maternal and child health

‘How Babies Come into This World Matters for All of Us’

Nashira Baril (SPH’06) aims to make birthing experiences more equitable, personalized, and liberating.

Boston boasts world-renowned healthcare and is the birthplace of the community health center movement, but markedly absent from the city’s healthcare infrastructure is a community birth center, says School of Public Health alum Nashira Baril (SPH’06). Soon, that will change.

With a goal to make birthing options equitable, personalized, and family-centered, Baril is leading the development of the Neighborhood Birth Center—the first independent, freestanding birth center in the Greater Boston area. The center’s official location and opening date are still being determined, but it could launch as early as 2022 in Boston’s Roxbury, Dorchester, Mattapan, or Jamaica Plain neighborhood.

Community birth centers are home-like settings where midwives, provide a safe environment for childbirth and wellness outside of a hospital. These centers often have relationships with area hospitals, but are equipped to offer individualized, comprehensive care to low-risk birthing people throughout the pregnancy, labor, birth, and postpartum periods.

Boston’s first birth center is imagined as a 5,000-square-foot, spa-like facility offering a range of physical, mental, and emotional support for patients and their families, including doula care, psychotherapy, support groups, childbirth and parenting classes, and wellness activities such as yoga, meditation, and acupuncture.

“The midwifery model of care means that there is a belief and a practice around physiologic birth—that birth is natural and not something that inherently requires a lot of intervention,” says Baril, who has served as the project director of the center since 2015. “It focuses on wellness, with the idea that birthing people and babies are innately designed for this, and that with the right kind of support, we can have good birth experiences and outcomes.”

Baaril has led this endeavor primarily in a volunteer role outside of her full-time position as a project director at Human Impact Partners, where she supports public health organizations to build capacity to advance health equity and racial justice. She says the Neighborhood Birth Center is a “rebirth” of an idea that originated among Boston midwives, activists, and leaders who tried to open a birth center in the 1980’s as a response to the high rates of maternal and child morbidity in the city’s Black neighborhoods, but they faced policy barriers and institutional pushback.

Now, almost four decades later—where Black maternal mortality rates remain significantly higher than other groups—the idea is regaining traction, and Baril is supported by a board of directors, as well as an advisory council that includes current and former SPH faculty members and experts in maternal and child health. Professors Eugene Declercq, Lois McCloskey, Candice Belanoff, and former SPH professors Jo-Anna Rorie (a certified nurse-midwife) and Judith Bernstein, and recent SPH graduate Ebere Opareke (SPH‘20), have assisted with needs assessments, data presentation, and policy and strategy development. Baril says she “feels very networked within the BUSPH community and wouldn’t be able to do this project in this city without their support.”

The midwifery model of care is one that Baril is both passionate about and familiar with, as the daughter and granddaughter of midwives, and as a mother to two children who were birthed at home. As a biracial Black woman, she says her White mother had a horrible hospital birth experience when Baril was born in a Connecticut hospital in 1979. Her younger siblings would later be born at home, shaping her worldview and securing her own decision to birth at home.

As she prepares to open a birthing facility centered on health equity in maternal and child healthcare, Baril says it is important to recognize the role of deep-rooted racism in midwifery practice dating back to colonization and slavery.

“There is a wretched history of racism in this country, and the way that that has manifested in healthcare is well documented,” she says. On midwifery, “policies and practices, connected to capitalism and the economy, were created with the explicit intention to move births into hospital settings and make midwifery illegal.

“Black midwives, who birthed most babies and across racial lines, were systematically and institutionally removed from the practice as White men became trained as OB-GYN’s,” Baril says says. “It’s important to name that history.”

Now, the US leads the developed world in maternal and infant mortality, and the maternal death rate for Black mothers is three to four times higher than other groups. Almost all births take place in a hospital, and deliveries at birth centers account for less than one percent of births. But studies show that these out-of-hospital births are gradually increasing, are less costly, and lead to fewer C-sections, preterm births, and low birth weight.

Changing the narrative around birth and midwifery is necessary to advance the practice and reclaim its standing as safe and healthy, says Baril.

“As much as my work is about developing business plans and financial models, figuring out real estate, and state regulatory policies to get us to the ribbon cutting, it is also about creating a culture change that says community-based midwifery is safe and should be an option for everyone,” she says. “How babies come into this world matters for all of us. It matters for our public health, for our economy, and for our collective healthcare. The birth center model just makes sense.”

Baril also recently helped launch Birth Center Equity, a national strategy to grow abundance in birth center infrastructure with a focus on  birth centers led by Black, Indigenous, and people of color.

“By understanding how our current structures unfairly advantage some and disadvantage other dimensions of our identities, we can co-create new models of healing and care that address the inequity. In this way, we can build birth centers that are liberating and luxurious for everyone” Baril says. “Everyone community that wants a birth center should be able to access a birth center.”

She says people frequently ask her how it will be possible to fund the pricey real estate and operational costs of a birth center in Greater Boston. Her answer is simple: “We can’t afford not to.”

To donate to the Neighborhood Birth Center, click here. To volunteer, or learn about other ways to support the birth center, click here.