In this episode, Augustine sits down with Dr. Koen Deurloo, a Dutch gynecologist at the Diakonessenhuis in Utrecht and the first physician in the Netherlands to perform a maternal-assisted cesarean (MAC) — a technique that lets the birthing parent help lift their own baby from the incision during a planned cesarean. What began as a single patient's request in 2018 has grown into a practice Dr. Deurloo has now performed more than 200 times, and one he freely shares with hospitals around the world.

This conversation goes far beyond the surgical technique. Dr. Deurloo talks candidly about the home births of his own two daughters and how that experience shaped his respect for the midwifery model of care, learning to ask "why" instead of overriding a patient's choice, and building one of the most collaborative OB-midwife relationships in the Netherlands — a country where roughly 90% of pregnancies start with midwifery-led care. He shares research on women who request care outside standard guidelines, why the "dead baby card" says more about a provider's own trauma than about safety, and how he trains residents, midwives, and doulas to work from a shared goal instead of competing silos.

Dr. Deurloo is also the author of Door de ogen van een gynaecoloog ("Through the Eyes of a Gynecologist"), a collection of 35 stories from his clinical life.

Whether you're a physician, midwife, doula, or student, this episode offers a rare, first-hand look at what it looks like when a high-risk hospital system chooses trust and autonomy over rigid protocol — and how that shift actually happened, person by person.

In this episode we cover:

• The story behind the first maternal-assisted cesarean in the Netherlands and how the procedure has evolved since 2018
• What selection criteria Dr. Deurloo uses for MAC, and why he doesn't offer it routinely to every patient
• How the Dutch maternity system integrates first- and second-degree midwives with hospital-based obstetric care
• Dr. Deurloo's research on women who request birth outside clinical guidelines — and what happened to their outcomes
• Reframing the "dead baby card" as a signal of provider trauma, not patient risk
• How to build trust between physicians, midwives, and doulas without changing the actual clinical care
• Practical advice for starting pilot programs and finding your "pioneers" when introducing new practices into a hospital system

Resources & Links:
🔗 Follow Koen on Instagram for MAC photo series and behind-the-scenes footage: www.instagram.com/kldloo

In this episode, Augustine shares a real one-on-one consult from the very first Midwifery Wisdom Fellowship cohort — a conversation with Emmelia.

Emmelia is navigating a question many apprentice and student midwives face: what does a sustainable path in this work actually look like? She's processing betrayal by a preceptor who left her stranded without signed-off skills, wrestling with whether solo practice or a birth center model fits her life, and trying to figure out if she can be both a hands-on provider and a business owner without losing herself — or her family — in the process.

Augustine and Emmelia talk through the Dunning-Kruger effect and why that crash in confidence after early competence is actually a sign of real growth. They talk about processing trauma from an unsupportive preceptor relationship, the difference between scarcity and abundance mindset in a competitive field, and why so many birth centers close within a few years while others last for decades. It's an honest look at the tension between calling and capacity — and a reminder that building something sustainable is its own form of midwifery.

Emmelia generously gave us permission to share this consult, believing other students and apprentices working through similar struggles might find something useful in it.

To learn more about the next cohort of the Midwifery Wisdom Fellowship starting September 1, 2026, visit our website https://www.midwiferywisdomcollective.com/midwifery-wisdom-fellowship-2

In this episode, Augustine sits down with Rafia Islam, a midwife from Bangladesh with eight years of experience spanning refugee camps, mentorship roles, and one of Dhaka's busiest labor wards. Rafia walks us through her training, her path from data collector to midwife, and what a 12-hour night shift with 13 deliveries actually looks like.

The conversation turns to the realities shaping birth in Bangladesh: a cesarean rate as high as 80% in some private hospitals, the financial incentives driving unnecessary surgery, and the coercion many families face in the delivery room. Rafia also shares why midwives are legally barred from home birth in Bangladesh, how the country's neonatal mortality rate has dropped dramatically since 2000, and a harrowing memory of delivering a baby during a hospital fire.

This is a candid look at what it means to fight for autonomous, respected midwifery care in a system still learning what a midwife is for — and a reminder that no matter where you practice, the work of holding space for birth looks remarkably the same.