A vacant farmhouse in central Minnesota has become the state’s newest birth center. But its clientele isn’t the crowd you might expect.
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“When they heard we were opening a facility in the Twin Cities, women were just flocking. Sight unseen, they said, ‘Sign me up!’” says Paula Bernini Feigal. Feigal operates the metro’s other licensed birth center, Morning Star, in St. Louis Park. But she’s overseen natural births at Morning Star’s original location, in Menomonie, Wisconsin, since 2003. Over the past three years, she says, “18 percent of my clients were women coming over from Minnesota.” The demand is palpable. While the Department of Health does not keep data on freestanding birth centers specifically, it does track midwife-assisted deliveries, whether they occur at home, in a hospital, or in a place like Morning Star. In 2009, 9.7 percent of all births were midwife-assisted—double the rate from 10 years ago—and most experts insist that number is growing.
Why such interest? For advocates like Johnson-Grass and Feigal, it’s a simple, commonsense reaction to delivery-room statistics that some find alarming. One in every three hospital births now results in a cesarean section. Without a midwife, pregnant women are up to nine times more likely to suffer a perineal tear. And in medical settings, rates of induction—the process of using the drug Pitocin to speed along contraction patterns—can be as high as 80 percent. If you ask Feigal and Johnson-Grass, women are simply doing their research and demanding more control over their care.
But Joy Parker, a St. Cloud-based midwife, has a less data-driven theory. And it involves Ricki Lake. In 2007, the talk-show host released the documentary The Business of Being Born. The film—sort of the Super Size Me of the maternity world—portrays American delivery rooms as quick-trigger birthing mills, driven by frenzied schedules and profit motives. The footage of Lake’s own labor, at home in a birthing tub, coached along by a midwife, seemed to many mothers a saner, more peaceful approach. “Women didn’t know this was an option,” says Parker. “I have clients where that [movie] is the only exposure they’ve had to the idea.”
She sees natural birthing as fitting the current cultural zeitgeist, part of the impulse for sustainable, organic everything. “It tends to be post-hippie, New Age. But then there’s this other contingent, the conservative religious people.”
And then, of course, there are the bragging rights. Commented one mom, who asked to remain anonymous: “There is an attitude of, ‘Oh, I did this without drugs. Aren’t I a fabulous superwoman?’ ”
But if natural-birthing advocates fear the dangers of the hospital, hospital officials fear the dangers of off-site deliveries. “When things go bad, they go really bad. And we’re the ones who see the complications,” says Dr. Jan Strathy, a Park Nicollet OB/GYN with more than 26 years of birthing experience. Strathy worries about the lack of standardized training midwives receive; certified nurse midwives, the ones who generally work in hospitals, she notes, are required to have graduate degrees in nursing. But certified professional midwives’ training can be as minimal as an apprenticeship or an associate’s degree. When it comes to quality of care, Strathy says, OB/GYNs have concerns about consistency. And since hospitals are legally obligated to treat any woman who might come in after a natural birth gone bad, “it places us in a tenuous medical-legal situation,” Strathy says. “If we don’t feel comfortable with what these places are doing in the first place, it’s hard to back them up.”
“There are criticisms that people fling, but it’s usually based on an anecdote,” says Dr. Steve Calvin, a doctor of internal fetal medicine at Abbott Northwestern, the largest hospital in the Twin Cities. “Something like, ‘Oh, when I was a resident, I saw this natural birth come in, and it was a mess.’” But he points to a new report issued just last February by the American College of Obstetrics and Gynecologists which put accredited birth centers on par with hospitals as “the safest setting for birth.”
Calvin’s been pushing his hospital for years to more fully embrace autonomous birth centers. He and his wife have even bought a house across the street from Abbott, which he plans to convert into a freestanding birthing center by this winter. “For low-risk women, who show no signs of complication, midwives provide excellent care,” he says. “We don’t use them nearly enough in the United States.”
OF COURSE, OUT ON THE PRAIRIE, none of this seems to matter. The tangle of politics, the academic debate, Ricki Lake—to Claseman, these are all senselessly frivolous city concerns. What matters out here is tradition. Peering out a window, the distant wind gusting across miles and miles of tall grass, she points out a line of squat little shrubs alongside the farmhouse.
“At the open house, the local families donated lilac bushes,” she says. “We thought it would be nice if they grew up with the children born here.”
Ruth Wingeier, perhaps Todd County’s most famous midwife, has dropped in at the farmhouse this morning. Wingeier, 56, has spent her entire 29-year career at Long Prairie Memorial and has delivered hundreds of babies—including Claseman’s own kids. But a huge chunk of her service has been attending home births throughout the county. “There was this whole community of Amish people up in Bertha”—40 minutes north of Long Prairie—“that I worked with for years,” Wingeier says. “I loved it.”
Recently, though, Wingeier had to rein in her practice. In 2005, as a liability measure, Long Prairie Memorial asked its midwives to keep their home deliveries to within a 30-mile radius of the hospital, ensuring an emergency drive of no more than a half-hour should complications arise. For Wingeier, a passionate woman with a tightly braided ponytail and a wrist full of silver bangles, it was a frustrating restriction. “Where would they go?” she says, clearly concerned. “There’s no midwife for them.”
Wingeier has been Claseman’s biggest cheerleader in opening Alisha’s Care Center. In fact, Gennifer Anderson, the woman who first delivered in the farmhouse, was Wingeier’s client and lived just five miles beyond the hospital’s radius.
As busy and as popular as Alisha’s Care Center is, though, it’s still not fully accredited. Claseman is hustling to arrange for a temporary license. A white binder, three inches thick with paperwork, sits on the table. The first site visit from the national Commission for the Accreditation of Birth Centers comes in February. Before then, Claseman has to figure out a way to create a handicap-accessible birthing suite. She has to prepare a scrupulous defense of her financial model—a task made even more complicated by the fact that she’s applying for nonprofit status. She’ll have to sit for interviews and endure the lengthy deliberations of far-away commissioners. The filing fees alone will cost her about $5,000.
But for now, her biggest focus is on where to put the footprints. She plans to coat the feet of each baby born at Alisha’s in paint, and create a trail of teeny feet along the living room wall.
“The Amish don’t really like photography,” she says. “But we’ll be sure each family leaves its mark here.”
Gregory J. Scott is the staff writer for Minnesota Monthly.