Courtney Jarecki, a lithe 36-year-old with an earnest gaze and a thoughtful countenance, was as prepared as a woman could be for childbirth when she became pregnant in July 2010. 

Jarecki teaches childbirth classes at her business Full Moon’s Daughter and has served as an apprentice at Alma Midwifery, on SE Ankeny Street. Between those two roles, she estimates she’s attended more than 30 births. Perhaps most important, Jarecki believed her body was designed to deliver a baby. She also believed that most women don’t need a hospital or a medical doctor to do it. 

When she went into labor in March 2011, Jarecki was sanguine, confident, expectant. Her husband, Dave, filled a birthing tub with warm water in the living room of their Northeast Portland home. When Jarecki began to have back labor—a particularly painful form of labor—she used every technique she knew to cope, including a mantra: Just this one, just this one. “I didn’t pack a bag for the hospital just in case,” she says, “because I was someone who was not going to go to the hospital.” 

But Jarecki’s labor did not go as planned. After 54 hours, she saw thick meconium—an infant’s first stool, which can be a sign of fetal distress, especially after a labor as long as hers. So an exhausted Jarecki climbed into the backseat of her minivan and headed for the one place she never thought she would: the hospital.

Given the history of hostilities between hospitals and the home-birth community, many women who choose home-birth remain trepidatious about how they will be received at hospitals. But the doctors and nurses at Legacy Emanuel, where Jarecki transferred, did not look down on her choice to try to deliver at home—this despite what would have been breaches of typical hospital practice, such as letting her labor for two and a half days after her water broke, which could increase a baby’s risk of infection. (The risk of infection is far higher in hospitals than at home, where there are fewer germs.) “To be honest, I was not ready for the kindness that was bestowed upon me,” she says. 

Jarecki’s certified nurse midwife—a nurse pratictioner with additional training in midwifery—sat down to talk to her so she could be at eye level. When it became clear that a C-section was necessary to deliver the baby, who was breech, the staff let Jarecki walk to the operating room on her own two feet. Emanuel also granted her every wish: no vitamin K shot, no vaccines. “It was like being at a spa,” she says. “I made a lot of demands, and they honored every one.”

Two hours after she arrived at Emanuel, Jarecki gave birth to a healthy baby girl. She and Dave named her Lazadae, a name she came up with in a dream. 

Jarecki’s experience reflects wholesale structural and cultural changes at Legacy Emanuel designed to make the hospital more appealing to women who start delivering at home and to the midwives who help them—thus providing a safe and welcoming alternative when problems arise. Last year some 1,500 Oregon babies were born out-of-hospital, but not every one had a happy ending. Some home-birthers and midwives fail to seek hospital care when a mother or baby may need it—for reasons ranging from fear of reprisal from doctors to some midwives’ lack of experience in recognizing the need for medical assistance. Sometimes this can have serious consequences. Such was the case for Margarita Sheikh, who hired two community midwives (who did not have nursing degrees) to attend her home birth in Eugene in 2011. Eight days after she began laboring, Sheikh, who has said that she repeatedly requested a hospital transfer during her labor, gave birth to a boy with no heartbeat. The boy, Shahzad, was stillborn. 

By reaching out to community midwives and bridging the traditional tensions between hospitals and home-birth advocates, Legacy Emanuel hopes to avoid these kinds of tragic scenarios. More than that, Emanuel has gone to great lengths to make its labor and delivery unit more appealing to a growing number of women who want a no- or low-intervention birth in the first place. Initiated in 2006 by the unlikeliest of heroes—a by-the-book, male obstetrician in his fifth decade of doctoring—the program is changing minds, attitudes, and outcomes on both sides of the hospital–home birth divide. 

“Home birth is going to happen whether we like it or not,” says Duncan Neilson, chief of Women’s Health Services at all five of Legacy’s hospitals. “Getting mad about it is like getting mad at the rain.”

There is nothing outwardly heroic about Neilson, no broad shoulders, no killer handshake. He’s a self-described introvert and speaks so softly that to record his voice, an iPhone’s microphone must be placed directly in front of him. 

Neilson is an obstetrician, though he never intended to be one. His father was an obstetrician. So was his dad’s identical twin. Later, the pair went into private practice together in Portland.

Neilson, who was raised in Northeast Portland and attended Reed College, imagined a career in neurophysiology. And then neuroanatomy. Or human pathology. Delivering babies? Not even a consideration. 

And then, just as he was starting his residency at Johns Hopkins and gearing up to pursue a career in academia or research, his wife had their first child. It was 1969, a time when fathers were not allowed in the labor room, but Neilson’s medical credentials earned him an invitation. (Neilson remembers having witnessed only one previous birth—a C-section, which almost caused him to pass out.) 

The baby, a boy, was turned the wrong way, so the doctor pulled out a pair of metal forceps, opened them up, and placed them around the baby’s head. “I thought if this goes well, my life will proceed according to plan,” Neilson says. “If not, everything will change.” It was the first time he understood the importance and magnitude of helping a baby enter the world. 

In the end, everything did go well (his son, Duncan Neilson III, is the composer-in-residence at the Portland Chamber Orchestra), but the course of Neilson’s life still changed. He became an ob-gyn, and over the next four decades helped literally thousands of women give birth—every one of the babies delivered in a hospital. 

During his career, Neilson has seen a lot of changes in how hospitals manage birth, from the 1960s standard practice of having women labor in one room and deliver in another to shifts away from pain medications such as morphine and nitrous oxide. Today epidurals are the norm, and while this kind of anesthetizing allows a woman to participate during the pushing stage of labor, it also requires careful monitoring of her blood pressure. Women with epidurals also must have an IV, and their fetuses’ hearts must be continually monitored in case a drop in pressure affects blood flow to the placenta.  

“Now we have this environment that looks like a high-tech intensive-care unit,” Neilson says. “That has caused some people to rebel from the modern obstetrics and seek a return-to-nature kind of approach.”