Take pregnant people seriously, support birth centers

Let science in to address failing maternity system

I RECENTLY RECEIVED a call from a pregnant friend. She felt that her prenatal visits with her obstetrician were a waste of her time. In the last visit, the OB had rattled off a series of dire complications that “had never occurred to her” but were possible. Seeking a different approach, she asked her obstetrician to recommend a midwife. The physician responded that she didn’t know any and that she couldn’t recommend one anyway because “the midwife would take over her care.” My friend was incredulous that after two decades of practice, this obstetrician wouldn’t know a single midwife and decided to change her caregiver.

Midwifery is safe. Birth centers are safe. These are scientific facts, some of which I shared in a book I wrote about how to open and operate birth centers in low and middle income countries. I also opened and operated birth centers in Chiapas Mexico (border with Guatemala), and another in Mexico City. In 19 years of operation, these two centers have had better outcomes than the local healthcare system, including no maternal deaths and a cesarean rate that remains stable at 10 percent (Mexico’s national cesarean rate is 45 percent).

This past week, a new study demonstrates the safety of birth centers in Bangladesh. If midwifery and birth centers are safe in these adverse, vulnerable environments, then they must be very safe in Boston. We know they are, and instead of supporting them, they are closing.

The recent closures of the Beverly and Cambridge Birth Centers are a discouraging reminder that that many highly renowned academic medical centers fail to follow scientific evidence in maternal health service design. Families and advocates are rallying for obstetricians, and the hospitals that they influence, to recognize and integrate the piles of evidence we now have on what works in maternity care. What works is a rational, responsive, and effective system that addresses the problems so clearly described in the Massachusetts Legislature’s report issued earlier this year, Racial Inequities in Maternal Care. One if its recommendations is opening more birth centers.

It is surprising to me that families fighting to save their birth centers in Beverly and Cambridge have less access to safe and culturally appropriate birth models than women in Bangladesh and Mexico. As a scientist, midwife, and global consultant in improving the quality of midwifery care, I urge that we work together to:

Integrate midwives into the healthcare system: For real. Not as a radical choice that alternative, high income moms make when they want a home-water-birth with dolphins. Midwifery must be an option as soon as women make their first appointment. Would you like to see a midwife or a physician? Are you planning for a home, birth center, or hospital birth? What makes you feel safest and most supported?  This is how we should approach maternity care design.

License and regulate certified professional midwives so that they can be part of the formal system: Keeping midwives marginal to the system worsens outcomes for moms and babies. I know because I was transported from a home to hospital during my daughter’s birth, and lived the brokenness of the system first hand.

Meet the Author

Cristina Alonso

Certified professional midwife/ Board member, Our Bodies Ourselves
Plan to open and operate more birth centers: This requires revising current regulations that support birth centers to function as such, not as surgery centers.

Provide more options for midwifery education: We cannot staff birth centers and hospitals with midwifery practices without midwifery education programs within our state.

Prioritize the voices and concerns of childbearing families: Parents like my friend must lead the conversation, because their own experiences are critical to addressing the problems we face.

The current system produces train crashes over and over again. As I read yet another report on the failing maternity care system in the US, I wonder when we will “let science in” and take pregnant people seriously.

Cristina Alonso holds a doctor of public health from Harvard University, is a certified professional midwife, sits on the board of Our Bodies Ourselves, and is mother of a child born by emergency cesarean in a Boston Hospital after an attempted home birth. She consults on domestic and global maternal health projects.