Leseliey Welch and Indra Lusero, parents and birth justice advocates, are helping to lead a movement to create community birth centers across the nation. To help address the maternal and infant mortality crisis, they’re realizing a vision where midwives are the leaders in care in a reclamation of the normal physiologic process of birth. They say birth centers provide racially and culturally reverent care founded in safety, love and trust.

This is an episode of the Bioneers: Revolution from the Heart of Nature series. Visit the radio and podcast homepage to find out how to hear the program on your local station and how to subscribe to the podcast.

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Transcript

Host: In this episode, we visit with Leseliey Welch and Indra Lusero, parents and birth justice advocates who are helping lead a movement to create community birth centers across the nation. To help address today’s dire maternal and infant mortality crisis – including the most negatively impacted communities of people of color and LGBTQ people – they’re realizing a vision where midwives are the leaders in care in a reclamation of the normal physiologic process of birth. They say birth centers provide racially and culturally reverent care that’s founded in safety, love and trust.

I’m Neil Harvey. This is “Midwifing a Movement: Community Birth Centers and the Care Economy”.

Leseliey Welch (LW): I want to invite you to picture a different way in birth. And the invitation is to imagine a world where birth is safe, sacred, loving and celebrated for everyone. Imagine giving birth with midwives in a community birth center designed in response to the dreams, hopes, and needs of the community it calls home.

Host: Leseliey Welch is co-founder and CEO of Birth Detroit, which will be the first midwifery-led birth center in Detroit. She shared her vision at a Bioneers conference…

LW: You walk through the door so happy to be able to receive care at a community birth center right in your neighborhood. You, your partner and your children are greeted by name, maybe even with warm hugs. You are asked how you are doing and you can tell that the person asking genuinely cares. They offer you water, tea, snacks, and you settle into a cozy sofa. There are shelves of birth, nutrition, breastfeeding and parenting books for you to borrow, and a little toy nook in which your little ones can play.

In the examine room, you feel at home with the warm colors and cozy furniture. Your partner even feels they belong here too, with posters celebrating Black and Brown fathers and disabled, queer and trans bodies. Your midwife greets you and you remember how relieved you felt the first time you met, knowing that they were from your community. They welcome your whole family to the visit. Your kids listen to the baby and see them on the ultrasound. Your midwife asks you about how you’ve been feeling physically and emotionally, what you’ve been eating and how much rest you’ve been getting. They talk with the whole family about ways to connect with the baby and how to support you. It’s unlike any medical care appointment you have ever had, and when it’s time to go, you almost don’t want to leave.

When you go into labor, there’s no frantic rush to the hospital. Your partner calls the midwife, the midwife reminds you what active labor looks and feels like, and how to know when it’s time to come into the birth center. Hours later, you’re on your way. You walk into your birth suite and breathe a sigh of relief. Your midwife is there and they have prepared for your birth journey. You feel loved knowing that  you can labor where and how you feel called to. Your power playlist comes through the speakers while you move and sway and breathe. You walk some. You sit on the toilet for a time. (Y’all know that’s comfortable if you’ve had a baby.) And then you move to the birthing tub.

Your partner whispers reminders of your beauty, your strength, your power. A familiar scent wafts from the kitchen where family is warming food they prepared for you earlier. Your kids are playing in the living room of the birth center. And labor is hard work, yet your surroundings are soft and gentle. You feel seen, heard, honored and supported, letting go of any concerns that you can’t do this.

You feel your baby’s head emerge. The midwife’s eyes are reassuring. You change positions at will, responding to the knowing in your body. The surges come with more intensity. You may burrow into your partner’s chest. The newest member of your family arrives Earth-side in this sacred container of love, and everyone and everything is forever changed.

Host: Leseliey Welch has long held this vision for community birth centers. As co-founder and CEO of Birth Center Equity, she helps lead the national initiative to help Black, Indigenous and people of color overcome the barriers to opening holistic birth centers in their communities, which are the most negatively impacted by the maternal and infant mortality crisis.

As a Black mother and queer person, she knows from experience what a difference specific kinds of care can make – including making the difference between life and death…

LW: I am doing the work that both breaks and bursts open my heart. I know the joy and grief of pregnancy and childbirth. I’ve had a pre-term baby myself. I’ve spent time in NICU with my baby myself. And I have had a loss. I have grieved a loss. I have had a rainbow baby, born on their due date and barely made it to the hospital. And I’ve also been present with my family when my nephew was born and passed away the same day – born too small, too soon. And at that time, I worked at the city health department in maternal child health, and I would later read his name on the list of infants we lost that year. Right?

And so I share that not to ground us in grief, right, I want us to center on vision, but I also want to honor the grief and loss that comes with our birth experiences, and that the visioning is joyful but it can also sometimes feel painful when we know that our births were nothing like that vision. Right? And so every day I work toward that vision because it’s the vision I wish my brother and sister-in-law had; it’s the vision that would be the reason my nephew is still here; and it’s the vision we all deserve.

Indra Lusero (IL): So about 22 years and two or three weeks ago, having completed the childbirth preparation courses at the local hospital, I, nonetheless, knew that something was missing. And I was not the gestational parent of my oldest son to arrive at this place of him being about 38 weeks gestated, we had already been through countless experiences of being othered and excluded from healthcare; we were told that we couldn’t have a family in this way; we couldn’t do this. So we were already at this place that people told us we couldn’t be. 

Host: As a queer Latinx person, Indra Lusero’s experience reflects the kinds of judgment, bias and othering that queer couples routinely face during the profoundly intimate and vulnerable journey of giving birth. 

Lusero is the founder and Director of Elephant Circle, a Colorado-based organization that also works nationally on reproductive justice.

Inspiration for the name came from how elephants give birth in the wild. The whole herd circles around the laboring elephant. They stay for the duration – connected, emoting, supportive. At this sacred and vulnerable moment of emergence, the elephants form a circle of protection and defense.

Indra believes that’s what humans need to do too.

IL: And I had this sense that there was basically a soul missing from this care that we had been so far receiving. I didn’t know what to do about that fact, I just knew it. I ended up just asking people, “Isn’t there something else? I feel like there should be something else. Isn’t there something more here?” Fortunately, I was connected with a woman who’s a midwife in the community who met with my partner of the time and I for like an hour, just free, sharing with us this alternative vision. 

At that time, my partner wasn’t able to make the leap mentally to planning for a home birth after having planned this whole gestation for a hospital birth, so this midwife agreed to be our doula and go into the hospital with us, undeniably and totally transforming that experience. I am 100% confident that it would have been totally different if we hadn’t made that connection.

Host: The context for the rise of birth centers is the scandalous national maternal health crisis. Among developed countries, the U.S. has triple the infant and maternal mortality rates. And it’s only been getting worse. Between 1999 and 2019, the number of U.S. women who died within a year of pregnancy doubled.

Poverty and race play a key role. Women face a 60 to 100% greater risk of death in counties with middle and high poverty rates. Black women are three times more likely to die from pregnancy-related causes than white women. Indigenous women are also at far graver risk.

Lack of access to quality health care can also be deadly. Half of all U.S. counties don’t even have an OBGYN. And a third to half of mothers die in the first three months after delivery — when hospitals seldom follow up beyond perhaps one in-office visit at 6 weeks postpartum.

Studies show that having access to quality health care would prevent 40% of all maternal deaths, regardless of race or socio-economic background.

LW: Survival should be the least of what we expect and hope for. The idea that we meet and speak to mamas who are so afraid of having their babies and have even been in conversation with a mama who was just saying, “I just didn’t want to die,” like that is horrific. 

And the fact that there are elements of hospital care that are unsafe for many of us, not just Black and Brown people, and that feeling safe, being heard, feeling valued, having a comprehensive care experience, having greater respect and autonomy, all of those things impact our outcomes. 

And so we should aspire to safe quality loving care for every birthing person, and I would also say that one of the things that we lift up and believe at Birth Center Equity is that birth centers are part and parcel of the answer to the maternal health crisis in our communities.

Host: There’s abundant evidence that one key to better birth outcomes for parent and child is the involvement of midwives from the beginning of pregnancy to several months after birth. 

More on that when we return, and how the burgeoning birth center movement is working to close the gap on racial and cultural inequities – how helping people of color and LGBTQ people open birth centers creates better outcomes for everyone.

I’m Neil Harvey. You’re listening to The Bioneers…

Host: Birth centers offer a fundamentally different paradigm anchored in preventative care. And Indra Lusero says that midwifery care provides the safest and most positive experience for a person giving birth. 

IL: Starting with doulas, they’re the non-clinical support providers. They’re there for the laboring person to provide emotional, physical support, encouragement, education, a sense of this is what’s going to happen.

In contrast to the midwife, who is a clinical provider. I think of midwifery as the original perinatal care provider, so preceding even the profession of medicine. People have always had midwives. Humans need assistance during childbirth partly because of our big heads, but also upright position. That, in particular, makes it such that humans can’t totally handle birth alone, like some mammals. And so that’s the role that midwives have played.

LW: When we think about our care systems, midwives as specialists in normal physiological birth, as trained healthcare professionals, have been devalued. And what we know from a public health perspective is that midwifery-led care results in a better experience and better birth outcomes, and is what we call “value-based care” or a very efficient use of resources for the value that midwives add.

Host: Leseliey Welch… According to data from Maternal Mortality Review Committees, including midwives in the healthcare system could prevent more than 80% of maternal and infant deaths.

In the U.K., where midwives deliver more than half of babies, the mortality rate for mothers is more than three times lower than in the U.S.

Along with reducing both maternal and infant mortality, midwifery-led care results in fewer preterm births, fewer low-weight babies, and greater rates of breastfeeding.

Given that the benefits of midwifery are well documented, why aren’t midwives playing a central role in the birth process in the U.S.?

As Leseliey Welch and Indra Lusero point out, starting a century ago, the medical profession launched a deliberate national campaign to eliminate midwives entirely.

IL: Midwives were framed as a problem. But the problem that midwives posed to doctors of that era, in particular, was the fact that women and women of color and women of low socioeconomic status, and immigrant women, could serve people in the perinatal period and do it well, challenged the prestige of white male doctors who wanted to also work in that realm. I mean, there’s literally quotes from doctors of that era talking about the profession of obstetrics can never rise to its place in society while there are these midwives. So the goal was to eliminate midwifery.

LW: You’ll also find campaigns that were highly racialized, that undermined Black midwifery in particular, describing Black midwives as unclean and uneducated, and ignorant. And so it was a political, cultural, multi-layered.

IL: Yep, multilayered. It really coincided with this historical moment too. It was, you know, the beginning of the Jim Crow era. It was the beginning of the Reorganization Act in terms of federal Indian law and policy, and eugenics had informed a lot of the preeminent scholars and thinkers of the day too. So there was this idea that society could be improved through reproduction, and managing reproduction of society was like the key to advancing society. So that’s also where eliminating a form of perinatal care was part of that strategy.

LW: And so when you have this deliberate undermining and shift, then you simultaneously have a cultural shift to the medicalization of childbirth. Right? Because in order to keep birthing people coming into hospitals to have their babies, we had to be convinced it was the safest place to have our babies. And from an evidence-based perspective, that is actually untrue.

Host: Still, to this day, the campaign against midwives continues.

IL: I consult with midwives across the country who are facing specific either policy barriers or legal barriers, like they’re being investigated, their professional license is being challenged, or sometimes they’re being criminally investigated, for things that are just about them being midwives. We’re not talking about fraud, we’re not talking about criminal behavior, we’re just talking about them being midwives. That’s happening.

Host: The rise of the profit-driven medical-industrial complex in the 1920s ushered in the medicalization of birth. It launched a relentless campaign to eliminate midwives and home births. By 1940, the number of in-hospital births rose to 40%. By 1955, it reached 99% where it continues to hover today.

With the average cost of U.S. maternity care at nearly $19,000, Uncle Sam spends far more on maternity care than numerous countries with much better outcomes. By contrast, the cost in a birth center is generally half or less.

As a case in point, 32% of in-hospital births are C-sections, which are both expensive and profitable. While C-sections put mothers at risk for a host of complications, studies show the involvement of midwives reduces C-sections to about 6%.

As professionally trained and certified providers, midwives are equipped to identify problems before they become emergencies. When necessary or appropriate, midwives help coordinate and manage next-level care. Hospitals are critically necessary for precisely such instances, and for those who simply feel safer there.

Meanwhile, birth centers are growing in popularity. They’ve even attracted venture capitalists, as Indra Lusero discovered herself.

IL: Part of how Elephant Circle got involved in creating this network of birth centers is because a venture capitalist had started a birth center, and closed it, decided to close it; gave folks 30 days’ notice, and they were like, we’re out of this business; it didn’t have the profit margins that they wanted. So because it was such a treasured community resource, and Elephant Circle already does—we mainly do– policy work in this area, we wanted to help see if we could save this community resource. 

Now that’s what we’re doing, and I think it does challenge and shift the economics. We’ve been curious, when folks like these venture capitalists say that it doesn’t have the profit margins they want, what are they really talking about? Because we know that it brings value, and we know that it’s as model that can pay for itself.

Host: The vision of birth centers that Leseliey Welch and Indra Lusero have been midwifing is emergent. According to the National Institutes of Health, between 2004–2017, home births increased by 77% and the number of birth center births more than doubled.

The approximately 400 U.S. community birth centers today were largely started and are owned by midwives. Because midwifery is devalued at large, there are structural barriers around payment systems, such as reduced Medicaid and insurance reimbursements, making it doubly hard to stay afloat.

White midwives own the great majority of birth centers, which is where the Birth Center Equity comes in. By 2023, the network involved 38 Black, Indigenous and people of color leaders who operate 14 birth centers and are working actively to open 24 more.

If just 1% of the population shifted to birth centers or home births, it would save $187 million, according to a study by the National Partnership for Women and Families. Birth Center Equity says those resources could be reallocated to opening and supporting more birth centers, while helping provide a sustainable business model.

Leseliey Welch says another systemic barrier is addressing the postpartum first 3 months after delivery generally excluded or underserved by hospitals.

LW: The baby comes out and everybody goes away, in terms of the care that our systems provide. And in that period of time, we need support and caring and help and advice, and love, and somebody to cook food, and somebody to wash dishes and wash clothes, and hold the baby while you take a shower, and all of those things. So one of the things that taking birth out of communities has done is also take the community out of birth in a lot of ways. Because birth, historically, in many of our cultures, it was a family experience and a community experience.

IL: Everybody knew what their role was when that happened in the community, and everybody had a role. At Elephant Circle, we’re now developing a network of birth centers in Colorado, and we envision offering things in these centers like mental health services that are integrated, that people could come and get those services even if they didn’t give birth there. Also things like legal services to sort of reduce some of the stresses and anxieties that families experience; for this idea of—these centers can really improve public health. They can be kind of centers of community wellness.

LW: Yes. When you’re coming to these spaces, you don’t have to wonder if you’re going to get a provider that is going to respect your gender or your attraction orientation, or your race or religion, because you’re coming to a space that is dedicated to providing care. In our case, our values are safety, love, trust and justice. That’s our long vision for what birth centers can be the anchor for in community. We know what better looks like and better is in the best interest of everyone.

My hope is that, you know, the tides will turn and we will see a shift to a day when birth becomes a true, moral, ethical, economic and political priority, where we really invest in what the beginning looks like.

Host: Leseliey Welch and Indra Lusero, bridging reality and hope to reclaim tradition and midwife a care economy with the best of all worlds…