Opinion: The urgent need for more birthing centers

Our country is experiencing a maternal mortality crisis. Too many women, particularly Black and Hispanic women, are at risk of dying due to complications of pregnancy and childbirth. And with women’s reproductive choices under attack all across the country, we must recommit ourselves to ensuring that all women are able to make the decisions regarding pregnancy and birth that are best for themselves and their families.

More and more women across our country are searching for alternatives to hospital births. Home births are on the rise, and so are births at birthing centers. These facilities provide a different option for women – one that is less medicalized and more in tune with the needs of the mother as she goes through labor and delivery.

While more birthing centers have been opening across the country to address this growing demand, New York’s few birthing centers are struggling and closing. The dwindling number of birthing centers statewide and the complete absence of an accessible birthing center in the Bronx underscores a critical reproductive rights issue: the absence of choice.

Birthing centers provide prenatal care, labor and delivery care and postnatal care through a midwifery and holistic care model geared towards women who are experiencing a low-risk pregnancy. They are centralized hubs that provide education, medical attention and pregnancy care to expecting mothers. In recent years, birthing centers have become more popular due to a cultural shift away from overmedicalization and hospital births and towards holistic care. Regardless of any individual’s preferences, the diversification of birthing options is essential to achieve reproductive justice.

According to the New York City Department of Health and Mental Hygiene, the Bronx has the highest rate of severe maternal morbidity among all five boroughs. It also has the highest percentage of low-risk pregnancies that ended in a cesarean section, which public health experts argue can increase health risks and financial stress when performed unnecessarily but which are nonetheless performed too often in the United States. Births at birthing centers are associated with fewer cesarean sections. Among individuals who birth in a birthing center, only 6% have a cesarean section after transferring to a hospital, much lower than the 26% of low-risk pregnancies that are delivered by cesarean section at hospitals in the United States overall.

Diversifying birthing care options in our state would be a strong step toward birth equity. Birthing centers provide wraparound services and are more accessible to patients. In New York City, the Bronx has the highest percentage of live births in which the mother had late or no prenatal care. It is possible that this is due to inaccessibility, and birthing centers can provide this missing prenatal care and many other resources by removing or reducing the cost barrier.

As Bronx borough president, I have been a fierce advocate for improving maternal healthcare in and out of our hospitals. In 2022, I collaborated with Public Advocate Jumaane Williams and our colleagues on the New York City Council to pass legislation improving public education about the city’s standards for respectful care at birth, the right to be free from discrimination in relation to pregnancy and the rights that pregnant women and new parents have in the workplace. Most recently, my office – in collaboration with birthing professionals and advocates across our borough and city – produced an in-depth report, “Delivering Change,” to outline the need for a birthing center in the Bronx and to make recommendations for policy changes to streamline the process of opening and maintaining birthing centers in our state.

As our nation engages in conversations about reproductive justice in recognition of Black Maternal Health Week, we must also acknowledge that the right to choose extends far beyond conception and into labor and delivery. We must diversify birthing options for Bronx women and give them a fair chance at motherhood. 

The maternal health crisis has reached a boiling point, and the numbers don’t lie: New York state is not keeping up with national trends, and Bronx mothers are suffering as a result. Birthing centers are crucial in the fight against maternal mortality and the fight for holistic maternal health, and we must work together as a community to bring a birthing center to the Bronx.