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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.

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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.



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.

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.

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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.