Baby-in-air-Alabama-midwives
You Are Here December 19, 2018

The Secret Baby Catchers of Alabama They work in hotel rooms, Airbnbs and secondhand RVs just over the state line, so that women can give birth on their own terms.

Story by Rebecca Grant Photographs by Adrienne Grunwald
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All the lights were off in the used RV that night, and the blinds were closed to prevent anyone from seeing inside. Five people huddled in the small main room. Kate Petty, 34, lay on a bed that had been converted from a fold-down dinette table, underneath a large painting of a leopard. Her husband, Caleb, whose beard and long hair is the same auburn color as Kate’s, sat by her head and clutched her sweaty hand. She had been in labor for more than 24 hours and she was breathless, exhausted. The only light in the RV came from a flashlight held by a woman standing on Kate’s left. Another woman crouched between her splayed legs, hands outstretched.

“Keep going, honey. You got it,” said the woman with the flashlight.

Kate groaned. Her baby’s head emerged into the quivering circle of light.

“Is he stuck?” she asked in fear.

Kate’s contractions had started on the morning of May 8, 2017, in the Pettys’ brick one-story home in Opelika, Alabama. After two pregnancies, Kate knew she had some time to kill, so she made a last-minute grocery run. When the contractions picked up that evening, she and Caleb hopped in their car and headed for the Georgia state line, a half-hour drive away.

The roads wound through soft, wooded hills until finally the couple saw the large wooden cross marking the entrance of 3 Creeks Campground. They’d picked 3 Creeks for two reasons: It was close to Alabama, and it had working sewage. “A really podunk hole in the wall,” was how Kate described the place. The RV was waiting for them in slot K-9, already stocked with the supplies they’d need: old blankets, towels, Chux pads, buckets, candles, raw honey for energy. That night, the contractions were coming about every five minutes but Caleb and Kate curled up together on the bed and managed to get some sleep.

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3 Creeks campground. The inside of Kate's RV.

By morning, Kate couldn’t talk through her contractions anymore. She got into the rose-patterned birthing tub that her doula, Ashley Lovell, had filled with water from a plastic hose. Kate’s midwives, Rachel Hart and Paige White, arrived around 9 a.m. During a check, they realized the baby was asynclitic, or entering the birth canal at an angle. They had Kate get out of the tub and move into different positions to align the baby’s head. Everyone took turns rubbing Kate’s back and fanning her face. Meanwhile, Kate’s mother, Elizabeth Landreth, and other relatives sat on John Deere chairs outside, waiting. The campsites at 3 Creeks were close together, so it wasn’t long before some of their fellow campers became aware of what was going on.

It was hot in Georgia in May and the midwives were cranking the air conditioning, but the breaker kept tripping and Caleb had to hop in and out of the camper to get the power back up. It got so hot in the RV, Kate wasn’t sure she could stand it. She could hear a group of guys who worked for the Georgia Power utility company grilling and drinking beer and cutting up outside. The campground’s owner came by to lend Caleb a hand with the breaker. At one point he was standing right by the window, about 5 feet away from Kate. The couple hadn’t told him they planned to give birth at his campground and weren’t sure how he would react. So every time Kate had a contraction, the midwives closed the windows to muffle her cries. “I was pretty loud, I feel like, but he had no idea,” Kate said.

Three Creeks Campground
3 Creeks is a secluded spot, but the campsites are close together.

Every so often throughout the day, the midwives used a Doppler fetal monitor to detect the heartbeat. To help the labor progress, they had Kate squat, sit on a birthing stool and try the McRoberts maneuver, in which she lay on her back and pressed her legs to her belly. As the light faded and Kate neared the 30-hour mark, she started to panic. She had been in labor for so long. She worried she didn’t have the energy to keep going. She asked if she should go to the hospital for a cesarean section.

But Hart knew the baby was close. She told Kate that she wouldn’t stop her from having a C-section if that’s what she wanted, but she wasn’t going to tell her to have one, either. Instead, she asked Kate to get on her back. She felt like a turtle stuck the wrong side up. At Hart’s direction, Caleb held one of her legs in the air. A painful contraction came, and then another, and then the baby was coming so fast that White didn’t even have time to get her gloves all the way on.

“Here he is! Here he is!” she cried. At 8:03 p.m., a full day after Kate and Caleb had arrived at the campground, their son Jett was born and soon announced his arrival with a wail. To Elizabeth, standing anxiously right outside the window, it was the most beautiful sound she’d ever heard. “Oh, my baby,” she heard her daughter say. Elizabeth started jumping up and down with joy and relief; around her, the campers who knew what was going on inside the RV clapped and cheered in the humid night.

There are women who prefer to use a midwife because of deeply held beliefs about religion or wellness. And then there are those like Kate, who are simply desperate to avoid having a baby in a hospital. Mothers in this latter category have often endured a traumatic hospital experience and fear being pushed into risky procedures or surgery if they deliver there again. These fears are hardly unfounded in Alabama, which has one of the country’s worst rates of infant mortality, with maternal mortality also on the rise.

When it comes to women’s reproductive choices, we think of the primary battlegrounds as contraception, sex education and abortion. We hear far less about the significant restrictions on childbirth. While midwifery care is mainstream in other Western countries, it’s relatively rare in the United States. The closest option is a nurse-midwife—a registered nurse with a midwife credential who mostly operates in hospitals under the authority of doctors. This is a very different experience from having a trained midwife supervise a delivery in the home or in a birthing center. In some places, it’s impossible to access such services without skirting the law. Seventeen states, including North Carolina and Illinois, have laws that put midwives at risk of criminal prosecution for assisting birth outside a hospital. In Alabama, midwives were not permitted to practice in the state during Kate’s pregnancy.

And so, each year expecting mothers jump the border into Tennessee, Mississippi or Georgia, where midwifery is either legal or at least exists in some kind of gray area. Whether the journey is 10 minutes or two and a half hours, these women often make the drive while already in labor and pray they aren’t forced to have the baby in a parking lot or by the side of the road. They give birth in makeshift spaces, often in secret—Airbnbs, cheap hotel rooms, campers, a network of birthing cottages nestled anonymously throughout the hills of small, southern Tennessee towns, the western part of Georgia or along the Mississippi line. These might not be places where most mothers would want to give birth, but they give women like Kate something far more precious: a greater measure of control over how they bring a child into the world.

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Birthing cottages at The Farm, a well-known midwifery center in Summertown, Tennessee.

Alabama has a rich tradition of midwifery, but it is one that has virtually been erased from living memory. As in most places in the United States, until the mid-1800s it was midwives who were responsible for delivering children. Birth was something that happened in the home, among women. To this day, midwives still refer to their work as “catching babies”—reflecting a belief that birth doesn’t require medical intervention under normal circumstances, just a pair of hands to safely collect the child.

But as medicine became professionalized, its leading practitioners took a very different view. In 1915, the influential obstetrician Joseph DeLee declared that midwifery was a “relic of barbarism.” He also called on physicians to save women from the “pathologic” process of labor using sedatives, forceps and episiotomies—the surgical cutting of the perineum. By the early 1930s, nearly two-thirds of births in the U.S. happened in a hospital.

There was one place where midwives remained crucial: the South. During Jim Crow, black families could not access white hospitals and white doctors often refused to treat them, so it fell to black “granny midwives” to deliver children. In Alabama, Margaret Charles Smith caught her first baby at the age of 5 and, in her own telling, went on to deliver 3,500 children without losing a single mother. She once described saving an extremely premature baby by making an incubator out of a cardboard box and hot water bottles. Onnie Lee Logan started practicing in 1931, delivering nearly every child born in one black Mobile suburb. “I do all my work keepin em from having lacerations and havin to have stitches,” she recounted in her book, explaining how she used hot towels to stretch the skin and how she knew exactly when the mother should start pushing so the baby was positioned correctly.

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Midwives Stacie, Rachel Hart and Beth.

The 1964 Civil Rights Act, as well as the introduction of Medicare and Medicaid, eventually led to the integration of medical services. By the 1970s, 99 percent of American births took place in hospitals and states were passing laws preventing midwives from practicing, ostensibly for health and safety reasons. Alabama ended the legal practice of lay midwifery in 1976. A tiny number of home birthers persisted, mostly white, middle-class women seeking an alternative to the hospital. It was technically a misdemeanor for midwives to assist them, but the likelihood of being prosecuted seemed slim.

One woman who defied the ban was Karen Brock. She’d delivered hundreds of babies since the 1980s, following the example of her midwife grandmother. In 2002, Brock was attending a birth that was complicated by a ruptured uterus and cord prolapse, which occurs when the umbilical cord drops through the open cervix into the vagina. She rushed the mother to the hospital, where the baby died. According to Brock, the doctor said her actions saved the mother’s life, but she was charged with the misdemeanor of practicing nurse midwifery without a license and pleaded guilty.

Brock, 61, is petite with straight silver hair and an abiding affection for Chaco sandals. She told me that at the time of her arrest, she didn’t want to abandon the 27 Alabama families still in her care. So she decided to move her practice to Tennessee, where she could operate as a certified professional midwife. (Certified midwives do not have to be nurses, but undergo training and apprenticeship programs.) For a couple of months, she delivered babies in a trailer in a midwife’s backyard. Then she rented a house in a small town right on the Alabama border. After about five years, she received a cease-and-desist order from the state of Tennessee for running an unauthorized birth center. (The state defines a birth center as any building “exclusively or primarily” dedicated to birth.)

The day she received the order, Brock happened to be attending a birth for a family from Huntsville, Alabama. When Brock told them about the cease-and-desist, they decided to help. “My husband and I really felt like the Lord called us to do it,” said a woman I’ll call Debbie, who asked to remain anonymous.

After months of searching, Debbie and her husband bought a three-bedroom house in southern Tennessee and enlisted friends and relatives to help convert it into a two bedroom, two bath.

They installed a capacious hot tub and an extra water heater. It is now one of about half a dozen birthing cottages scattered around the towns of St. Joseph, Elkton, Pulaski and Lawrenceburg. There is also a renowned midwifery center nearby in Summertown called The Farm, which has cottages that expecting families can rent. The Farm was originally founded as a commune in the 1970s by hippies who caravanned across the country from San Francisco in school buses. Many of the women in the caravan were pregnant and learned how to deliver each other’s babies, which inspired them to become midwives.

Alabama’s border birth community is a tightknit sisterhood. It includes engineers, meteorologists, nurses, real estate agents and stay-at-home moms of varying political persuasions. They drop terms like “proven pelvis” and “colostrum” into casual conversation and share information via word of mouth. The cottages don’t openly advertise their services, for fear of being identified as unlicensed birth centers.

In theory, any Airbnb or vacation property could be used as a birthing cottage, but there are benefits to using one within the network. The owners are supportive and flexible about booking. After a birth, Debbie and her family clean the house themselves. (“It’s hard to find someone and say, ‘There may be blood, you may need to wear gloves, and the tub needs to be disinfected,’” she explained.) The cottages, which cost anywhere from $250 to $1,500 a week, tend to be filled with the quaint, fusty furniture that inhabits secondary properties everywhere. One is affectionately known as the “barbershop house” because the owner also cuts hair in the garage. When Marie Douthit’s husband dropped off supplies there in preparation for his wife’s labor, he got a quick trim.

Douthit decided to jump the border after her first pregnancy resulted in a C-section that left her deeply distressed. A data-oriented engineer, she ran the numbers and concluded that a home birth with a midwife was less risky than another C-section in a hospital. She went into active labor for her second baby on January 18, 2017. On the way to the barbershop house, Douthit and her husband stopped to use the bathroom and get Douthit a Hardee’s milkshake. A convenience store clerk asked if she needed an ambulance, and Douthit, who was terrified of being taken to the hospital, rushed back to the car. When they reached the cottage, the midwives didn’t even have time to fill the tub all the way to the top before she felt the urge to push. Her baby was born an hour later.

Marie Douthit and her children
Marie Douthit and her children at home.

Brianna Barker gave birth using the network around the same time. She’d had her first child at 20; the baby was preterm and breach. It was months after her C-section before she could even walk standing up straight; she still has recurring nightmares about being trapped in a dark hospital. She used birthing cottages for her third and fourth pregnancies. For one of them, her doula taught Barker and her husband how to do a car birth just in case the baby came during the two-and-a-half-hour drive.

One reason Barker opted to use a midwife was that many doctors and hospitals won’t allow women to give birth vaginally after a C-section, due to a widespread misconception that a vaginal birth after cesarean, or VBAC, is unsafe. In fact, VBACs are associated with fewer complications than elective repeat C-sections, according to the Mayo Clinic. The American College of Obstetricians and Gynecologists (ACOG) endorses their use for low-risk moms, although it doesn’t recommend VBACs outside a hospital environment and generally supports hospitals and accredited birth centers as a safer option than home birth.

There have been no large-scale randomized clinical trials of planned home birth that the ACOG considers adequate. Existing research suggests that in the U.S., they are associated with fewer interventions but also with higher rates of infant death. In countries like the Netherlands and Canada, however, where home birth is well established, it’s considered safe. A study that included researchers from the University of British Columbia; the Child and Family Research Institute in Vancouver; King’s College, London; and the University of Alberta, Edmonton compared planned home birth with planned hospital birth. The authors found that home birth was associated with “very low and comparable rates of perinatal death,” as well as fewer surgeries and complications for moms.

All 14 Alabama women I spoke to said their decision to jump the border was connected to their desire to avoid unnecessary medical procedures. Most of them described harrowing hospital experiences—being derided for writing a birth plan, feeling pressured into C-sections, epidurals or Pitocin, a synthetic hormone that induces contractions.

Alabama is one of nine states where more than 34 percent of deliveries are cesareans. The ideal, according to the World Health Organization, is 10 to 15 percent. While cesareans may be essential in complicated births, they can come with higher risks of (sometimes life-threatening) complications and infection. “You have to look at the outcomes from hospital births, and they are not that good,” said Dr. Jesanna Cooper, an obstetrician who works with nurse-midwives in her Birmingham practice. “If it’s risky to have a hospital birth, it’s pretty hard to say a home birth is too risky.”

Credits

Story
Rebecca Grant is a freelance journalist based in Brooklyn. She covers reproductive rights, women's health and gender-based violence. Her work has appeared in Vice, The Washington Post, NPR, The Guardian, Cosmopolitan, The Atlantic and The Nation.
Photography
Adrienne Grunwald is a documentary photographer based in Brooklyn, New York. Her work has appeared in The New York Times, Bloomberg Businessweek, Time Magazine, M Le Magazine du Monde and ESPN the Magazine. Adrienne was selected for PDN's 30 in 2016.
Creative Direction & Design
Donica Ida is the creative director of Highline.
Kate LaRue is a freelance creative director.
Development & Design
Gladeye is a digital innovations agency in New Zealand and New York.
Research
Emily McCullar is an assistant editor at Texas Monthly.