MORGANTOWN, W.Va. -- They say there are no second acts in American lives, but that's not always true.    

Certified nurse-midwife Patricia Harman used to help deliver babies, then became a writer after the insurance premiums for herself and her obstetrician/gynecologist husband suddenly doubled.

"Eight years ago, we had a nationwide medical malpractice crisis," the silver-haired 68-year-old, who goes by Patsy, explained.

Across the country, the cost of malpractice insurance for OB/GYN professionals, including doctors and midwives, went up sharply. Harman and her husband, Tom, went from paying $140,000 a year to $280,000 a year.

While the couple still operate the Partners in Women's Healthcare clinic in Morgantown, the cost to continue delivering babies was too much for them to absorb.

"Everybody gave up delivering babies," Harman said, sounding a little bitter. "And we did too."

Harman turned to writing to help fill the empty space left from no longer being called at all hours to help bring children into the world. Her third book, "The Midwife of Hope River," was recently released by William Morrow Paperback, a division of HarperCollins Publishers.

The author will talk about her book at 6 p.m. Wednesday at the Kanawha County Public Library main branch in Charleston.

A midwife is made

Babies and their mothers have been a way of life for Harman for decades. She gave birth to her first child in 1970 and delivered her first for someone else in 1977, back when she and her husband lived on a commune in rural Roane County.

In those days, Harman wasn't a midwife, and her husband wasn't a doctor. They were just a couple of young hippies who'd come together through the anti-war movement.

Harman was interested in natural childbirth and had taken a few classes, which she in turn taught to others who were also interested in natural childbirth. But that first delivery was mostly an accident. She and her husband had gone to dinner at the home of a couple expecting a child and decided to stay over.

Late in the evening, the woman went into labor. The nearest hospital was two hours away.

In the home, a converted barn, Harman and her husband together delivered the first of what would be thousands of children. They began together what became a calling. Harman's husband later went to medical school and became an obstetrician, and Harman turned to midwifery.

Hippie to 'local expert'

Harman met her husband at a commune in Ohio, between war protests and the occasional arrest for civil disobedience.

Like many of the other "back-to-the-landers," they left the urban sprawl with some like-minded individuals to clean the slate and start over.

"We came to West Virginia because it seemed like an ideal situation," she said. "The land was cheap, and it was beautiful."

They wanted to grow their own food and find a better way to live. While in Spencer, the two started a natural food co-op and began teaching childbirth classes, something she'd done while living in Minnesota. Midwifery grew out of local need.

"I became this kind of local expert," she said. "I used to carry this big textbook around with me, 'Williams Obstetrics.' I'd take it with me when I helped deliver babies."

In the beginning, she helped deliver babies for the women in and around the communes.

"I couldn't have picked a better group to do that with," she said. "We were all very confident in our bodies."

The women on the communes were also mostly young and in good health.

Eventually, traveling around with a book under her arm wasn't enough. She trained with a collective of home-birth midwives in Austin, Texas, got a nursing degree from the Arch A. Moore Vocational School, and helped found the West Virginia Cooperative of Midwives.

She also started seeing women beyond the loose borders of the communes: expectant mothers who lived in real poverty, who didn't have good nutrition and often came from dire circumstances.

"These were the kind of women who really needed to go to hospitals for delivery," she said. "They just couldn't."

Leaving the commune

Harman continued her education, getting a four-year degree in nursing administration, but by the start of the 1980s, life at the commune was winding down. People were leaving.

"The commune didn't fall apart all at once," she said. "I think through most of the time we all lived on the commune, we were united against the Vietnam War. When that ended, we started looking at each other and asking, 'What are we doing out here in the sticks?'"

There were other subtle pressures too. Harman said that it seemed like every time she spoke to her mother, she heard how well old friends from high school were doing. They had careers and lives that seemed bigger and more important than what she had on the commune.

"I wanted to do something more," she said.

So, in 1985, not long after the birth of their third son, the family left West Virginia. Patsy studied at the University of Minnesota, where she earned a master's degree in midwifery, while Tom earned a medical degree from Ohio State University.

They stayed away from West Virginia until the early 1990s, when they settled in Morgantown and opened a clinic. Coming back to West Virginia was easy, Harman said.

"We knew the state, and we knew the people."

Harman said she and her husband have had a lot of good years here.

On a wall inside the clinic, there's an explosion of cute, sometimes bewildered faces -- photographs of just some of the babies the couple has helped deliver during the past 20 years.

Their office still cares for expectant mothers up through the first trimester and offers a variety of other kinds of treatment and care for women. They just don't handle births anymore.

"It's sad what happened with the insurance," Harman said, looking at the photos. "The good news is I have more time to write."

On writing

Getting published wasn't instant. Harman said she was rejected more than 80 times before an agent took her first book, "The Blue Cotton Gown," a memoir that covered her daily struggles as a nurse-midwife and some of the women she came to know.

Her second book, "Arms Wide Open," was a kind of prequel to the first book. It talked more about her "hippie days" and how she gradually became a midwife.

Both books are surprisingly frank.

"I started with writing about myself and the courage of ordinary women," she said. "People often write about important people, but I think it takes quite a bit of strength to go through life."

Harman's latest book, "The Midwife of Hope River," is her first foray into fiction.

"I decided I wanted to stop milking my own life," she laughed.

Set in coal country at the start of the Great Depression, the book follows the story of Patience Murphy, a 36-year-old midwife, Harman described as "too old for courting and wanted in two states."

She chuckled. "There are a lot of issues in the book besides birthing babies. The book deals with race relations of the time, coal mining, poverty."

Still, the novel does draw quite a bit from Harman's background, though she added that unlike her memoirs, she had to do a lot more research.

"Like taillights," she explained. "I wrote a scene that included a reference to taillights on a car, and I wasn't sure if they even had taillights in 1929."

Some cars did and some didn't, Harman found out.

Looking forward, looking back

Harman is pleased with her surprise second career, though becoming a writer wasn't something she imagined for herself when she started out living in that first commune in Minnesota.

Where she is now in her life is so far away from where she was. Sometimes she misses the life of the commune.

"It was a peak time in people's histories," she said and smiled. "It was a great time to share work and make music at night."

However, Harman didn't think most of them were very realistic about the life they'd embraced.

The routine, the struggle for sustenance and the austerity of trying to live outside of society ground her down.

"I've always loved nature, the beauty of it, but the plodding of the work on the commune, the life, I stopped looking at nature. I felt like a beast of burden."

Harman said, "Our problem was we were so extreme. I think it might have worked if we'd have made some compromises. We were always striving for sustainability, but the lifestyle wasn't really sustainable. Living life on 'Little House on the Prairie' sounds great, but after 10 years it wasn't a lot of fun."

Still, she added, communal living hasn't lost its attraction. There are still a lot of positive ideas in trying to create a sustainable society outside the hustle of the mainstream.

Harman said she knew people who'd gone back to it -- gray-haired retirees, mostly. People who've embraced the ethic of group living but with the wisdom to accept a few compromises, like keeping a vehicle and taking advantage of improved technologies like solar and wind power to retain a certain amount of comfort without losing independence.

"Get away from what you don't want, but don't give up running water," she added.

Harman is happy with her life now. With her first novel under her belt, she's already considering a sequel and also working on a children's book. She isn't really considering giving up her day job, though.

"I love what I do," Harman said. "I love my patients, and I love being a writer. I think it's just easier to get up and get going when you love what you're going to do."

Reach Bill Lynch at ly...@wvgazette.com or 304-348-5195.