A startup nonprofit called Birth Detroit is working to address a seemingly intractable problem pervasive across the United States: a health care system unequipped to provide culturally congruent care in a way that ensures equitable outcomes for all birthing persons and their children.
Gender Inclusivity in Pregnancy
Recognizing that pregnant, birthing, postpartum, and parenting people have a range of gender identities and do not always identify as “women” or “mothers,” this story uses both gendered terms such as “women” or “mothers” and gender-neutral terms such as “people” and “birthing persons.”
Among 11 high-income countries analyzed in a 2020 research report by The Commonwealth Fund, the United States was the only country not to guarantee access to maternity care provider home visits or paid parental leave in the postpartum period. The U.S. also had the highest maternal mortality rate and was found to have too few providers relative to the number of births.
While this affects all Americans, communities of color bear the brunt of the burden. When compared to their White peers, Black and Latinx women are significantly more likely to experience physical or mental illness related to pregnancy or childbirth, and Black women are three times more likely to die. With the United States already spending more on health care than any other nation, these persistent racial disparities point to the need for a new approach, which is exactly what Birth Detroit is bringing to the table.
“Birth Detroit is a justice-oriented response to systemic racism in the health care system,” says Leseliey Welch, the organization’s co-founder and CEO. “Our goal is to change the culture of birth and establish a model of care in Detroit that produces better birth outcomes, a better patient experience, and reduces costs in our health system.”
To do so, the organization is embracing a community organizing model to develop Black-led, community-based midwifery clinics and birth centers, both of which have been proven to improve outcomes and experiences for birthing persons at lower costs when compared to hospitals.
In a Nutshell
What: Startup nonprofit Birth Detroit is addressing persistent racial disparities in the health care system for birthing persons of color and their children by establishing a new model of care in Detroit, with a goal to open the city’s first freestanding birth center. The center will be Black-led, staffed by Black midwives, and focused on supporting birthing persons of color before, during, and after they give birth to improve health outcomes, strengthen the patient experience, and lower costs as compared to hospitals.
Sector: Health care
Location: Detroit, MI (Fitzgerald)
IFF Support: Facility feasibility analysis completed by Michigan real estate team
Anticipated Impact: In the next 10 years, the development of two birth centers, multiple neighborhood midwifery clinics, and midwifery training partnerships that enable culturally congruent care and healthy birth outcomes for more than 10,000 pregnant families in Detroit, as well as training and capacity building for hundreds of Black midwives.
As the name suggests, midwifery clinics are staffed by midwives, who are trained health professionals that partner with birthing persons and families to support them in making smart health care decisions informed by the culture of the family and the community where they live. In the neighborhood clinic setting, midwives provide safe, nurturing, hands-on prenatal and postpartum care.
Birth centers offer the same services provided by midwives, but also enable birthing persons to choose to have their baby on-site as an alternative to hospitals. In both settings, which are generally home-like atmospheres, midwives honor pregnancy and birth as normal life events and are focused on creating positive birth experiences.
While the midwifery model of care offered at clinics and birth centers is well established in much of the world, access is limited in the United States – and almost non-existent in communities of color. There are nearly 400 freestanding birth centers across the United States, and less than five percent of them are BIPOC-led. In Michigan, there are only six birth centers statewide – none of which are in the City of Detroit and none of which are BIPOC-led.
Birth Detroit, which launched in 2018, set about addressing this challenge by hearing directly from members of its community about what was needed to better support birthing persons of color before, during, and after they give birth.
“One of the first things that we did was to hold a series of stakeholder interviews with folks who are already doing maternal health work in Detroit, as well as a focus group with moms and a community survey that almost 400 Detroiters – mostly Black – completed,” Welch says. “What we learned was that there’s a resounding need for the type of services provided at birth centers and that people didn’t want to wait to have access to prenatal and postpartum care provided by Black midwives while we raised the millions of dollars that it takes to open a birth center.”
That realization led the organization to open a neighborhood midwifery clinic called Birth Detroit Care as an interim step on its path to developing a birth center. Birth Detroit Care began operating in October 2020 in northwest Detroit, enabled in part by a partnership with child and youth services agency Brilliant Detroit, which made part of its existing facility, Fitzgerald House, available to house the clinic.
Birth Detroit Care is the only community-based, easy-access midwifery care clinic in Detroit, and it offers services like confirmation of pregnancy, prenatal screenings and labs, ultrasound, labor preparation, childbirth education, and warm referrals for other supports. To make its services as accessible as possible, the clinic offers non-traditional clinic hours two days per week and, since opening, has cared for nearly 120 families and completed approximately 175 perinatal health visits – all of which were free of charge to patients because of private funding secured by the organization. In the coming year, Birth Detroit expects to expand the clinic’s service offerings to include routine gynecological care within the midwife’s scope of practice and begin billing insurance providers to generate new revenue for the organization.
What we’re talking about is changing the culture of birth. Looking ahead 10 years, my hope is that every birthing person who wants a midwife can have a midwife and every birthing person who wants to have their baby in a birth center can do that.
While opening the Birth Detroit Care clinic was a major accomplishment, Birth Detroit has continued to work toward its ultimate goal of opening Detroit’s first freestanding birth center. IFF’s real estate team in Michigan completed a facility feasibility analysis to determine the space needs for a birth center, estimate development costs, and examine how the organization’s operating budget will change after opening the center. Empowered with that information, Birth Detroit is now focused on identifying a suitable location for the center and securing the remaining funds necessary to develop the center and support its operations for the first two years after opening. Though much work remains, Birth Detroit’s vision for the center is already well established.
“Imagine walking into a beautiful, warm home where there are plants and artwork that reflects your culture,” Welch says. “It’s not a mini-hospital, but a maxi-home that just happens to have exam rooms and large birth suites with all of the clinical supplies needed to support birthing – just not as the most prominent features in the space. The home also has a community space for childbirth education, a large kitchen for cooking classes, a room filled with toys for children, and a beautiful garden in the backyard to source food for families who visit the center. Essentially, it’s a private, cultivated community space that supports a positive experience for the hundreds of families who visit every year.”
Research shows that 80 percent of people giving birth in the United States could safely do so in a birth center, supporting the potential of Birth Detroit’s efforts. By establishing Black-led centers dedicated to providing culturally congruent care to BIPOC families, while also partnering with hospitals as part of an integrated system, Birth Detroit’s work can meaningfully improve public health outcomes for Black mothers and their children.
“What we’re talking about is changing the culture of birth,” Welch concludes. “Looking ahead 10 years, my hope is that every birthing person who wants a midwife can have a midwife and every birthing person who wants to have their baby in a birth center can do that.”
Photo Gallery: Birth Detroit in Photos
Click the image below to see photos from Birth Detroit’s work, including an initial design concept – still to be finalized – for the organization’s first freestanding birth center.