Colleen Envrizzi went to the hospital four years ago planning to deliver her daughter through a natural birth. Instead, she found herself on a medical assembly line: intensive monitoring, drugs to accelerate labor, and in the end a Caesarean section. "It was not a great experience," said Envrizzi, now 44.

When she became pregnant a second time, she was able to give birth to her son the way she wanted. But she had to drive from her home in West St. Paul to the Morning Star Women's Health and Birth Center in Menominee, Wis., to do it.

Starting this year, women with the same wish won't have to go so far. Three birth centers are opening in the Twin Cities -- places where healthy mothers can deliver naturally in home-like environments with the help of midwives. They signal the arrival in Minnesota of a slow but steady national trend to make birth a more natural biological event and less a high-tech medical procedure.

Birth center deliveries are also much cheaper than hospital births. That fact has inspired a bill at the Legislature to establish licensing standards and regulatory oversight of birth centers, a step to encourage health insurers to look on them more favorably.

"The traditional medical system over-medicalizes normal deliveries," said Sen. Linda Berglin, DFL-Minneapolis, who is sponsoring the bill. "Even if [women] want a perfectly normal birth without intervention, they get [medical interventions] anyway."

Last week, the birth center Health Foundations opened on Grand Avenue in St. Paul, and Amy Johnson-Grass, the midwife who owns it, expects the first baby to be born in one of its two sun-filled bedrooms later this month.

In March, Morning Star, the Menominee birth center, is expected to open a branch in St. Louis Park.

Next September, the Minnesota Birth Center is expected to open across the street from Abbott Northwestern and Children's hospitals in Minneapolis. That will be the largest of the three, with four to six midwives working in conjunction with doctors literally a stone's throw from two hospitals well-known for their birth and pregnancy specialty care.

"I had a paradigm shift," said Dr. Steve Calvin, the Minneapolis specialist in high-risk pregnancies who is behind the Minnesota Birth Center. "We don't provide really good care to women whose pregnancies are not diseases, illnesses curable by C-section."

Too risky?

Births outside of hospitals have been controversial in maternity care for years. The American Congress of Obstetricians and Gynecologists (ACOG), the leading professional group for that specialty, firmly opposes home births because they are too risky, it says. It supports birth centers as long as they are accredited by the American Association of Birth Centers. There are now birth centers in 33 states.

ACOG is cautious because, even for healthy women, births that start fine can go suddenly and tragically wrong, it says.

Midwives who specialize in home births say those sudden emergencies are extremely rare. Most of the time, they say, there's plenty of time to get their patients to a hospital if necessary.

In fact, the number of home births in Minnesota has been rising. In 2008 there were 500 babies born at home. That's a small fraction of the 72,000 births that same year, but it's higher than the 354 home births recorded in 2001.

"I have a large immigrant population in my district," Berglin said. "They don't understand this going to a doctor when you are pregnant."

Supporters say they believe that many women would opt for a birth center as a good compromise between home and hospital. Calvin said 80 percent of pregnant women are not high risk, meaning they are young, healthy and not carrying multiple fetuses. Research has shown that about 15 percent of women who start labor in a birth center have to be transferred to a hospital during labor, he said.

Sudden emergencies happen in hospitals, too, he said, and often small hospitals don't have surgeons or other experts on hand either.

Insurers balk

At this point, the biggest barrier to giving birth outside a hospital might be health insurance. Many health plans either won't pay for them or consider them "out-of-network," meaning patients must shoulder a larger part of the expense.

Envrizzi said that when she became pregnant with her son, obstetricians wouldn't agree to a natural birth because of her prior C-section; she ran a small risk of a ruptured uterus if she went into labor. She was willing to take that risk in order to have a natural birth, even if it meant driving to Menominee.

But her health plan, Medica, would not provide full coverage at the birth center, considering it "out of network,'' even though the cost in her case was less than $5,000. That compares with an estimated $7,000 to $9,000 for the cost of an uncomplicated hospital delivery, and twice that for a C-section.

She appealed Medica's decision, but lost, she said.

"I would say: 'I saved you thousands of dollars, and you still choose to say you won't pay,'" she said.

Health plan officials in Minnesota say that they won't cover deliveries in any unlicensed, unregulated facility. But some say they are starting to warm to the idea of birth centers, if there is oversight.

"We are open to this, but the issue is making sure that there is safety and quality built in," said Larry Bussey, a Medica spokesman.

That's one reason why Berglin hopes her licensing bill will pass. If it does, health plans might be more willing to cover deliveries in birth centers, as they do in some other states. That would also take some of the costs out of maternity care, one of the biggest expenses in the state's Medicaid program, she said.

Hospitals, however, resist the idea.

"There are significant safety and quality issues you have to be concerned about," said Lawrence Massa, president of the Minnesota Hospital Association.

There are also competitive issues, he added. Increasingly, Minnesota hospitals recognize a market exists for natural, low-tech births, one that hospitals might like to serve themselves. But if so, he said, they want a level playing field, one in which birth centers have to abide by the same regulatory rules as hospitals.

Josephine Marcotty • 612-673-7394