When director Elaine Epstein and her wife decided to have their first child, the entire process felt wrong. “We went into it blindly, we followed all the prescribed medical routes for a gay couple to get pregnant,” she recounted to Jezebel. But the couple struggled with the impersonal, clinical setting and feeling unheard by health care workers. Working with a midwife who “got to know who we were” changed everything, Epstein said. The couple had their first daughter at a midwifery practice attached to a New York City hospital. But when they tried to return a couple of years later, as they planned for their second child, they found it was closed.
Epstein researched further, eventually theorizing that the hospital system shut down the practice because midwifery—a health profession that offers more personalized care—generates far less profit than the conveyor belt of hospital births. And then, upon even further research, Epstein learned that midwives across New York state are being pushed out of their work thanks to rigid licensing laws. In 2019, Epstein discovered the story of Liz Catlin, an upstate New York-based midwife who worked primarily in Amish communities and had just been arrested. “At first, Liz didn’t really respond to me, and then when we did connect, I thought the case against her was so ridiculous, I didn’t think it would go anywhere,” Epstein said. Then, shortly after they spoke, Catlin was indicted on 95 felony charges. “And so, I packed my bag, went upstate, and we started filming.”
Catlin and two other New York midwives, Linda Schutt and Melissa Carman, ultimately became the subjects of Epstein’s latest documentary, Arrest the Midwife, which premiered at SXSW in Austin, Texas. This week, a Texas midwife, her employee, and a nurse practitioner were all arrested, and charged with allegedly providing illegal abortions practicing without a medical license.
All three midwives served primarily Mennonite communities, which are highly private and, for generations, have exclusively chosen home births facilitated by midwives. Filming the documentary required Epstein to build trust with community members, and she said she was surprised and heartened by how enthusiastically Amish families, who traditionally avoid activism and the political sphere, rallied in droves behind Catlin, Schutt, and Carman, and began organizing for policy change.
From 2019 through 2021, Epstein follows the three women’s journeys through the legal system, as they navigated the charges against them, including practicing midwifery without the right license. Catlin also faced a criminally negligent homicide charge, stemming from the October 2018 death of a baby that was born after Catlin transported a laboring woman—who showed signs of possible complications—to the hospital. The hospital eventually cleared Catlin of any responsibility in the infant’s death—but not before a nearly two-year-long court battle.
Midwives are highly trained and skilled, and home births facilitated by midwives have the same safety rates as hospital births. Catlin, Schutt, and Carman all hold the credential Certified Professional Midwife (CPM), which is recognized in 37 states, though it isn’t recognized in New York. Throughout the documentary, while the women challenge the criminal charges against them, they also partner with Mennonite communities to lobby for a bill in the state legislature to allow CPMs to legally provide birthing services in the state. The women’s arrests, despite safely delivering over 2,000 babies between them and being universally beloved by the communities they served, reflect a broader crisis that lies at the heart of Arrest the Midwife.
The documentary lays out the chilling state of maternal health across the U.S. As of 2022, 1,119 of 3,142 U.S. counties (35.6%), home to over 5.6 million women, are considered maternity care deserts because they have no birthing hospitals, birth centers, or obstetric providers. The U.S. leads wealthy nations in maternal mortality, with a rate that’s more than doubled in the last 100 years. And, in the era of abortion bans, fear of varying legal risks and liabilities has prompted several hospital systems to shutter labor and delivery departments altogether, creating even more maternal care deserts. Medical experts and reproductive justice advocates have overwhelmingly called for more midwives and fewer restrictions on midwives providing care as a solution. Since Roe, multiple blue states have worked to pass legislation to allow midwives to perform abortions. But, even in Demcrat-led states like New York (which, again, doesn’t recognize CPMs), midwives increasingly fear persecution.
The far-reaching impacts of the maternal care crisis, as well as dwindling options for pregnant people seeking health care, have united a broad coalition of women and advocates, Epstein says. In Arrest the Midwife, Amish women as well as Black women-led reproductive justice groups organize together toward the shared goal of more agency in one’s pregnancy and birthing choices—namely, the choice to work with midwives and have home births.
Black women face the most adverse maternal health outcomes in the nation, “so, including their voices in the film was vital,” Epstein said. The documentary raises that, in New York City, Black people are more than 12 times more likely to die from pregnancy-related complications than white people. Black pregnant women’s experiences with medical racism speak to the importance of culturally competent health care, which some Black patients find through working with Black midwives. Everyone “deserves to be empowered during the birthing process,” Epstein said.
At different points, the documentary explores how, as Epstein put it, “this business model of health care” through the for-profit medical industry has emboldened hospital systems to shut down their midwifery services, and even lobby for legislation that pushes midwives out of work. “There’s a dollar sign on everything,” Epstein said, pointing to the birthing process. Services from a midwife are far cheaper than going to the hospital. “That’s not profitable, so that’s dismissed.”
“We could still be filming right now,” Epstein told Jezebel one week before the midwife in Texas was arrested. But to Epstein, the end point of the documentary, as the women see resolutions in their cases, move forward with their lives, and continue to lobby for midwife-supportive legislation in New York, felt like the proper conclusion. “Even with so much uncertainty right now, it felt right to end on a triumph.”
GET JEZEBEL RIGHT IN YOUR INBOX
Still here. Still without airbrushing. Still with teeth.
