the current context in MA

NBC’s Policy Director is Katherine Rushfirth, Certified Nurse-Midwife and Legislative Co-Chair of the MA Affiliate of the ACNM. In spite of working in the field of maternity care for a decade, she is a Lynn, MA mom who could not access the care she wanted for the birth of her children old.  At the time she was pregnant in 2019, Beth Israel Lahey Hospital had underfunded and understaffed the North Shore Birth Center so badly that if a midwife were sick or on vacation, they couldn’t staff the birth center and all their patients were funneled to the hospital. That was the case when she went into labor on October 20, 2019.  By the time of her second pregnancy in 2022, the birth center had completely closed and there were no independent midwifery services in the North Shore.

The birth center closure that impacted Katherine is happening all over the state.  There have been six maternity care closures since 2020 – two of which are hospital-owned birth centers – leaving just one open birth center in Western Mass. And while maternity care closures are a national issue, Massachusetts is doing particularly poorly with access to midwives and birth centers.

Massachusetts needs midwives! (and Water is Wet.)

MA ranks 32nd in the nation for the integration of midwives (meaning how midwives are made a part of the healthcare system.) We are in the minority of states and the only state in New England that does not reimburse midwives equitably to physicians for the same service. MA is 1 of only 12 states that do not license Certified Professional Midwives (CPMs), who are experts in out-of-hospital birth who would be ideal birth center staff members. For decades, MA birth center regulations have been onerous, costly, not rooted in the evidence, and do not to contribute to patient safety. And all of these lead to inadequate access to midwives, birth centers, and their life-saving and life-affirming care. 

And there is a growing number of people who know this and are calling for equitable access to midwifery.  Report, after report, after report – produced by health policy experts, clinicians, public health researchers, community members, and the Governor – have named midwifery care as a solution that needs to be valued and invested in. We need no more research – water is wet and midwifery is the answer to the crisis of maternal health. We need action!

“Impossible Math”

Our next hurdle to tackle is what our colleague in Minneapolis calls the “impossible math.” That the systemic undervaluing of midwifery care, birth centers, and frankly birthing people, means that birth centers revenue can rarely keep up with operating costs.  Too many birth centers face this with the Herculean effort of midwives – birth center midwives work an average of 99 hrs/week, make $30-40K less than their hospital counterparts (or forgo salaries for the first few years altogether!), or because of having less negotiating power than hospitals, they are offered atrocious reimbursement, and decline to accept Medicaid or even private insurance. A cash pay model, of course, shapes who can access care.

At Neighborhood Birth Center, we are committed to fair salaries and reasonable work hours for our midwives and to serving at least 50% MassHealth clients.  But integrating our values into the operating model gives our team nightmares about the “impossible math.”

But look what can happen if we don’t even “reimagine” the system – we just make the current system fair. We did an analysis last summer with graduate students on reimbursement rates for birth centers.  They found that birth centers are being reimbursed less than half of what their transfer hospitals are for the same service – normal vaginal deliveries, pap smears, IUD placements, and even whooping cough vaccines. Our analysis found that if birth centers were reimbursed equitably by all insurers, our reliance on philanthropy to cover our operating costs would go from almost 50% to less than 10% by year 2. We are pushing this issue at the MA Legislature, the Dept. of Public Health, with MassHealth, and with private insurers, and we are hopeful for lasting change!

Here are NBC’s top things to celebrate from 2023!

We grew our team! In 2021 Nashira and Jessie became our first paid staff. They lead the organization with might at 1.5FTEs. This spring, with Jessie headed to midwifery school, we reflected on the growing needs of the organization and added capacity: we are now 5 people strong! Charlotte is our fearless operations and sustainability manager – we see her role to midwife the organization through this long labor and to focus on how we build a sustainable organization. Tiffany and Shaw Pong lead our community engagement strategy and communications. Together they are working at the grassroots to shift the narrative from birth as scary to birth as powerful. Katherine, our amazing policy leader and nurse-midwife, began as a consultant in 2022, and came on full time in 2023. And there’s our Executive Director, Nashira, has stewarded this project since 2014.

key highlights!

Tiffany and Shaw Pong led the launch of our free programming this fall. The programming was intended to gather pregnant and postpartum (even those of us perpetually postpartum) people to share birth stories through talk and art and to build empowered birth plans. Each of the workshops brought out new friends and created space for people to connect. 

2023 was a year of NBC and midwifery in the news! From Op/Eds to podcast interviews to an NPQ piece called Birthing Black: Portals to a Gentle Future, we did our best to shift the narrative from the trauma-porn of the crisis of maternal health, to talk about solutions, birth joy, and what lies ahead when Boston has a birth center. (See all the news here!)

We had our 1st Midwifery Advocacy Day! In partnership with Baystate Birth Coalition and the Mass Affiliate of the American College of Nurse Midwives. On the hottest day in October, we gathered with nearly 100 people on the steps of the state house to raise awareness of the dire state of midwifery in the state and the bills submitted that could redress the decades of divestment in midwifery. We engaged our #fav legislative champions and brought in new supporters.  

Best moments of 2023

We bought property in February! After signing a transfer agreement with Boston Medical Center in 2021, we dropped a pin in the map and began searching for property with less than 10mins drive to the hospital. In the late summer of 2022, we heard about 4 residential parcels for sale by a developer in Nubian Square, Roxbury, the heart of Boston. Just 6 minutes from the hospital and steps to a bus stop on Warren Street, we began to inquire about how a birth center would be received by the abutters. After many conversations in the neighborhood, we believed we had enough buy-in and the commitment to design a property that integrates neighbors’ wishes. We are still in the design phase, having gone thru many iterations of schematic design this year in our efforts to be a good neighbor, and to build something we can afford.  

Capital campaign by the numbers

Before we even had property, we knew we’d need to launch a capital campaign to have any resources ready for when we found property. Knowing how vulnerable birth center operations are, we set a goal to raise $3M so we could purchase property and not saddle the birth center with a mortgage. We anchored ourselves in the spirit of abundance - knowing that there are enough resources in this city and this state and this country, for us to have the birth center Boston deserves. We did not want to cut corners before we started. We were guided by Alison and Alyssa and the wonderful folks at Wright Collective – our incredible fundraising team. We couldn’t have done it without them!

While $3M is a rounding error for some institutions in this city, we were commited to a barn-raising-grassroots campaign. With nearly 2000 donors, 25 events, and contributions ranging from $5 to $800K, we raised $3M in under 24months. Give yourselves a round of applause. You did that! We did that together! Now we enter our “Gratitude Campaign” - a year of activities to bring you all in closer to the birth of this birth center. We’ll have architectural charretts, fun family events, and many opportunities to engage on the policy front. 

Building a solidarity economy

Our journey to owning property and building the birth center in Roxbury did not begin and end with our capital campaign. Seven years ago we began conversations with other movement leaders that practice and are working to build a solidarity economy - where resources and power are shared, where social impact outweighs financial profits. Our partners in this work include City Life Vida Urbana, The Center for Economic Democracy, Resist, and Movement Sustainability Commons. Together this collective imagined the “Community Movement Commons” as a portal to a just and sustainable future that is anchored by the birth center, and boasting gathering space for community. When we found the property near Nubian Square, we began to easily envision how each of our organizations could co-exist in this shared space, and also have the autonomous space they need to thrive. To engage with neighbors and hear their ideas, we launched a summer series called Wednesdays on Winthrop – with hot dogs and ice cream and music, that culminated in an – albeit rainy – block party in October and weeks of door knocking this fall to share the renderings and ask for support as we head into a rezoning process with the city of Boston. The process to get here so far has been held by our project managers at Co-Everything and our architects at MASS DESIGN Group. This effort is not without significant challenges, but no work of liberation has never been easy.

This is where we landed this fall - and this design will likely change again as we wrestle with construction costs, timelines, and continue to integrate community feedback. The process to get here has been held by our project managers at Co-Everything and our architects at MASSDesign Group.

behold, Your birth suite!

Far right is a rendering of the first and second floors of the birth center. Clinic space in the front along Winthrop Street and 3 birth suites in the rear, nestled in the trees.

And in the center is a rendering of a birth suite from our architects at MASSDesign Group! Notice the Swedish bars in the foreground for hanging on and stretching while in labor. There is a large birth tub, birthing stool, hooks in the ceiling for a silk swing that can provide comfort in labor. The bathroom is fully tiled so that water can be sprayed on the back or perineum while on the toilet. The bathroom is spacious enough for the midwife and/or birth partner to join. French doors lead to a “labor garden” where people can get fresh air, touch the elements, and move about.