The farmhouse on county road 38 in Todd County seems an unlikely place to bring a child into the world. The floor is unfinished wood, its cardboard-colored panels swept bare and cold. Raw insulation bulges out from around the edges of the windows. An old corn-burning stove, like a prop from some historical reenactment, fills the room with heat. To give birth here is to eschew every formality of the delivery room. But women do just that. Lots of them. Since September 2010, more than 20 babies—at least two per month—have gulped their first breaths of air here. And yet the only nod to obstetrics is a tiny, marker-written sign posted above an oversized tub in the bathroom: “TEMP FOR WATER LABOR: 92°.”
Welcome to Alisha’s Care Center, Minnesota’s newest freestanding birth center. Situated on five acres of prairie, about an hour northwest of St. Cloud, it’s a place where pregnant women come to avoid the OB/GYN. Over the past five years, freestanding birth centers—homelike facilities, unattached to any hospital, where deliveries happen with little to no medical intervention, assisted not by doctors but by midwives and doulas—have enjoyed a surge of interest. To a new generation of moms, they are the organic co-ops of the maternity world, places where a natural phenomenon is treated naturally. Want a pesticide-free tomato? Hit the farmers’ market. Want a cesarean-free labor? Well, you might consider a birth center.
Only Alisha’s doesn’t cater to the Whole Foods crowd. The women that come here are not part of a progressive elite. They’re farm wives without health insurance. They’re Amish and Mennonite mothers, for whom a hospital birth represents an unthinkable break from cultural tradition. Of Minnesota’s three existing freestanding birth centers—the other two are both located in the Twin Cities—Alisha’s is the only one to serve an exclusively rural community.
As if to drive this point home, the facility’s founder, Amy Claseman, 33, is padding barefoot around the farmhouse. Fly swatter in hand, she’s stalking a few bugs that have infiltrated the front screen door. “It may not look like much,” she says, “but to people like us, this is very homey.”
Claseman, a trained doula and birthing assistant, has spent her whole life in Eagle Bend, Minnesota. When she speaks, her voice comes soft and meek. She shows off one of the farmhouse’s two birthing areas. It’s a teeny country bedroom, a crib nestled in one corner, a single twin bed pressed into the other. The painted butterflies on the wall, Claseman explains, are in memory of her sister Alisha, the birth center’s namesake, who passed away in a car accident seven years ago. The last Mother’s Day gift Alisha ever gave to their mother, a heart-shaped ornament made of bent wicker branches, hangs above the bed.
Claseman says she established the birthing center specifically for Todd County’s Amish and Mennonite women, so they could have a safe, respectful environment in which to deliver. “A lot of women were asking for this,” she says. “Traditionally, they would just stay at home. But some of them have five or six kids. And their kids only go to school through eighth grade, so they’re teenagers. The Amish mothers wanted a private place where they could come, have their baby, and then go back home.”
In December 2009, after years of considering the idea, Claseman decided to do a test run. A pregnant woman in Eagle Bend, Gennifer Anderson, a beekeeper’s wife, wanted to avoid the hospital but wasn’t fully comfortable with a home birth. Her midwife suggested Claseman’s farmhouse. It was vacant, but usable enough. And it was only 12 miles from Long Prairie Memorial hospital, should any complication arise.
Anderson said she was game, so Claseman scrambled to fix the place up.
“When I walked in, it felt just like the house I grew up in,” recalls Anderson. “I told Amy, ‘I love it. I could be so happy here.’” The labor went smoothly. Just the ability to get up and move around, Anderson says, was liberating, especially compared to her first two births, which happened in a hospital. “Two hours after, I was up making a Tony’s frozen pizza in the kitchen there. I just felt like I had the freedom to do what I wanted to do.”
That was all Claseman needed to hear. The next summer, she launched an intense renovation, powered by a local carpenter and an army of Amish volunteers. By fall, she was ready for her grand opening, and on September 18, 2010, Alisha’s Care Center was born.
WHILE BIRTH CENTERS—freestanding or otherwise—have existed for decades out on the coasts in cities like New York and Seattle, the concept is new to Minnesota. Brand new, practically. Although hospitals in the state have offered in-house midwifery units since 1971—in fact, Long Prairie Memorial, in Todd County, was one of the first in Minnesota to offer a low-intervention option for birth—autonomous birthing centers, which enjoy complete independence from any OB/GYN department, really only came on the scene in 2010, after a landmark piece of legislation paved the way for licensure through the Minnesota Department of Health.
“Prior to that, it wasn’t illegal to operate as a birth center. It was just a-legal. There was no regulation around it,” says Amy Johnson-Grass, founder of Health Foundations Family Health and Birth Center, in St. Paul. Health Foundations was one of the first to open under the new rules, in February 2010. Since then, the door has been flung wide open—both legally and in terms of mainstream acceptance. For the first time, new birth centers have a framework for emerging as legitimate, state-approved facilities.
And pregnant moms are rejoicing.
“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.