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SPEAKER 1: In any given week, midwife Rebecca Knapp may drive hundreds of miles in Western Minnesota providing pregnancy care to women delivering their babies at home. In the second of two reports, Catherine Richert now takes us on the road with one of the state's busiest midwives.

SPEAKER: Here on the road, Rebekah Knapp is literally looking for signs from above.

REBEKAH KNAPP: So if I see two eagles in a day, I can know, oh, there's a baby coming.

CATHARINE RICHERT: Knapp developed the habit as a coping mechanism when her mentor unexpectedly passed away eight years ago. Knapp inherited many of her clients and struggled to keep up with the work. Knapp says she was called to midwifery by God when she was 14 and saw news reports of Haitian babies suffering. So at one of the lowest points in her career, she turned to her faith for some help.

REBEKAH KNAPP: I was just praying, Lord, I need help with this because I can't be this stressed. I need a sign from you, just to know when babies are coming, so I can just relax a little bit more.

CATHARINE RICHERT: Knapp says scanning for eagles has helped her cope with the uncertainties of birth. Every week, Knapp juggles dozens of stops for births, prenatal appointments, and well-baby checks throughout Western Minnesota. In the 21 years since she first started apprenticing at the age of 18, Knapp has been involved in the delivery of nearly 900 babies. Knapp is so passionate about birth, she makes her home in fertile Minnesota.

REBEKAH KNAPP: I purposely moved there several years ago.

CATHARINE RICHERT: On a Tuesday in August, Knapp drives an hour and 40 minutes to the first of seven appointments in the Detroit Lakes area.

REBEKAH KNAPP: We'll be doing a two-week visit and a six-week postpartum visit, prenatals, just a little of everything, really, today.

CATHARINE RICHERT: This summer alone, Knapp has put more than 21,000 miles on her baby-blue Buick LeSabre. It's packed with gear like blood pressure cuffs, swaddles and slings to weigh newborns. On the dashboard, is a stack of paperwork on each of her clients. The first stop on her circuit is the home of Savanna and Tony Snyder, who welcomed their fourth child justice a day and a half earlier.

REBEKAH KNAPP: Good morning.

TONY SNYDER: Good Morning.

SAVANNA SNYER: Morning, come on in.

CATHARINE RICHERT: Knapp greets Savanna with a hug. She's 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 family. She works with.

REBEKAH KNAPP: Oh, Justice, It's OK.

CATHARINE RICHERT: As Knapp draws blood from Justice's foot for his newborn screening, an older sister asks Knapp if she can watch.

REBEKAH KNAPP: So when I push the button, then a little needle comes out and pokes him and then it goes back in.

SAVANNA SNYER: Can I see the needle.

REBEKAH KNAPP: Can't see the needle. You can kind of--

CATHARINE RICHERT: Savanna turns and says, this moment shows why she thinks Knapp is so good at her job.

SAVANNA SNYER: She's not just about the baby. She's about the whole family. She always involves the kids and makes them feel very important.

CATHARINE RICHERT: 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 the car, Knapp says many of her clients are conservative Christians who homeschool their children. Others aren't religious at all. But Knapp says the thread that unites her clients is their desire to have autonomy over their pregnancies, births, and bodies.

REBEKAH KNAPP: Women want to be treated with respect. With a home birth, we're trying to make it as peaceful and intimate it as when you created that baby.

CATHARINE RICHERT: Knapp says that can be difficult in some hospitals if there are a lot of practitioners involved.

REBEKAH KNAPP: You usually don't invite 20 people to be there when you make the baby. [LAUGHS]

CATHARINE RICHERT: Knapp says there's another common theme among some of her clients. They're skeptical of the medical profession. Amish families make up about a third of Knapp's client list, and it's a community that views home birth as normal. But working with Amish families presents unique challenges for Knapp, partly because they don't often speak directly about sexuality and pregnancy the way non-Amish families do. So Knapp has become accustomed to getting these cryptic letters from Amish women that avoid details or even a mention of their pregnancy, like this one.

REBEKAH KNAPP: Hello, just a few lines, was wondering when you are coming around again for checkups. I would 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.

CATHARINE RICHERT: So you don't know how far along in the pregnancy?

REBEKAH KNAPP: I have no clue how far along she is.

CATHARINE RICHERT: Communication with her Amish clients is also a challenge for Knapp because most don't have phones. As we pull up to Jonas and Anna Miller's home near Frazee, Knapp explains that a few weeks ago, Jonas had called Knapp from the single phone their entire Amish community shares. He explained that Anna was having a miscarriage and bleeding heavily about nine weeks along. Knapp says miscarriages early in pregnancy typically don't require a trip to the hospital, unless there's a lot of blood loss.

REBEKAH KNAPP: That is when a miscarriage goes bad. That's the times when the hospital is needed.

CATHARINE RICHERT: Knapp told Jonas to take Anna to the emergency room, a rare experience for the Miller family. Anna had been inside hospital only once before. Today, 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 a big smile.

Anna and Knapp sit down in rocking chairs as a grandfather clock ticks away. Anna and Knapp at first, make small talk about her garden, the weather, a bad bug Anna is recovering from. And my recorder is off out of respect for the Amish tradition. Later, after visiting two more Amish families, Knapp tells me small gestures have helped her win the trust of the Amish community she works in. For instance, she brings news of other families and refers to them with Amish shorthand.

REBEKAH KNAPP: We just saw Joe Ida. We saw Andy Nancy.

CATHARINE RICHERT: She dresses to fit the culture, too.

REBEKAH KNAPP: Wearing a head covering when I'm around them, you know, wearing skirts and dresses, trying to wear darker colors.

CATHARINE RICHERT: At the Miller home, Knapp checks Anna's iron levels and reminds her it's still possible to get pregnant right after a miscarriage. Anna says quietly that she's OK with whatever God has planned for her family. Before she leaves, the Millers encourage Knapp to take some tomatoes, corn and cucumbers from their garden as payment, which Knapp welcomes in lieu of money.

Knapp says blending with Amish culture has been helpful, but her role in saving a newborn solidified her reputation in this community. She'd been asked by two Amish midwives to help deliver twins, and the birth wasn't going well. The second baby was breech and was not breathing when he was born. She performed CPR and asked the other midwives to grab her oxygen tank.

REBEKAH KNAPP: They said, in unison, what is oxygen? And then I knew I was at this birth completely by myself.

CATHARINE RICHERT: Both babies lived, earning Knapp a hug from their father. An unusual gesture in this staid community. Unlike most homebirth midwives, Knapp has never secured a license from the state to do home births. Midwife licensure is voluntary in Minnesota, and the choice is controversial, even among midwives.

Knapp says state restrictions around home birth, for instance, not being able to deliver babies past 42 weeks of gestation, would prevent her from serving some Amish mothers. Those moms may rely on women in their community who have no training at all, like those who didn't know what oxygen is.

REBEKAH KNAPP: I wouldn't be able to serve some of the people that I serve. And I'm not trying to break laws, but the Amish are going to have home births, whether there's a midwife there or not. I feel it's important for those who want to have a home birth, to have access to somebody who has training.

CATHARINE RICHERT: As evening approaches, the eagles have signaled there will be no babies born today. So Knapp starts the long drive home. Catharine Richert, MPR News, Detroit Lakes.