The Mayor’s Office of Women’s Advancement has awarded a $50,000 grant to Roxbury’s Neighborhood Birth Center (NBC) to support the advancement of Boston’s first community birth center, the city announced last month.

A birth center is different from a hospital in that it aims to offer a more homelike, comfortable, and non-medical atmosphere and allows patients more agency and choice in the way they deliver their baby. Typically, birth centers are staffed by midwives and other support staff.

There is only one other birth center in the state, Seven Sisters Midwifery in Northampton, which is independently owned. Two other birth centers owned by hospitals in Cambridge and Beverly were closed in 2020 and 2022, respectively, because of the pandemic. In total, 38 states professionally license midwives, but Massachusetts is not one of them, which means they can’t accept insurance.

“Ensuring that residents have access to support before, during, and after birth is critical for their health and well-being,” said Mayor Wu in the grant’s announcement. “As we work to make Boston a city for everyone, we are excited to invest in organizations that are working to improve birth outcomes and secure reproductive justice for all families.”

Nashira Baril, the executive director of the birth center in Roxbury with a masters in Maternal and Child Health from Boston University School of Public Health, said she remembers the exact moment when she realized she wanted to take on establishing the birth center after having had home births with her two children.

“I was having lunch with my BU advisor years after I graduated, Dr. JoAnna Rorie, a midwife,” Baril said. “And I was saying something about how I had the most incredible home birth experience, but it’s just terrible that I could only access it because I could afford to pay for it. And she said, ‘Well, yeah, that’s why we’ve been wanting a birth center.’ And I said, ‘a what?’ I’d gone through undergraduate and graduate school without hearing those words or knowing that was even an option.”

The Roxbury operation grew slowly but surely – in 2023, the staff grew to five. In just under two years of fundraising, NBC was able to raise $3 million and purchase land at 14 Winthrop Street in Roxbury’s Nubian Square. The center plans to officially open for business in 2025.

Tiffany Vassell, co-manager of community engagement and communications, has designed 14 workshops and informational sessions that NBC is running throughout 2024. The purpose of these, she said, is to empower and inform.

“Generally, people know when you go to have your baby, you’re either gonna have the baby vaginally or with a C-section,” Vassell said. “But a lot of times, people don’t understand that there are so many components to that. Things like bodily autonomy, like ensuring that your healthcare team knows that you are the expert of your body and when you say something is wrong, or you have an inkling of something, it should be followed up on. Also, things like reproductive justice, what’s that? Informed consent? What does that mean and how do you obtain that?”

Vassell said people sometimes overlook the fact that not only is there a new baby once someone gives birth, but there’s also a new parent.

“We’re wanting to bring community back, and help people feel connected and that they have resources, and that there’s someone they can talk to that will listen and that’s available to listen to them,” she added.

Baril said that a major goal of NBC is to integrate as seamlessly as possible into the neighborhood.

“One of our biggest commitments is to be a good neighbor and to be bringing midwifery back into the community,” she said. “We didn’t want to build in a commercial zone. We spent the last year listening to neighbors and designing and redesigning. And we’ll go to the neighbors again before we go to the [Zoning Board].”

Another crucial aspect of birth centers, Baril said, is that they aim to serve whoever wants to be served. And NBC is aiming to be as inclusive as possible, especially since they will be located in the heart of Roxbury. The neighborhoods with the highest percentage of low birthweight at birth – a common indicator of infant health – from 2019 to 2021 were Mattapan, Dorchester, Hyde Park, and Roxbury.

Baril said it’s not a coincidence that these neighborhoods are also where a majority of Boston’s people of color reside. But, she noted, maternal outcomes for women in the United States in general, regardless of race, are less than acceptable.

“I think it’s important that, when we talk about inequity, that we’re also talking about how the system isn’t working for anyone,” she said. “So, when we grow this center in Roxbury for some of the folks with the worst outcomes, we’re also going to create the best birth center in the city of Boston. We’re aiming for that saying, ‘A rising tide lifts all boats.’”

Baril said midwifery is “age-old” and only over the past century have people switched to hospitals, in part because of smear campaigns from medical stakeholders to paint midwives as unsanitary and unsafe.

Nevertheless, Baril and Vassell said, midwifery and home birth are once again becoming a more and more popular option, particularly after the pandemic limited hospital options. The city’s grant highlights their commitment to establishing the birth center in Boston, they said.

“It’s felt very isolating as a nonprofit start-up to fundraise in people’s backyards trying to do this, all the while like, ‘Boston, hello! This is the answer to our wildest dreams,’” Baril said. “To have the city’s attention now, it just feels like there is so much possibility.”

Doulas say that state rates won’t cover costs, demand
By Alison Kuznitz
State House News Service

About 50 doulas are expected to enroll as new MassHealth providers this spring, but maternal health care advocates warn that the state’s payment structure is too low and may hamper the workforce from growing enough to keep up with demand for publicly funded doula services.

Doulas, who are non-medical individuals trained to support people throughout pregnancy, delivery and the postpartum period, could make up to $1,700 per client under a revised payment scale rolled out by MassHealth in December following a public comment period.

The overall amount includes $900 for labor and delivery support, a figure that doulas say is inadequate when factoring in the average number of hours it can take for a client to give birth — in addition to other costs doulas face, including liability insurance, transportation, food, and childcare expenses.

“We’re Massachusetts. We’re supposed to be the lead for most things medical-related, so why are we not setting the bar?” Katia Powell-Laurent, a birth and postpartum doula and the founder of Black Girls Nutrition, said. “I do not know where they got the $900. It’s definitely not enough. We live in Boston — everything is expensive, really expensive.”

For high-risk clients, Powell-Laurent said she charges a bundled rate between $2,500 and $3,000. When labor exceeds 15 hours, she calls in for back-up support from another doula and uses a cost-sharing agreement that Powell-Laurent said could be difficult to deploy under MassHealth regulations.

While doulas are grateful that the state is rolling out the new MassHealth program, advocates like Powell-Laurent said they’re also pushing Massachusetts to reevaluate how it can be more attractive to the private doula workforce and aspiring providers – and to other states with similar doula initiatives.

Maternal health advocates say they’re also focused on supporting doula workforce legislation (H 1240 / S 782), which remains in the custody of the Joint Committee on Health Care Financing, that could boost competitive rates and diversify the provider landscape. The committee reported the bill out favorably last session, but the House Ways and Means Committee did not take further action on it.  It was sponsored last session by Rep. Lindsay Sabadosa and then-Rep. Liz Miranda.

Erika Laquer, a doula and childbirth educator based in western Massachusetts, said she wants to enroll as a MassHealth provider to help vulnerable people who could benefit most from the service. Yet she expressed worry that the state’s payment scale may drive people away from joining the already small doula workforce. More reasonable compensation would land between $2,200 to $2,800, she said.

“I’m concerned that from doulas’ point of view, there won’t be an incentive to carry a full load of MassHealth clients compared to clients if they are doulas who do private pay,” Laquer said.

Asked about criticism of the maximum reimbursement rate of $1,700, a spokesperson for the Executive Office of Health and Human Services said the regulations incorporated feedback from doulas, clinicians, hospitals, and other stakeholders through various public listening sessions, requests for information to collect feedback, a public hearing and a public comment period.