Here on the road outside Detroit Lakes, one of the busiest midwives in Minnesota is literally searching for signs from above.
Rebekah Knapp knows something good is on the way when eagles are soaring above her. "If I see two eagles in a day,” she said, “I can know, ‘Oh there's a baby coming.’”
Knapp juggles dozens of stops for births, prenatal appointments and well-baby checks each week along Minnesota’s western border. This summer alone, she’s driven more than 21,000 miles — roughly 18 months worth of driving wedged into three.
Her baby blue Buick LeSabre is packed with blood pressure cuffs, swaddles and slings to weigh newborns. On the dashboard sits a stack of paperwork on each of her clients. In the 21 years since she started as an apprentice midwife, Knapp, 39, has been involved in the delivery of nearly 900 babies.
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She is so passionate about birth, she makes her home in Fertile, Minn.
The reasons for that passion extend beyond her beliefs that home birth is best for most women, or that her clients are skeptical of the medical profession. At 14, she says, she was called by God to be a midwife.
The women she serves, including those in Minnesota’s Amish communities, would not disagree. In an era of high tech medicine, she has never been busier.
‘Little bit of everything’
On a Tuesday in August, Knapp drives an hour and 40 minutes to the first of seven appointments in the Detroit Lakes area.
"We'll be doing a two week visit and a six week postpartum visit, prenatals,” she says. “So, just a little of everything really today."
The first stop on her circuit is the home of Savanna and Tony Snyder, who welcomed Justus, their fourth child, a day and a half earlier.
Knapp, who helped Savanna deliver, greets the woman with a hug at the back door as the sounds of an unhappy Justus pour from the house.
The midwife is a familiar presence in the family's house because she's delivered two other Snyder kids as well — a point of pride for Knapp, who says she often delivers several children in each client’s family.
As Knapp draws blood from the new baby’s foot for his newborn screening, an older sister asks Knapp if she can watch. Sure, she says, and walks the girl through what’s she’s doing.
"Where do you poke it?” the girl asks. “When I push the button then a little needle comes out,” Knapp replies.
Savanna Snyder turns and says this moment shows why Knapp is so good at her job.
"One of the greatest things about Rebekah is that it's not just about the baby,” she says. “She's about the whole family. She always involves the kids and makes them feel very important."
Since 2000, the number of Minnesota women choosing home birth like Savanna Snyder has exploded, and Knapp's practice has grown along with it. Home birth is generally considered safe if the mother's pregnancy is uncomplicated.
Back in her car, Knapp says many of her clients are conservative Christians who home-school their children.
Others aren't religious at all. Knapp says the thread that unites her clients is their desire to have autonomy over their pregnancies, births and bodies.
"Women want to be treated with respect,” she says. “With a home birth, we're trying to make it as peaceful and intimate as when you created that baby."
That can be difficult in some hospitals if there are a lot of practitioners involved.
Adds Knapp: "You usually don't invite 20 people to be there when you make the baby.”
Whatever God has planned
Reluctance to submit to the medical industry’s approach to birth runs deep among some of Knapp’s clients. That's especially true for her Amish clients, who tend to shun hospitals all together.
Amish families make up about one-third of Knapp's client list. It’s a community that views home birth as normal.
Working with Amish families, though, presents unique challenges for Knapp, partly because they often don't speak directly about sexuality and pregnancy the way non-Amish families do.
The midwife has become accustomed to getting cryptic letters from Amish women that avoid details or even a mention of their pregnancy.
One reads: "Hello, just a few lines. I was wondering when you're coming around again for check-ups. I'd like it if you'd stop by if you're in the area in the next week or so. If there's time to let me know, I'd appreciate it. However it suits you.”
“I have no clue how far along she is,” says Knapp.
Communication with her Amish clients is also a challenge for Knapp because most don't have phones.
In Jonas and Anna Miller's home near Frazee, Minn., for instance, the entire Amish community shares a single phone.
Anna met some challenges in pregnancy. She miscarried recently at about nine weeks, and was bleeding heavily. Knapp says miscarriages early in a pregnancy typically don’t require a trip to the hospital, unless there’s a lot of blood loss.
“That’s when a miscarriage goes bad,” she says. “That’s the time the hospital is needed.”
When Jonas called, Knapp told him to take Anna to the emergency room, a rare experience for the Miller family. The woman had been inside a hospital only once before.
Today, the conversation is lighter. Knapp is visiting to check Anna's iron levels.
Anna opens the door of her tidy white colonial house in an emerald green dress, dark hair tucked into a white bonnet, and wearing a big smile.
Anna and Knapp sit down in rocking chairs as a grandfather clock ticks. They start with small talk about the garden, the weather and a bad bug Anna is recovering from.
Then Knapp checks Anna’s iron levels and reminds her it's possible to get pregnant right after a miscarriage.
Anna says quietly that's she's OK with whatever God has planned for her family.
Before Knapp leaves, the Millers encourage her to take some tomatoes, corn and cucumbers from their garden as payment, which Knapp welcomes in lieu of money.
Knapp charges from $1,000 - $5,000 for a birth, but she’s flexible. Amish families typically pay right after the baby is born. She also accepts trades from Amish and non-Amish. One family bought her a new set of tires for her car.
Later in her circuit, Knapp tells me small gestures have helped her win the trust of the Amish communities she serves.
For instance, she brings news of other families and refers to them with Amish shorthand: "We just saw Joe-Ida, we saw Andy-Nancy."
She dresses to fit the culture too, wearing a head cover, skirts and dresses and generally darker colors.
A bond forged in crisis
Knapp said blending with Amish culture has been helpful, but her role in saving a newborn solidified her reputation in the community.
She'd been asked by two Amish midwives to help deliver twins. And the birth was not going well. The second baby was breech and was not breathing when he was born.
Knapp performed CPR and asked the other midwives to grab her oxygen tank.
"They said in unison, ’What's oxygen?’" Knapp recalled. “And then I knew I was at this birth completely by myself."
Both babies lived, earning Knapp a hug from their father — an unusual gesture in this staid community.
Unlike most home birth midwives, Knapp has never secured a license from the state to do home births.
Licensure for home birth midwives is voluntary in Minnesota, and the choice is controversial among midwives.
Knapp says state restrictions around home birth — including not being able to deliver babies past 42 weeks of gestation — would prevent her from serving some Amish mothers who might otherwise rely on women in their community who have no training at all.
"I'm not trying to break laws,” she said. “But the Amish are going to have home births whether there's a midwife there or not. I feel like it's important that people who want a home birth have access to someone who has training."
For all the joys that come with the job, it also can be exhausting and unpredictable.
Knapp’s daily search for eagles above her began as a coping mechanism after her mentor unexpectedly passed away eight years ago.
Knapp inherited many of her clients and struggled to keep up with the work. So, at one of the lowest points in her career, she turned to her faith for some help.
"I can't be this stressed,” she recalled. “I need a sign from you just to know when babies are coming. Just so I can relax a little bit more.”
As evening approaches, the eagles signaled there would be no babies born on this day. So Knapp began the long drive home.