SXSW '25: Elaine Epstein on Arrest the Midwife

In 2018, Elizabeth Catlin was arrested on felony charges for practicing midwifery in the Amish and Mennonite communities of upstate New York. Charges swiftly followed for two other midwives, sparking a wave of activism from Amish and Mennonite women to protect reproductive rights and freedom of choice. Feature documentary Arrest the Midwife, which had its world premiere at the SXSW Film Festival, charts the court cases and their impact on the surrounding communities, connecting the story to the broader reproductive rights movement in the United States.

We sat down with director Elaine Epstein to discuss how she approached telling this story, navigating legal and personal obstacles, and creating trust with the documentary’s subjects.

The following conversation has been edited for length and clarity. 

How did you get involved with telling this story?

I came to the story through my own personal experience with having children. When my wife and I decided to have children, we were really completely clueless, and we were like, “We'll do what most people do. We'll go to the clinic.” And we tried, and it just felt horrible. It felt very alienating and impersonal. And so a friend of ours suggested that we meet with a midwife, and we met with her, and the experience was so radically different. We really got to know her. She got to understand us. She took into account what we wanted. And the process worked very fast and our child was delivered by a midwife nine months later. And then when we were thinking about having a second child, we went back to the same midwifery practice because there was this huge demand, and we wanted to use the same practice again. And to our surprise, it had shut down. 

I started digging deeper, and then I learned about the pressure against midwives from so many directions, from the medical industry, from the health insurance industry. I didn’t want to do a big essay film, so I wanted to find a story that I could explore the issue through. And I was reading the New York Times, and I read about Elizabeth Catlin's arrest for being a midwife in an upstate New York community. [We were in conversation] and I was packing for a family vacation, and [Elizabeth] called me and she was like, they've just indicted me on 95 felony charges. So I canceled the vacation, pulled the team together, and we went up and started filming. That really is how the film came to be born,

How long did the production process take from conception to the final product? 

We started in January 2020, and I never expected that the arc would play out the way it did. I thought I was making a film about one midwife, and the story just developed in this whole new way, because then Melissa Carmen was arrested, then Lisa Horning was arrested. The most surprising aspect of the film was the Mennonite and Amish communities, many of whom don't get involved in politics, have never voted before, and how they become these political activists fighting for reproductive rights. 

Did you find it difficult to adapt as the story was changing in real time?

I hate to say this, but it was the story that just kept on giving. I was like, I can't believe this story is developing. I was shocked. It was just this narrative that got stronger and stronger as we went along.

Some of the scenes that most stuck with me were where you’re filming the midwives as they’re helping birth babies. How did you build trust with your subjects and approach those personal, intimate scenes?

Firstly, we knew we couldn't make the film without the participation of the Amish and the Mennonite communities, and they don't normally let cameras in. So in the beginning, I met with Liz, and with the help of Liz's daughter, we just had an informal meeting with a number of women that Liz served, and it was a great meeting. And we just discussed if they would be willing to participate in the film, and if they did, how would they like us to go about filming? And that was key in moving forward. A lot of people have said, “Oh, you've got such intimate access. How did you do that?” Really, it was the woman's passion for the issue. And I really think it was like an extension of their activism that they agreed to be involved in the film. And then it was kind of a self-selecting process, because I met different community members along the way, and met the more outspoken woman, and they really let me in. 

We were very sensitive to not overstepping. As a filmmaker, sometimes you get really excited about filming a scene and you're like, “Oh God, I just need to get the camera in there,” and I did that once with Lisa. It's a scene that's not in the film, and it's not a birth, but I definitely overstepped a little, and I felt so terrible. I called [and said] I never meant to overstep, and we chatted about it, but it was at that point that I really was like, “the minute we feel like we're not wanted, or even if there's the slightest bit of discomfort in the room, cameras go down.” And so we approached filming in that way, which didn't give my editor, Rachel Schuman, a lot of footage to work with. So she did an amazing job pulling this film together. 

With the birth scenes, we were just very respectful again. We weren't there to film the birth, we were there to film Melissa. That was our focus. So I think going in with that understanding enabled us to capture those scenes. 

I thought those scenes were really special. It’s not something you typically see onscreen, but it adds so much more meaning to the story you’re telling.

Right? And I always have to say it's like, how lucky we are that the baby that we filmed is the cutest baby. I was like, “No baby comes out that good looking.” I was shocked. [Laughs]

You were dealing with a lot of intersecting, thorny issues with this documentary. Were there any obstacles you faced as you were telling the story?

We had access to the courtroom in the beginning, and then they shut us down. In New York State, you can film an arraignment, you can't film a trial. That was challenging. Another challenge was being respectful and not filming hours and hours of footage. We really were tight in terms of the footage. But it was just amazing how these women let us in. 

I also had a young child at home, and having to travel up to the Finger Lakes all the time [was difficult]. Three weeks after my son was born, I went and sat up in the Finger Lakes for a week waiting for a birth that never happened.

Is there a filmmaker or a particular movie that influences your work? 

I think I learned my lessons about filmmaking along the way. I definitely have a very strong activist voice, and so I always have to quiet that down and remember that I'm making a film first, the story first and activism second. In terms of filmmaking, there's always one person that I come back to. It's a filmmaker out of the UK, Kim Longinotto. I love her work. She shoots the most insane verite films, and so I've always drawn on her films as inspiration.

What are you hoping the reaction to be after releasing this?

South By was great. It was our first public screening, and it's always nerve wracking. No pun intended, but it really is like bringing your baby into the world. And the reaction has just been so fantastic. We were blown away. And we're excited to roll this out. It's going to be airing on the PBS POV documentary series next year, and we'll continue to do festival rollouts. And then we are working on a very robust impact campaign, which is in the works as we speak.

Do you have any other projects on the horizon?

After living in New York for 25 years, I have moved back home to Cape Town, so I'm really excited about telling a story that is based in Africa. I'm helping on a film about global health in Africa, which is the complete flipside of what's happening [in the U.S.], where we have the super high C-section rate, and in Africa it's 2% of women don't get access to C-sections and are dying. I always say that I want to do something that's light-hearted and fun, but I definitely keep getting drawn to the darker stories, and there are a lot of them right now. 

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