BELLEVUE -- Heather Ramsey predicted she likely would have 20 births her first year of operation.
But 34 babies have been born in the first four months at The Midwife's Place, the state's first freestanding birth center.
Their tiny footprints climb up the door frame outside each of the two bedrooms or birthing suites.
Knox, 8 lbs., 13 oz., Dec. 17.
Sophia, 6 lbs., 13 oz., Jan. 27.
Donatella, 8 lbs., 10 oz., March 18.
The bedrooms, with quilted comforters and plenty of plump pillows on the beds, are the focal point of The Midwife's Place in Bellevue.
One bedroom has a four-poster Victorian bed, mahogany or oak dressers and night stands.
And Dad can crawl in bed with Mom if he wants.
It's difficult to put into words the difference between a hospital and a natural birthing center, said Ramsey, a 16-year veteran certified nurse midwife, most spent with the University of Nebraska Medical Center.
"You almost have to experience it."
You don't have technology. You don't have IV machines. You don't have fetal monitors.
You don't have different nurses coming in and out of the room. One nurse, on duty for 24 hours, is available.
And certified nurse midwife Ramsey is there when the mom needs her -- calming, coaching, encouraging.
Although the bed looks like the central attraction, only a couple of women have given birth in one.
Most women give birth in the hot tub in the adjacent bathroom, Ramsey said.
Nicola Plummer was certain she did not want a water birth.
But Plummer said she found the water so soothing, so much more comfortable than the bed, and that's where she was when her body decreed Donatella Lucille would be born.
There are safety precautions, just in case -- resuscitation equipment for both mother and newborn, medication for resuscitation and bleeding afterward.
And the center is just two minutes from the Bellevue Medical Center, which is one major reason it's in a strip mall, Ramsey said.
The center does not handle high-risk pregnancies. No multiple births, no breach babies, no hypertension or pre-eclampsia. No diabetes here.
High-risk pregnancies have better outcomes in hospitals, Ramsey said.
Women attracted to the birthing center are the healthiest of the healthiest, Ramsey said. So the odds of something going wrong are small.
"They don't smoke. They don't drink. They exercise. They eat well. They grow a healthy baby and therefore grow a healthy placenta."
The Midwife Center is one of more than 230 freestanding birth centers across the country, and the first in Nebraska.
It's difficult to start a midwife-operated birth center in Nebraska, in part because of a strict state law that requires certified nurse practitioners -- RNs with master's level training -- to have written agreements with supervising physicians.
A midwife built a birth center in Norfolk in 2005, but it never opened after the supervising physician decided not to sign an agreement.
Lincoln could support its own birth center, said Jearlyn Schumacher, a certified nurse midwife who practices at the Hearts and Hands Clinic.
"We have enough patients in our group who would love to be able to deliver at a birth center," she said. "And we have had several patients, who have talked to us about a birth center.
"At this point, we don't have a physician in Lincoln who is really comfortable with an out-of-hospital birth."
Nebraska women have had no good options other than hospital births because state law forbids certified nurse midwives from helping at home births.
Still, some Nebraska women do give birth at home, with family or uncertified help.
And Ramsey has been surprised by the number of women seeking her out who previously have given birth at home.
"These are good, honest people and I think they don't want it to look like they are doing something illegal," she said.
The Midwife's Place is a low-cost option for women who want to give birth naturally, without drugs or other medical intervention.
The cost -- about $2,000 compared to the $10,000 average for a hospital delivery -- is covered by most insurance policies, Ramsey said.
Women also stay 12 hours or less. Mom and baby go home four to six hours after delivery.
Women should be recovered and should feel safe to go home in a few hours. If not, then they should be in a hospital, she said.
And there is early and consistent follow-up for mom and baby, she said.
Ramsey can keep costs low because she doesn't have to have a blood bank or a 24-hour in-house anesthesiologist. There's no operating room, and she doesn't staff seven days a week.
The center is licensed by the state, accredited by the Commission for the Accreditation of Birth Centers, and Ramsey practices under an agreement with Bellevue physician Brian Finley, who is medical director and collaborating physician.