As the nation battles a maternal health crisis, more women of color are choosing birth centers over hospitals

By Nicquel Terry Ellis, CNN; Photographs by Alyssa Pointer for CNN

(CNN) — Vernette Kountz had given birth to four children in hospitals — including a set of surrogate twins — before deciding she was ready for a different experience.

Kountz said while her previous deliveries had all been healthy and smooth, she felt her hospital and medical office visits were rushed, routine and impersonal.

“When you’re in this medical model, you feel kind of shuffled around, told what to do, you have all of these assessments and ultrasounds,” Kountz said. “It feels more so transactional and less intimate.”

So, in 2021, when Kountz found out she was pregnant with her fifth child, she decided to have the baby at the Atlanta Birth Center. The facility, she said, provided the holistic, personal and intimate care she had longed for as a mother and she had a water birth to deliver her son, Hudson.

Kountz said she valued the experience so much she’s preparing to deliver her sixth baby at the same birth center in January.

“It’s more than just treating a mom that’s pregnant,” she told CNN during a mid-November appointment at the center. “It’s like there is space for all parts of her. It creates a level of intimacy that you’re not really getting from a traditional medical office.”

Kountz is among a small but growing number of women of color who are choosing birth centers over traditional medical facilities for prenatal, childbirth and postpartum care.

While the majority of births in the US still happen in a hospital setting, in 2020 nearly 2% of people chose to give birth in a “community birth setting” such as a birth center or home birth, according to the most recent data from the National Partnership for Women & Families, a nonprofit that tracked these trends based on birth certificate data.

Between 2019 and 2020, there was a 30% increase in Black women opting to give birth in those settings, and a 26% increase for Native American women, according to the nonprofit. The number of Hispanic women choosing to give birth in those settings increased by 24% and 18% for White as well as Asian women.

The decision by some families to move away from traditional hospital birth settings comes as the nation battles a maternal health crisis in which Black women are nearly three times more likely to die from pregnancy complications than White women, according to the CDC.

Birth centers are often home-like facilities that offer clients longer appointments and more freedom and autonomy in their birth experience. They are designed to care for those with low-risk pregnancies and state regulations prohibit them from performing c-sections, according to the American Association of Birth Centers.

Atlanta Birth Center Executive Director Tamara Taitt said if a client has complications beyond the scope of care— such as elevated blood pressure, a breeched baby, or if the baby’s weight is smaller than its gestational age — they are transferred to a local hospital. The birth center also does not offer epidurals, or medications to induce labor, she added.

Birth centers also generally have risk assessment criteria that helps them to determine whether it’s safe for someone to give birth at their facility or if they need to be transferred to a hospital, Taitt said.

The pivot to birth centers also comes as maternity wards across the nation are closing, with many citing low birth rates and insufficient funds as key reasons for shuttering.

The Centinela Hospital Medical Center in Inglewood, California — a majority Black and Hispanic city — closed its maternity unit in October. A statement released by the hospital said, “the demand for maternal health services at Centinela has significantly declined over the last several years, with fewer than two deliveries a day.” 

Leseliey Welch, co-founder and co-director of Birth Center Equity, said birth centers are often focused on showing respect, building trust and bonding with families – something women of color across the country desire, especially those who have experienced trauma or racism in health care.

According to a report released in November by the National Partnership For Women & Families, Black women are “twice as likely as White women to report that a medical professional ignored them, refused a request for help, or failed to respond to requests for help in a reasonable amount of time

Welch said she feels the disparity in maternal mortality rates is yet another example of the legacy of systemic racism in America.

“This whole country has operated in a hierarchy of human value based on race,” Welch said. “Our hospitals and health systems are no exception. Survival should be the least we expect in birth care. That’s the least we can do for so many families in this country.”

Fueled by a desire to address those inequalities, Welch said she plans to open Birth Detroit in 2024, the city’s first free-standing birth center led by Black women.

A more tailored experience

Many birth centers are designed to provide families with the comforts of home. The delivery rooms at the Atlanta Birth Center, for example, resemble bedrooms with queen size beds, lamps, paintings on the walls and changing tables for babies.

On a recent Friday, Kountz eased herself into a light blue velvet chair in a dimly lit room across from her midwife, Anjli Hinman.

“How is your body feeling these days?” Hinman asked.

Kountz, who was 32 weeks pregnant, cupped the side of her belly and explained to Hinman that today had been a good day — she didn’t have much pelvic floor dysfunction and she was able to walk up and down the stairs at home without help.

They chatted for 30 minutes about everything from Kountz’ mental health state and her job as a chiropractor, to her family life, water intake and sleep routines. When they were done, Hinman took Kountz’ blood pressure and used a fetal Doppler to listen to the baby’s heartbeat.

“I see them moving,” Hinman said, as she moved her hand around Kountz’ stomach.

It’s these interpersonal moments, Kountz told CNN, that make appointments at the Atlanta Birth Center, feel so unique. The staff, she added, is fully invested in her physical, mental and emotional health.

Joia Crear-Perry, president and founder of the National Birth Equity Collaborative, said she thinks birth centers are rising in popularity because women want to interact with providers who understand their cultural needs.

Crear-Perry said many women of color also choose to deliver at a birth center to combat the racial bias they say they often experience in traditional health care facilities.

The Breath of My Heart Birthplace has served the Indigenous community of rural northern New Mexico since 2010.  Founder Beata Tsosie-Peña said the facility currently handles about eight childbirths a month, with half of those being Native American families.  According to the CDC, “American Indian and Alaska Native women are two times more likely to die of pregnancy-related causes than White women.”

Tsosie-Peña said she opened the center because she felt people in the community needed a place that embraced cultural traditions around childbirth with bilingual staff.

Families who deliver at the center are allowed to have ceremonies around the baby’s birth with music, fire, food, herbal medicines and special clothing. A lot of these practices, she noted, might be limited in a hospital setting.

“There are a lot of things that different cultures hold around birthing … and it’s so special and unique,” Tsosie-Peña said. “I think it really focuses on the needs of the client.”

‘A life-changing time’

Back in Atlanta, Kountz, said she is looking forward to giving birth in the Atlanta Birth Center’s “Fire Room.” It’s one of three nature-themed birthing rooms at the facility.

The Fire Room boasts an orange and black painting of a tree on the wall, a queen size bed topped with a soft orange and blue comforter, a rocking chair and a canvas that reads, “Some women fear the fire and some women simply become it.”

“It accommodates that desire to feel home and safe and grounded and protected,” Kountz said. “They have aromatherapy, they have music, tapestries, words of affirmation hung up. They are promoting pain coping skills versus narcotics.”

Hinman, Kountz’s midwife, said she believes birth centers are part of the solution to the maternal health crisis facing Black women because of their holistic approach.

Staff members, she said, are closely monitoring their clients even during the postpartum period when many face life-threatening complications and depression.

According to a study published in the journal JBI Evidence Synthesis, while nearly half of maternal deaths occur on the first day of birth; 24% occur between days two and seven; and 25% between days eight and 42. 

Simply checking in with a client, Hinman said, can save their life.

“It feels like family,” Hinman said. “This is a life-changing time for people.”

CNN’s Rikki Klaus contributed to this report.

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