Author Interviews/Features


Meet Patricia Harman

Patricia Harman    Patricia Harman has spent over thirty years caring for women as a midwife, first as a lay-midwife, delivering babies in cabins and on communal farms in West Virginia, and later as a nurse-midwife in teaching hospitals and in a community hospital birthing center.

For the past twenty years, Ms. Harman has been a nurse-midwife on the faculty of The Ohio State University, Case Western Reserve University and most recently West Virginia University. In 1998 she went into private practice with her husband, Tom, an OB/Gyn, in Morgantown, West Virginia. Here they devoted their lives to caring for women and bringing babies into the world in a gentle way.

When, in 2003, the cost of liability insurance for Obstetrics sky-rocketed from $70,000 a year to $110,000, the Harman's decided to give up deliveries. Though many loyal patients grieved the loss of their favorite mid-wife/physician team, the change in life style gave the author time to begin writing her first book, The Blue Cotton Gown: A Midwife's Memoir.
(from Patricia Harman's website)

Read Susan Wittig Albert's review of The Blue Cotton Gown for

Interviewed by Susan Wittig Albert
Posted on 10/23/2008

At the beginning of the book, you offer this extended definition of midwifery: "To midwife: To be with women, at childbirth and for life." Why did you enlarge the definition? Beyond the physical act of birthing, what have you have helped to birth?

"To be with women at childbirth and for life" is a concept promoted by the American College of Nurse-Midwives. Originally midwives took care, only, of pregnant and birthing women, but in the past twenty years patients that had babies with nurse midwives wanted to return to these same care providers for birth control, annual exams, menstrual problems and eventually menopause transition. I take care of females from 10 to 80, actually more like four to 85 if you want to add in the extremes. The midwifery model of care can be used with all patients. We listen to women's concerns. We provide information and teach them about their bodies. We guard them from harm.

When I see a patient in the exam room, I'm not thinking just about her female parts, or even her over-all physical health but her whole being. I'm interested in who she is, where she wants to go. It is a compulsion of mine, I suppose. I'm curious about other people and what their lives are like. Sometimes, even when I don't ask how a woman's stress level is, she starts to tell me. Maybe there is a big sign around my neck: "You can confide it me." Yesterday out of the blue, while I was doing a laser hair-removal treatment on a woman I had just met, she says, "My son is very sick."

It almost took my breath away. "What?" I ask. "What is wrong with him?"

She tells me her story. He's thirty-five with two kids, a big strapping guy with no previous health problems and he keeps having spontaneous rupture of his lungs. "It's called Bleb disease," she says. "They don't know what to do at the University Hospital. I'm afraid he will die."

Giving birth to a baby is a great gift, but that is only a small part of life. What interests me more is helping women give birth to themselves, like butterflies coming out of a cocoon. The butterfly emerges only once. We have a chance to give birth to ourselves over and over.

Your personal story is one strand of a braided narrative through which the stories of other women are woven: Heather, Nila, Trish, Rebba, and others. Why did you choose this structure?

I've always been so impressed by the courage of the ordinary woman, so I started out to write a book about the patients I meet in the exam room. Eventually, my own personal story became as important as the tales of the seven main women characters. As the book developed, the challenges of being in private practice also became an important theme. The health care system in the United States is in crisis. Good medical providers are being forced out. Middle class people can barely afford health insurance. Families who don't have insurance go without care until they are so sick they have to go to the Emergency Department and then they lose their shirts. I also thought it was important for readers to know the personal and professional pressures that health care providers are under, shrinking reimbursements, rising costs of medical liability insurance and threats of malpractice litigation.

The structure of The Blue Cotton Gown developed the way it did because I used my laptop as a diary. For over a year, I would come home at night and write about the women who impressed me in the exam room that day. Sometimes I would write about what was going on in my own life and in the life of the practice. It helped that I have insomnia. You can get a lot of work done between midnight and two. The chapters are short and the reader develops insight as the author does.

One of the things I love about this memoir is the way the stories illuminate each other: one story seems to frame and clarify and even (as the stories develop) change the meaning of the other stories. Was this intentional, or an accident of the braided structure?

The way the women's stories illuminate each other isn't intentional, but it isn't random, either. Though they all occurred in the space of about sixteen months, I had an opportunity to choose where to place them in the book. I'm sure, without thinking too much about it, that I considered the flow, like music.

Your own story seems to be so fully revealed. What issues of privacy did you confront as you wrote it?

I share my personal experiences with my patients more than most professionals do. I think everyone in my family shares the feeling that telling the truth is important. We don't guard ourselves much, and maybe this is a fault. I did have my sons and my husband read the chapters in which they were mentioned, and I changed my boys' names. In fact, all of the people in the book, patients and professionals, have been deeply disguised, except my husband and me. It seemed pointless to use a false name and then use my own name as the author.

This is your husband's story, too. What issues of privacy did you confront on Tom's behalf? How did he react when he read it?

Most physicians wouldn't want their vulnerability exposed, but Tom, my husband and partner, was great about it. He felt, as I do, that people need to know what it's really like to be a physician. I read many of the chapters to him, aloud, but when he first read the completed book to himself, he loved it. He is a big fan of my writing, but also able to be critical when he needs to.

The blue cotton gown is a powerful symbol in the book, as well as the title. Did you start with this image, or did it develop as you worked through the stories?

I chose The Blue Cotton Gown as the name of the book because it is a symbol of the vulnerability that females feel when they come to the gyn exam room. I thought it would be familiar to every woman who has been to a gynecologist. It's something that in the U.S., at least, binds us. If we are being "good girls" and getting our checkups, we all have to lie on the exam table, naked and nervous under the blue cotton gown. We all have to let our bodies be touched by strangers in private places.

As a book, The Blue Cotton Gown also examines private places, the hearts of women. Though the stories take place in a unique setting, a university mountain town in Appalachia, they are universal. Women in NYC, Dallas, Duluth, and San Francisco all face the same challenges and will be able to relate, no matter what their walk of life.

You've chosen to tell the stories in present tense. Why? How have readers reacted to this choice?

I chose to write in the present tense because I wanted the reader to be at my shoulder. I wanted her to be standing at the door to the exam room as I entered or sitting with me on the porch looking out at the stars. I haven't gotten much feedback about what readers feel about the present tense. I think they must like it, because most women, and the few men who have read it, find the writing compelling. One physician who is reading the book now (his wife sent him to the bookstore to buy it for her and he can't put it down) told me that one of the reasons he likes the short present-tense stories is because it seems just like his work. You open the door of the exam room and there is an individual with a story. You open the next door. You do this 20 times a day. Sometimes, he told me, you go home and have a stiff drink. When it's overwhelming, that's all you can do.

In the author's note, you say that some of the patients are composites. What have you gained by choosing to do this? Do you think anything has been lost, or perhaps compromised?

Two minor patients and one health care provider in The Blue Cotton Gown are composites. The main reason I did this was for patient privacy. By combining two stories, it made finding out whom the character were almost impossible. I live in a rather small town and there are fewer than five degrees of separation between people. I also had to be careful not to overwhelm the reader with two many characters. There were two related stories that I felt were important and I chose to combine them into one woman.

I think the issues of privacy are so important in health care. All the patients in this book had an opportunity to read their chapters and I told them I'd change whatever they wanted or, if they didn't feel comfortable, leave them out of the book completely. Not one asked to be omitted. This so impressed me. Each woman told me that if her story would help someone else not feel alone, she wanted it told.

Sharing stories is one of the themes of the The Blue Cotton Gown. So many women feel alone with their troubles. What I am trying to say in the book is, we are not alone. We need to reach out, to share, to support, to love one another.

Of the women's stories, I am most interested in the story of Kaz's transformation from female to male. It's so full of wonderful paradox and contradiction. (You are midwifing a woman who transforms herself into a man!) It's full of hope, but unresolved, as almost all of the stories are. Do you have a favorite story? Which? Why?

I think my favorite character is Nila, the mother of seven who ran away from her abusive husband. She was such a spunky, courageous woman. I see so many women who feel trapped, who don't have the imagination to follow their hearts, who don't even know their secret hearts. All of the women in this book had courage and they are people we all know. There was Trish, whose daughter died of a drug overdose. She taught me so much about being a mother. Even Penny, the woman who had been sexually abused by a gynecologist. She ran out of the office with her shoes untied when I kept badgering her for more information about the physician. "Get off my back, lady," is what she was saying. "It happened a long time ago. I don't want to remember!" Really, I love them all. The book is a tribute to all women.

Did the writing of the memoir affect your life in any way? I very much hope you're working on another book. Are you? What can you tell us about it?

Writing the memoir was a culmination of my love of women, my creative drive, and my discipline. It took two years to write the book and another year to find an agent and publisher. I'll admit it; I got a little obsessed. Since The Blue Cotton Gown has just come out, I don't know how the publication will affect my life. I know that I've learned that writing the manuscript is just the first part of making a book.

I am working on my second book, now, also a memoir, tentatively called Broken Halleluiah: An Earth Mother's Song. The book follows the flower child, Patsy Harman, from homestead to commune to a lakeside home in Blue Rock Estates. An ambitious project, summing up thirty years of your life in 100,000 words!


Susan Wittig Albert Susan Wittig Albert left her career as a university professor and administrator in 1985 and began working fulltime as a novelist and freelance writer. For the past 16 years, she has written the China Bayles herbal mysteries, and for the past five, a series of historical fantasies called The Cottage Tales, featuring Beatrix Potter. With her husband, Bill Albert, writing as Robin Paige, she coauthored a dozen historical mysteries set in Victorian-Edwardian England and over sixty books for young readers. She has also edited two anthologies for the Story Circle Network: With Courage and Common Sense (2004) and What Wildness Is This: Women Write about the Southwest (2007).