The first-ever joint conference of the Midwives Alliance of North America, the Canadian Association of Midwives and the American College of Nurse Midwives took place in Niagara Falls in November 2011. I was present at the first-ever MANA conference (still have the t shirt!) and have been at most of the ones since. It is one of the great honors and joys of my life that I was invited to do a plenary presentation at this meeting. Talks are flexible, things come up, and I never could or would give a written-out version of a talk. But here's the gist of what I had to say.