To grow a powerful infrastructure of community birth centres we need to shift the ways that people think about, talk about, and imagine birth centres.

In recent years, the landscape of maternal and infant healthcare has undergone a transformative shift, with an increasing recognition of and need for the vital role that birth centres led by Black, Indigenous, and people of colour (BIPOC) play. This shift is perhaps most obvious in the US where maternal mortality is the highest in the world amongst developed nations, especially for Black women and birthing people. These centres are a direct response to the demand and need from these communities for culturally competent, holistic care, and community empowerment. In this blog post, we delve into the essence of BIPOC-led birth centres in the US, exploring their potential to address disparities in maternal health outcomes and the obstacles they confront in expanding their reach. 

In anticipation of their inaugural Birth Center Week (September 14-20), we connected with our partners at Birth Center Equity, an organisation dedicated to making birth centre care an option in every community, to learn about the role and potential of BIPOC-led birth centres within the American health system and beyond.

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What is a birth centre?

According to BCE, a birth centre is a home-like place where midwives provide prenatal, birth, and postpartum care. Birth centres are freestanding and not in hospitals. Community birth centres provide safe, culturally-reverent, midwifery-led healthcare for all. Birth centres are anchors for community wellness and community health infrastructure. They should be seen as the crucial part of a vibrant health care system and the core to rich community culture that they are.

The present birth care system is recent and left behind much of the best practices and wisdom of care that birth centres seek to educate the community about. They aim to empower the community with knowledge so they can make the right decision for themselves and very often, that will be using a birth centre.

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What is the Midwifery Model of Care?

The midwifery model takes a holistic, relationship-centred approach to the pregnancy and birthing continuum. BCE recognises four key principles for this model of care: 

1. Care that is built on a trusting and respectful relationship between the midwife and the childbearing person.
2. Care that prioritises and encourages the parent’s autonomy, self-determination, and satisfaction.
3. Informed decision-making in partnership and the child-bearing person.
4. An environment of care that creates a sense of safety and assurance for client and midwife.

Research indicates that midwife-led continuity models of care are associated with benefits for mothers and newborns, such as reduction in the use of epidural anaesthesia, fewer episiotomies and instrumental births, and increased spontaneous vaginal births and increased breastfeeding. Women were less likely to experience preterm birth or lose the baby before 24 weeks gestation. The chances of being cared for in labour and birth by a midwife they had gotten to know increased. 

Additional information on midwifery-led continuity of care is available through the International Confederation of Midwives. 

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Birth Centre Potential

Midwives and midwifery-led birth centres are critical to improving sexual and reproductive health care and outcomes, reducing maternal mortality, and saving newborn lives. Midwives who are educated and regulated to international standards can provide 87% of essential care needs for women and newborns. Universal midwifery coverage by 2035 would avert 67% of maternal deaths, 64% of newborn deaths and 65% of stillbirths. It would save an estimated 4.3 million lives per year by 2035. Even a modest increase of 10% midwifery care by 2035 would result in a 20% reduction in maternal and newborn deaths. 

Midwifery is a ‘best buy’ for maternal and newborn health, with more efficient use of resources and high standards of care than other forms of reproductive and maternal health care. Investing in midwifery education and training and funding more birth centres results in a 16-fold return, in lives saved and medical interventions avoided. 

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Barriers to Expansion

In their work and in community with others, BCE sees three key narrative barriers that stand in the way of community birth centres: fear, scarcity, and oppression.

Fear: Problems and fear overshadow the powerful expertise and leadership of midwifery-led community birth centres that is necessary for change. 

Scarcity: Birth centres are seen as “boutique” models of care that cater to high income and white people. 

Oppression: Action with a narrow focus on shifts in individual birthing people’s actions (e.g., “look for good providers”), or a shift in individual providers’ actions (e.g., “be culturally sensitive”). 

These narrative barriers contribute to:

• Birthing people – especially Black, Indigenous, people of colour – feeling alone and afraid and disconnected to birth centres;
• Reinforcement of racist stereotyping and victim blaming of Black and Indigenous birthing people;
• Erasure of the legacy of Black, Indigenous, and immigrant midwifery expertise on which current best practices are based; 
• Under-resourcing of birth centres generally, especially to crucial BIPOC-led community solutions;
• Birth centres being seen as luxuries for a few rather than as core health care for all;
• Resources directed at marginal and ineffective interventions;
• Systemic harm remaining intact and people feeling powerless to make real change.

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How to Make Change

Join the Birth Center Equity Network in launching the first annual Birth Center Week starting September 14th until September 20th - a week of virtual convenings, a video release, and more!

Birth Center Week will amplify, celebrate, and grow resources around the impact, power, and potential of birth centres, with a focus on lifting up Black, Indigenous, people of colour-led community birth centres. Sign up and learn more at birthcenterweek.com and use the hashtags #MidwifingJustice, #BirthCenterWeek, and #BirthCenterForEveryCommunity on social media.

This year’s theme is Midwifing Justice which means that in our work and words we are:

• Moving from fear to safety.
• Moving from scarcity to abundance.
• Moving from oppression to liberation.

These centres are not just healthcare facilities, but beacons of hope and change. Their commitment to culturally sensitive care, maternal empowerment, and community involvement paints a picture of a brighter future for maternity care—one that is accessible, respectful, and considerate of every individual's unique needs.  The barriers they face in expanding their reach highlight the need for collective support and advocacy so, let's continue to champion these centres, celebrate their accomplishments, and collaborate to create a future where every birthing person receives the care they deserve.