Born Free Method: The Podcast

After my OBGYN residency, my wife and I moved from Los Angeles to San Diego for my final year of training at UCSD in hospice and palliative medicine. People have called me a “bookend doctor”, as my two specialties square me up with both birth and death in a deeply intimate way. The two events seem disconnected and maybe even in opposition, but when an individual is dying or giving birth, something enormously important and difficult is happening, and nobody in the room can do the hard thing for the person going through it. They are mostly on their own. Then, all at once, the world welcomes a new person, or says goodbye to an old friend.Anybody who has been present for births and deaths has felt that these two experiences each carry a juicy dose of mystery. Many midwife colleagues will find their way into working with death at some point in their career, so there must be a shared impulse there. I’m not totally crazy despite what my OBGYN colleagues presumed.And still, Mother Culture teaches us that one of these events is a joyful arrival and the other a sad departure. How could birth and death feel like two sides of the same coin when they are treated as diametrically opposed?I think the answer lies in a word we have nearly stopped using intentionally: sacred. It is a hard word to define, but the felt sense of the sacred is probably what attracted me into these two “medical” fields to begin with. Great dictionaries marry it to religion, yet people with no religion at all reach for it when they experience a birth or a death. So this essay can not begin with a definition. It begins with two real-life examples in which the feeling is strongest, and then we’ll work backward from them.The sacred was palpable in those room. In a sacred experience, the room goes quiet. Time slows. All eyes turn to one person’s breathing. Phones go unanswered and meals are forgotten. People who were strangers an hour ago speak in low voices and look after one another. Hands are placed on the smalls of backs as bodies slowly shift despite the absence of anything to be done. Nobody needs to be told that this moment is different from every other moment of the week. These moments are sacred.To fully appreciate the sacred, the five sections of this essay compare birth and death, each drawing from myriad traditions and cultures, each taking us a little deeper into the mystery. My claim is that what birth and death have in common is the essence of what we mean by sacred.1. Birth and death are thresholds2. The body does birth and death in the same way3. Birth and death mirror each other4. They may be one door5. No one crosses alone, and no one is left unchangedNathan Riley, MD, FACOG, is a dual-board certified physician in obstetrics and gynecology and hospice and palliative medicine. He is also the co-creator of the Born Free Method, an online platform that supports families around the world throughout the fertility through postpartum continuum. Find more support at Beloved Holistics and Born Free Method.This episode was sponsored by Born Free Method.The Born Free Method digital playground includes over 60 hrs of pre-recorded lessons (w/ slides) spread out over 180+ lessons when you enroll. You will also be invited to a Zoom call (recorded) every other week hosted by me, Sara, and both. We also often have guest speakers, and you will have access to recordings for all 100+ of our past calls/interviews. Enroll for your 7-day free trial!More ways to work with Nathan:Support for Midwives | Private Consultation | Clear & FreeMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Hemolytic disease of the newborn (HDN) was first described in 1609 by a French midwife. It took centuries of case reports to find a potential cause. A 1939 study out of JAMA by Levine, et al, was the first report on blood compatibility as the culprit, and then in 1940 Landsteiner and Wiener identified the specific protein responsible. They named it “Rh factor” after the rhesus monkey cells that were used in their experiments. It wasn’t until anti-D antibody, aka Rhogam, was introduced in 1968 that we began to see a sharp decline in HDN. I will present the basic process as told by the conventional model of obstetrics and midwifery and along with some welcome criticisms of this story. As a foreward, this is not by any stretch a systematic review of every study that has ever been published on this topic. But it’s a start…The Conventional StoryRhesus factor, also known as D-antigen or Rh-factor, is a protein found on the surface of red blood cells (RBCs). If your blood type is “negative” (e.g. O negative, A negative, B negative, AB negative), your RBCs don’t have this protein. If your blood type is “positive (e.g. O positive, A positive, B positive, AB positive), your RBCs have this protein on their surface. Your RBCs are floating around in your blood stream, and if an antigen like D is sitting on their surface, your immune system will recognize the antigen as “self” and you won’t mount an immune response. If such an antigen is introduced into the blood stream of a person without this antigen on her RBCs, during childbirth, for example, her immune system can recognize the foreign protein (antigen) and remember it through a series of chemical messengers. This memory is referred to as “alloimmunization”. In subsequent exposures, like future pregnancies, her immune system will mount a robust immune response to the foreign D-antigen through the production of antibodies that can destroy cells with D attached. This is one potential issue with blood transfusion that is mitigated by a process called crossmatching, which ensure that the new blood doesn’t contain RBCs with foreign antigens. In pregnancy, a baby with a “positive” blood type growing within a mother with a “negative” blood type and who has become alloimmunized against D-antigen can be susceptible to attack on the part of their D-antigen displaying RBCs, as those anti-D antibodies can cross the placenta. As such, that unborn baby’s RBCs can be destroyed by mother’s immune system, causing hemolytic disease of the newborn (HDN), which results in very watery blood that flows more swiftly through the baby’s circulatory system and accumulation of into tissues, leading to a condition known as fetal hydrops, which is often fatal. There are interventions to prevent fetal death, however.To prevent this process, a pregnant woman in the United States who has not been alloimmunized will be offered a dose of anti-D antibody (aka Rhogam) around 28 weeks and again within 72 hours of birth. Rhogam works by masking the D-antigen on the fetal RBCs from the mother’s immune system, thereby preventing the immune response that leads to alloimmunization. If the father also has Rh-negative blood, then all of the babies conceived by him and his wife will also be Rh negative. If the father is Rh-positive, then there is a roughly 75% chance that any baby conceived between him and his Rh-negative wife will also have a Rh-positive blood type and thus Rhogam may be beneficial. If you are an Rh-negative mother carrying an Rh-positive baby, there is a reportedly 1-in-7 (14%) chance of alloimmunization if you decline Rhogam. In subsequent pregnancies of alloimmunized mothers, roughly 20-25% of babies will develop some degree of HDN. In severe HDN (determined largely on ultrasound studies of the middle cerebral artery performed by high-risk OBGYNs called maternal fetal medicine (MFM) specialists), blood transfusion will be recommended for the baby while the baby is still inside the uterus. This is done directly into the umbilical vein with a long needle through the abdominal wall. For clarity’s sake, first pregnancies are rarely affected by alloimmunization and fetal hydrops. The exception is when an Rh-negative woman is previously exposed to D-antigen through poorly crossmatched blood in the event that she received a blood transfusion. Otherwise, the “memory” phase occurs during a pregnancy or birth in which a bunch of Rh-positive fetal blood crosses over into maternal circulation. If alloimmunization occurs, those anti-D antibodies can cross the placenta in future pregnancies and harm the baby by destroying its blood cells. There are a number of studies dating back over 50 years to support this story:* Freda 1964, Transfusion* Freda 1966, Science* Clarke 1963, BMJ (PMC)* Cochrane postpartum review in PMC* Bowman 1978, CMAJ* Tovey 1983, Lancet* PLOS ONE systematic review* Targeted antenatal anti-D systematic reviewCriticisms of this storyThe basic mechanism of alloimmunization doesn’t have a lot of critics, but the critical thinker might have a few important questions. Cochrane reviewers noted that the randomized trials of Rhogam were small and low-quality, and if this intervention does indeed save lives, it would be unethical to withhold it in a robust randomized, double-blind, placebo-controlled trial, so like with many questions in obstetrics, we are forced to rely on observational data to drive counseling and policy. * Why do the dosage and timing of anti-D antibody in the United States differ with other countries like those in the UK?* Dosing has not been studied as well as efficacy. If this technology works, then what’s the minimum effective dose? In the US, two 300-µg doses are given, the first at 28 weeks and the second within 72 hrs postpartum. In the UK, a dose of 100-µg is given at 28 weeks and a second 100-µg dose is given at 34 weeks. After birth in the UK, an additional dose of 100-µg is administered but only if the baby is found to be Rh positive. Additional Rhogam may be administered based on Kleihauer testing. In both the US and UK, Rhogam is only offered in the event of a negative antibody screen prior to administration. * Quick note: Kleihauer testing involves taking a sample of blood from a pregnant woman and measuring the percentage of RBCs in that sample that came from the fetus. This is a rudimentary means of determining how many fetal RBCs passed into the mother’s circulation during a miscarriage, subchorionic hemorrhage, or the birth itself, all of which carry the risk of maternal-fetal blood mixing, which is how the mother’s immune system gets exposed to fetal RBCs in the first place.* The big stink to this answer is that these two regimens - or any other regimen, for that matter - haven’t been compared head to head. Even observational data is scant, but from what we can gather, they’re comparable in efficacy from an absolute risk standpoint. The reason we use a bigger dose in the United States is due to the additional work and cost of Kleihauer testing and then determining the appropriate dose based on that result. So we use a bigger dose of 300-µg which is thought to be sufficient to cover any amount of maternal-fetal RBC mixing. Interestingly, even a 50-µg dose was found to be effective according to Cochrane reviewers (link above) when compared to 100-µg. A primary issue with studying “failure” rates of Rhogam at different doses is that the failure rate is so low that a sufficiently powered study to detect differences in groups receiving different doses would have to be so large that it would be very costly to complete. * Lastly, most if not all of these studies were designed to determine whether Rhogam administration prevented alloimmunization, not HDN, and the methods used to detect anti-D antibodies in maternal circulation aren’t perfect nor is pre… Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

In the United States, we universally recommend rectovaginal screening for Group B Strep (GBS) with rare exception. Unless you had a baby affected by early onset GBS disease of the newborn in a prior pregnancy or GBS was detected in your urine during your current pregnancy, you will be cultured for this bacteria at 36 weeks. The result is thought to be good for up to 5 weeks. If GBS is found in urine, you had a prior newborn impacted, or that swab comes up positive, you will be offered antibiotics throughout your labor with the hopes of reducing the risk to your baby. What’s the risk? We don’t really know, but the data that is advertised suggests that 10-30% of woman are colonized, 50% of babies born vaginally to those women will become colonized, and a small percentage of those babies will become sick with early onset GBS disease of the newborn. Of those, a small percentage of term babies might die. The risk is even higher to extremely premature babies.Given these numbers, why not just universally treat every birthing woman with antibiotics? Good question. The answer is that there are downsides to antibiotics as well.In this short clinical episode, Nathan will walk you through the many considerations around the decision to screen or received antibiotics against Group B Strep.This episode was sponsored by Born Free Method.The Born Free Method digital playground includes over 60 hrs of pre-recorded lessons (w/ slides) spread out over 180+ lessons when you enroll. You will also be invited to a Zoom call (recorded) every other week hosted by me, Sara, and both. We also often have guest speakers, and you will have access to recordings for all 100+ of our past calls/interviews. Enroll for your 7-day free trial!More ways to work with Nathan:Support for Midwives | Private Consultation | Clear & FreeMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

[00:02:23] - IntroYour due date is March 14th. A single, confident, perfectly circled square on the calendar, handed over by a smiling professional with a plastic wheel. And God help us, we believe them. We want a date so badly that we will take one from a cardboard dial, knowing full well that only about one baby in twenty is punctual on their appointed day. When the date rolls past with no baby yet to speak of, people start asking questions. They start to pressure you into evacuating your unborn child from their warm, amniotic universe. Because there’s a new numbers game at play. “Your baby could die if they wait too long to be born”. Childbirth is ripe with opportunity to examine our ongoing challenges in making predictions and ascertaining risk.Why are human beings so bad at judging risk, and why does it feel even harder in high stakes games like childbirth? Fertility, pregnancy, and birth offer a lot of uncertainty. You are forced to make decisions with never a guarantee of outcome. To understand why decision-making is so hard in the face of uncertainty, we have to drag four modern witnesses into the light: Nassim Nicholas Taleb, Daniel Kahneman, Amos Tversky, and Gerd Gigerenzer. They do not agree on much, but they have contemplated the same wound.[00:03:50] - The Problem is Not NewThe troubles we face in decision-making around risk are not new. In the 1700s, a Scottish philosopher named David Hume noticed that we tend to play tricks on ourselves to uphold our faith in whatever tomorrow brings. The sun has come up every morning of your life, so you assume it will come up again. But yesterday’s sunrise does not guarantee a sunrise tomorrow. Your first pregnancy was easy, so surely your second will be, too. All of your friends and family skated through childbirth, so you’ve got this in the bag. Your Instagram followers are also rooting for you because you “did everything right”. You are betting that biology is a creature of habit, like the bartender who remembers your favorite cocktail. You have no proof that the future will unfold just as it did yesterday, though a streak is a streak, and sometimes that’s the best you’ve got. Philosophers call this inductive reasoning, whereby specific observations are used to formulate a generalized conclusion about the world. This is the process that leads to hypotheses and better research questions. Deductive reasoning, on the other hand, moves from general blanketed observations in order to get clear on specifics. This is the process that is used to challenge hypotheses. The pregnancy continuum and all of its advisors - credentialed or otherwise - often fall into the trap of inductive reasoning, like a moth lured to the flame. The issue is that a flame cannot cast a shadow on itself. A flame may leave you blind to the greater context of life outside of abstraction. [00:05:17] - Black Swans For millennia, Europeans had seen nothing but white swans and concluded, with the serene ignorance of inductive reasoning as so often practiced by the “well-informed”, that all swans were white. In 1697 some Dutch explorers wandered into Australia and found black swans, and the whole theory that all swans were white was incinerated. One black swan killed it. Karl Popper built a philosophy on this inconvenient asymmetry: you can never prove an idea true, only fail to break it. Any obstetrician will tell you the same thing in a softer voice. Ninety-nine uneventful deliveries do not make the hundredth safe. This soothing balm makes you less worried about your chances.In 1921 an economist named Frank Knight drew a sharp distinction between “risk” and “uncertainty”. Risk governs over the casino. You know the odds of your roll before you throw. Uncertainty is starting a new company in a bad economy: nobody knows the odds of you succeeding, but they don’t sound great. Fertility sits on the boundary between risk and uncertainty. The statistics are real but is the risk to your own birth truly found in the data? A young, healthy couple has roughly a one-in-five chance of conceiving in any given month, and most get there within a year. But those numbers describe a crowd, and you are not a crowd. You are one person with one body on one road, and the average does not care to learn your name. This is, in fact, the problem with the Law of Averages: nobody is average. You either fall below or above the average of something happening. Keynes made a related point, arguing that no man alive could calculate what interest rates would be in twenty years. Nobody can likewise calculate your twenty-year-old self’s answer to “when should we start trying?” So how do you navigate a dark alley, rife with uncertainty? The ancients had two answers. The Stoics, men like Seneca and Epictetus, suggested sorting life into two piles: what you control and what you do not. You can control what screenings you receive throughout your prenatal care. You can control the questions you ask. You can control where and with whom you give birth. You can control which advice you turn to in improving your chances of conceiving. But you cannot control whether conception takes two months or two years, and you certainly cannot control the outcome of your birth. Spend your effort on the first pile and make peace with the second, like a sailor who has stopped arguing with the ocean. Blaise Pascal, who in 1654 swapped letters with Fermat and helped ignite the modern discourse around probability itself, offered a more practical tool: weigh the stakes. You cannot know if labor will start early. But having all of your ducks in a row costs you almost nothing if you guess wrong.[00:07:55] - Taleb: The Turkey Knows NothingMathematician Nassim Nicholas Taleb takes this philosophical discourse straight into Wall Street. But it applies just as well to the maternity ward. Suppose you were a turkey. You are fed every day for 1,000 days by an amicable farmer. Every meal makes you more certain that the farmer is your dearest friend, your guardian angel in overalls. On day 1,001, the day before Thanksgiving, you wake up feeling the most certain about your friendly farmer friend. But later that day, the farmer shows up with an ax.Your observations were on point. But your intuition remained silent about the one event that mattered most. Taleb calls these rare, ruinous surprises to our plans “Black Swans”. By nature, Black Swan events are always perceived as an ambush, because they don’t tabulate into our certainty about life until after they happen. In pregnancy, sudden complication are Black Swan events. Others are pregnancy losses or stillbirth that come without warning, or consider a baby who decides she is ready to come out of her warm amniotic universe 8 weeks early. Most pregnancies go fine, and that is exactly the problem with these events when we apply this framework to the pregnancy continuum. The spreadsheets of the statisticians are filled with data from healthy, unremarkable births. But the Black Swan events fill our nightmares and drive policy. After a tragedy on the maternity unit, the mind goes hunting for a reason, a sign, some “thing” that should have been done, because a story we can blame feels safer than a world where it simply happened. This fallacy is most cruel in maternity care, because in your grieving you go looking for guilt even when there may be none at all.The critics say the whole thing is hard to test because any disaster can be pointed to as a Black Swan. This is what the outspoken, authoritative, alternative health community does really well. And they are not wrong. Even Taleb admits that this point is slippery. In obstetrics, a team of professionals who has seen enough of these disasters no longer sees them as Black Swans, which is still a fallacy in and of itself. But the impact that these disasters has on both birthing families and the staff in attendance to the birth are sufficiently horrific that health care professionals plan accordingly in an effort… Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Elizabeth Catlin is a proud CPM and mother of 14 (!!) living in central New York. She was charged arrest twice back in 2018, and we met sometime 2020 when she was officially charged with 95 felony accounts: 94 accounts of practicing a profession without a license and one additional homicide charge over the death of a baby. She ultimately walked away with community service hours rather than a lifetime in jail. This conversation gets to the heart of what ails the midwifery community at-large.* What toll does a three-year experience with the legal system have on your family and emotional body?* What does it mean when your community stands up for you, knowing that you aren’t guilty of anything but being an exceptional birth attendant and community member?* How does this experience change your perspective on the value (or detriment) of hyper-regulation of midwifery through licensure and credentialing?Liz will be coming with us to Austin, TX, in November 2026 for (likely) the last Born Free Twins-Breech Gathering. She’ll be on a panel with Elizabeth Beachy, CPM, Danielle Kitt, CPM, and Nubian Earth Martin, CPM. Liz asked me after the recording why this might be the last gathering of this sort that I will be offering. First off, I haven’t decided this to be so. But I do wonder how much more juice can be squeezed from the analytical, computational way of attending to births. Certainly, there is value in peer-reviewed literature and hands-on training. No doubt. But what are we missing? Why is the needle not budging? Why do outcomes appear to be getting worse despite the volume of training and education available to individuals who feel the calling towards attending to childbirth? These are the questions I have been sitting with, and more projects are in the works for exploring some of these more immaterial, mysterious motifs. Stay tuned…You can reach Elizabeth by email: [email protected] from our conversation:* My first interview with Elizabeth back in 2020* Arrest the Midwife PBS documentary featuring Liz* NYCPM * A Tale of Two Midwives across Four CenturiesThis episode was sponsored by Born Free Method.The Born Free Method digital playground includes over 60 hrs of pre-recorded lessons (w/ slides) spread out over 180+ lessons when you enroll. You will also be invited to a Zoom call (recorded) every other week hosted by me, Sara, and both. We also often have guest speakers, and you will have access to recordings for all 100+ of our past calls/interviews. Enroll for your 7-day free trial!More ways to work with Nathan:Support for Midwives | Private Consultation | Clear & FreeMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Joni Edelman is a registered nurse who began attending births when she was 18, then lived out a career in hospital birth, transitioned to hospice care, and then eventually found her way to traditional midwifery. She calls herself a “holistic attendant” due to the reality that terms like “midwife” and “birth attendant” are now the property of the state. That seems like a bold statement, but in effect it means that the state can dictate what a “midwife” can or can’t do, without any consideration perhaps for what birthing families in that state desire out of their care team. This is where the ongoing licensure debate has some teeth. On the one hand, proponents for licensure might argue that licensure offers an avenue by means of which a person trained in the skills of midwifery can practice without fear of being jailed for practice of a profession without a license. On the other hand, opponents of licensure may argue that licensure often comes with unreasonable restrictions to the practice of midwifery, which may be the oldest “profession” in the world alongside prostitution. Way back when, there was no need for labels, licensure, and regulatory influence. A woman doing what is now called “midwifery” would be doing so out of necessity in service to her clan, community, or tribe. She may not have even been charging money (not that that’s a problem), because the tribe was small enough for her to serve this function and have her needs met. She learned her skills through other elders in her community, and, whether she wished it or not, would ultimately become the most experienced living caretaker of birthing women over her lifetime. But nowadays, with human society being as complex as it must be to serve hundreds of millions of people through equality and equity, and with economics of inequality, a midwife must find their place through the myriad regulations and other red tape that would otherwise have been vested to a woman with a calling to this “vocation” through lived experience alone. This has led us to an impasse in our current state of affairs, where high-quality midwives are being prosecuted for deaths for which they aren’t responsible and other credential holders are walking away from tragedies hiding behind the protections of their credentials. My conversation today with Joni attempts to provide some grounding to the challenges of birthwork which are paralleled by the challenging to birthing families who wish to proceed with childbirth with any degree of autonomy. And if we truly believe in autonomy, how does abortion fit into this conversation? We touch on that, too…Find Joni at her website or on InstagramThis episode was sponsored by Born Free Method.The Born Free Method digital playground includes over 60 hrs of pre-recorded lessons (w/ slides) spread out over 180+ lessons when you enroll. You will also be invited to a Zoom call (recorded) every other week hosted by me, Sara, and both. We also often have guest speakers, and you will have access to recordings for all 100+ of our past calls/interviews. Enroll for your 7-day free trial!More ways to work with Nathan:Support for Midwives | Private Consultation | Clear & FreeMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

My guest on this episode of Born Free Method: The Podcast is Robin Lanier, pedagogical director at the Waldorf School of Louisville. Robin has been teaching children for over 20 years, meaning he’s been working on his own spiritual growth for at least that long. In this conversation we discuss Archangel Michael through the lens of Rudolf Steiner, the story of Parzival the knight, and even tie in some J.R.R. Tolkien to keep things interesting. This is a fascinating and beautiful conversation that is especially important for the work that I bring to the world through childbirth and as a father, husband, and friend during especially trying times. Here is some important background context…Archangel Michael has played a prominent role in a variety of the abrahamic and esoteric traditions for ages. Michael can be seen as Christ’s second-hand man. He carries “cosmic intelligence”. As human beings moved toward more independent, earthly thinking, Michael “released” this intelligence to be developed by humans themselves, through free will and reason rather than divine revelation.Michael is also the adversary of Ahriman, one of the “devils” in Steiner’s cosmology. Ahriman is not “Satan”, per say. Ahriman embodies the reductive materialistic ways of the modern world, with its mechanization and reduction of the spirit to pure calculation and technology. Michael doesn’t reject the material or intellectual world, but wants it infused with spiritual awareness rather than dominated by soulless rationalism.As a small aside…let’s review some basics of esotericism:* Lucifer = too much spirit, too little earth (illusion, escapism)* Ahriman = too much earth, too little spirit (materialism, mechanization)* Christ = the balance point between them* Michael = Christ’s “regent” or forerunner in the present age, specifically tasked with keeping Ahrimanic forces in check so humans can find that balance through free, conscious thinking rather than old-style mysticism or cold rationalismThis is important today because Steiner taught that we are living in the “Age of Michael”, a period (he said starting in the last quarter of the 19th century) where Michael’s influence makes it possible — and necessary — for humans to consciously choose spiritual knowledge rather than have it given to them. This is tied to Steiner’s broader idea of anthroposophy as a path of free, thinking cognition of spiritual reality. If you are new to the idea of materialism and are already doubtful about what has been said about Ahriman, consider what has happened in technology and artificial intelligence over just the past decade, and you’ll begin to see what Steiner alluded to when he spoke to the “Ahrimanic forces” of the world. These are the forces that Archangel Michael is actively working against in order that the spirit of each human is not consumed by earthly forces but rather balanced between earth and spirit, like a cosmic antenna.We are now entering the season of Michaelmas, which is punctuated - even in medieval times - by a great feast around September 29th, marking the re-embodiment of the ego consciousness into our earthly, vital bodies. This time of year is associated with themes of courage, willpower, and confronting fear (symbolized by Michael slaying the dragon) as inner qualities needed for this age, which explains the deeper meaning of the Dragon Faire for Waldorf children around ages 6-7. The essence of Archangel Michael also comes through in the Middle High German poem: Parzival, written by Wolfram von Eschenbach between roughly 1200 and 1210, running to about 24,800 lines across sixteen books. The story follows a naive young knight raised in isolation by his widowed mother, who eventually leaves home, is inducted into King Arthur’s court, and stumbles into the mysterious Grail castle — where his failure to ask a simple question of compassion condemns him to years of wandering and further trials before he can return, mature and enlightened, to finally heal the wounded Fisher King and receive the Grail. It is ultimately Michaelic influence through which Parzival finds strength and will within himself to “do the right thing” which brings that which he is seeking within reach. This theme is relevant to our work as people living within a community, and it’s especially relevant to birthwork, where the birth attendant must support a family sometimes out of impropriety for the rules and procedures of society. This work is a sacred calling, but fully expressing your unique human genius is also a sacred calling, and it is this time of the year that we are impressed with the importance of exercising our will to find our heart center and answer the call. References from this conversation:* Parzival: A Romance of the Middle Ages, by Wolfram Von Eschenbach (author), Helen M. Mustard (translator) (Best translation for prose)* Parzival, by Wolfram Von Eschenbach (author), Jessie L. Weston (translator) (Best translation for poetry)* The Hobbit And The Lord Of The Rings, by J.R.R. TolkienThis episode was sponsored by Born Free Method.The Born Free Method digital playground includes over 60 hrs of pre-recorded lessons (w/ slides) spread out over 180+ lessons when you enroll. You will also be invited to a Zoom call (recorded) every other week hosted by me, Sara, and both. We also often have guest speakers, and you will have access to recordings for all 100+ of our past calls/interviews. Enroll for your 7-day free trial!More ways to work with Nathan:Support for Midwives | Private Consultation | Clear & FreeMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Egg meets sperm. This is what we are told happens for a baby to be born. On closer examination, you will notice that the egg, when rushed by not one but tens of thousands of strong sperm begins to spin. Counter clockwise. Or perhaps it is spiraling, like a whirling dervish, like an ammonite fossil, like the Lakota Sun Dancers around a sacred cottonwood, like the horns of the Ekoi dance mask. The great song of creation is played out through myth, storytelling, and dance across many cultures, from subatomic particles all the way up through the cosmos. Spirals appear everywhere in nature, including in the human heart, which when boiled and teased apart unravels into a single strip of muscle tissue that coils around itself into a four-chambered structure, the structure of which creates a vortex of blood passing through. Is your heart merely a pump? There has been sufficient curiosity evoked by the team at the HeartMath Institute, Branko Furst and his colleagues, “Paco” Torrent-Guasp and his contemporaries, and even the brilliant Leonardo da Vinci that the heart has more elegant roles than merely pushing and pulling blood.You might be thinking: “This is ridiculous. Of course it is one egg and one sperm. Of course the heart is a pump.”And maybe that is the problem. Maybe there is a problem with the mind (thoughts/emotions). It is your mind that has led to your partner is dissatisfaction in your marriage or in your bedroom. It is your mind that gets you in trouble when birth politics arise on social media. It is your mind that makes you react impulsively during periods of heartbreak or when a piece of media enrages you. Do not get me wrong. The mind is valid and important, and the only people without an intact mind are either dead or in an insane asylum. It is your mind that has taught you to be afraid of the world. Somebody - or some thing - has impressed upon you to be afraid of this or that thing, idea, feeling. Fear must be sometimes turned ON to stay alive. This is not the issue. The issue is that we were never taught to turn fear OFF. By doing things that scare us, we can learn to relate to fear more effectively. The antidote is embodiment. Embodiment is the consequence of connecting to our feelings in addition to our mind. Your mind interfaces with your will, with your choices, and with your words, but I suspect that we are far too consumed with “thinking” and far too out of touch with the pull of our hearts. If you were to imagine existing solely through your thoughts and emotions, you would be left with the reach of the artificial intelligence (AI) movement. This abstraction of the human experience should make you feel something, and the notion that we can be human in our reach for mind without heart sounds like living hell on Earth.The Great Song of CreationMost of my time is spent advocating for maternity care system reformation, fueled by passion to restore traditional midwifery care to its rightful place as the default care offered to birthing families in the United States. Birth has long been seen through the lens of Western medicine as a medical procedure, and yet for even longer than our written history permits, females have been giving birth as a biologic imperative. It is true that some babies of the past would have been saved through induction of labor, antibiotics, c-section, and other medical technologies, but that is not my point. The Sioux nation did not need to rely on a story of immaculate conception to believe in miracles. The beauty of the natural landscape around them was enough. They felt this deeply. Ohiyesa, author, physician, and member of the Sioux, or Dakota, nation wrote about the ways in which the women of his tribe gave birth. He shares that the mind of the woman does play a role in this process, but it is limited and may surprise you. When she falls pregnant, she meditates daily on a great individual in her tribe who embodies the ideal qualities of the creative impulse of nature, like reciprocity, courage, and patience, in order to impress upon the unborn child the attributes of this great individual. That is where the mind ends. She does not think her way into growing a baby or birthing her baby any more than she thought her way into making love to conceive her baby.In order to disturb this impression, she avoids personal contact, favoring isolating whenever possible. She practices stillness in the forest. She wanders the prairies alone. She feels everything such that the majesty of Mother Earth can be impressed upon her child. In her heart, she conceives of this child as a reflection of Great Spirit, born from the natural world, “dreamed out in a hush broken only by the sighing of the pine tree or the thrilling orchestra of a distant waterfall”. (Ohiyesa, 1858-1939)When the day comes to meet her child, she remains isolated, fully embodied with the necessary preparation demanded of this exciting gift. When she hears her baby cry in the darkness, she knows that she has fulfilled her “holiest of duties” as a member of Great Spirit’s song of creation. Immersed in nature, she is not distracted by questions and concerns of her fellow tribespeople. She is instead showered with the praise of the birds, bees, trees, and flowers beneath her knees. Contrast this with even the best intended advocates for reform within maternity care, where we are arguing about Georgia’s licensing laws and the ARRIVE Trial. The Heart Can Grasp What the Mind CannotWhile reading this story, something may have moved within you. You might relate that it brought you joy, or sadness, or anger. Those are emotions.Forget about thinking…What did you feel?The heart is the center of your feeling life. The heart is what is moved. The heart is not afraid. The heart does not judge. Fear and judgment are activities of the mind. Master storyteller Michael Meade describes well the experience of the heart (versus the mind):“The mind may come to know things through a process of acquiring knowledge and information. The knowledge of the heart is instantaneous and it is revelatory, it is also holistic, and thus it is the primary source of coherence in our lives. While the slightest thing can cause us to change our minds, a life-changing or a life-enhancing moment depends upon a change of heart…Great visions and deep understandings do not come through thinking alone, but rather it is imagination that carries messages between our brain or mind and our heart, allowing thought and feeling to meet. To grasp the truth, we must get to the heart of the matter. To truly know something, we have to know it by heart. To fully express ourselves, we must speak from the bottom of our hearts…And what we need at this fearful time on Earth is the kind of radical transformation that can only begin in the depths of the human heart.” (Michael Meade, Living Myth Podcast, Ep.504, 2026)A mere pump ca not do that.A Change of HeartI was recently blessed with an experience in darkness with Edmund Knighton, PhD. When your visual cortex is removed from your experience, you get the perfect amount of medicine, with the right amount of spirit, and just enough universe to have a breakthrough in reconnecting to your self. This is the experience of embodiment, which, put simply, is the act (art) of connecting to the experience of your body and heart. You have no idea how much the mind distracts from your inner life until you are blindfolded in pitch black darkness for 36 hrs. That is when the magic begins…For me, the magic came through dance. I remember lying on the grass and being invited to stand and move to some soft music. Without fear, without judgment, without fear of judgment, I began to move. It was subtle at first, but soon evolved into a kaleidoscopic flow of masculine and feminine energies through my four limbs and my heart. I moved myself to tears, as I felt whole again. I had clar… Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Most electronic health records (EHRs) were designed for a different era, with clunky interfaces, confusing navigation, and tools that were never quite right for the way you actually work.Sena EHR was built specifically for CPMs and midwives doing out-of-hospital births. That means charting that reflects real midwifery scope, including vaginal breech and multiples. Billing, messaging, scheduling, and documentation in one place. A system that works on any device — even offline at a birth with no signal.In this interview with founder Dani Sigmon, you’ll get the scoop for the latest and greatest EHR platform and what sets it apart from the rest!We don’t typically do promotional podcasts, but Sena EHR is the only sponsor that we permitted at the 2026 Born Free Twins-Breech Gathering. Their support made it possible for us to add an additional scholarship this year, and we are so grateful!This episode was sponsored by Born Free Method.The Born Free Method digital playground includes over 60 hrs of pre-recorded lessons (w/ slides) spread out over 180+ lessons when you enroll. You will also be invited to a Zoom call (recorded) every other week hosted by me, Sara, and both. We also often have guest speakers, and you will have access to recordings for all 100+ of our past calls/interviews. Enroll for your 7-day free trial!More ways to work with Nathan:Support for Midwives | Private Consultation | Clear & FreeMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

In this episode, I chat with Farah Tanis, founder of Restore Forward. For the 2026 edition of their WILD Healing Summit, the theme is “A Harvest of Medicine”. I can’t impress upon you how beautiful this offering is, and it was right up my alley when Farah asked me to present as a speaker. Here are the reasons that I want you to support this event: * There are a number of amazing speakers that will presenting online, including - Dr. Mmatshilo Motsei, Iakowi:he’ne’ Oakes, Dr. Neena Van Luven, and more - then it culminates in physical presence on their sanctuary in upstate New York — a feast, a performance, and a “medicine walk” * The language throughout leans on “walking with” rather than “attending” — suggesting a relational, participatory model rather than a passive audience experience* The 2026 theme, “A Harvest of Medicine,” ties the event to seasonal/agricultural imagery — suggesting themes of gathering, culmination, and traditional or plant-based healing practices, consistent with the “medicine walk” element on the landOverall, the ethos reflects: nature-rooted healing, intergenerational and communal participation, and a hybrid of digital accessibility with grounded, in-person ritual, all of the components of a more beautiful world that we know is possible. My personal presentation is probably the best I’ve ever given. I explore the complex nature of fertility and the limitations of conventional medical approaches. I begin by discussing how modern medicine’s focus on reductive materialism misses important aspects of fertility. I outline my expanded approach to fertility workups beyond conventional reproductive endocrinology, incorporating functional medicine testing, nutritional interventions, and emotional/relational considerations. I challenge the gene-centered view of human biology, discussing epigenetics, intergenerational trauma transmission, and the possibility that water’s properties within cells could influence genetic expression. My presentation concludes with insights about the importance of embodied experience over intellectual approaches to conception and birth, drawing parallels between human fertility challenges and our disconnected relationship with nature.The 2026 WILD Healing Summit takes place on September 9-10, 2026, online, culminating in an in-person opportunity on their land in upstate New York on September 12th. Even if you can only participate online, please go register at www.wildgala.com. This episode was sponsored by Born Free Method.The Born Free Method digital playground includes over 60 hrs of pre-recorded lessons (w/ slides) spread out over 180+ lessons when you enroll. You will also be invited to a Zoom call (recorded) every other week hosted by me, Sara, and both. We also often have guest speakers, and you will have access to recordings for all 100+ of our past calls/interviews. Enroll for your 7-day free trial!More ways to work with Nathan:Support for Midwives | Private Consultation | Clear & FreeMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe