrolled through her medical files on a tablet, Jennifer and Jonathan explained why they planned to deliver their child at home. Their experience at a hospital for their first child wasn’t “horrible,” Jennifer said, but it struck them as needlessly stressful and intrusive. Her labor had stalled in the hospital; the problem, she suspected, was that she was tethered to her bed by a fetal-heart-rate monitor, which uses belly bands and an ultrasound machine to follow a baby’s heart rate during contractions. Jennifer wanted to work through the animal pain of labor by moving around, maybe taking a shower; when the time came to push, her instinct was to squat, or bear down on her hands and knees. But hospital protocols fixed her on her back, with her legs spread. Jennifer believes she narrowly avoided a Cesarean section only because of a turnover in staff; the hospital’s midwife was the one to catch their child.

“I was dumbfounded,” Jonathan recalled. “I’ve delivered hundreds of calves. If I poked and prodded a cow as much as she was poked and prodded, a calf would never come out. It’s just not natural.” Jennifer’s next two children were delivered by an unlicensed midwife, who has since moved to another state.

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