Cara’s Birth Center Solution

Cara Osborne is the founder and chief clinical officer of Baby+Company, a network of independent birth centers that offer women real choices about where and how to deliver their babies.

Cara is also a midwife, long-time friend of Every Mother Counts and advisor to the board for our grantee, Midwives for Haiti. Cara’s birth center model provides a safe, skilled middle ground between home and hospital for low-risk women. Studies show that birth centers provide real solutions for the challenges women face while giving birth in America. Cara explains more about her work and her vision for giving women what they need.

Every Mother Counts: Cara, how are birth centers different from traditional maternity units?

Cara: A birth center is an out-of-hospital environment where low-risk moms give birth in a low-intervention model. It offers everything you need to facilitate normal physiology for patients who go into labor on their own and have un-medicated, un-augmented births. We can handle any immediate complications like hemorrhage or shoulder dystocia. Should a mother need more acute care, we transfer to our partner hospitals and physicians.

EMC: What community need did you identify that led you to open birth centers?

Cara: The Listening to Mothers survey is a big nationally representative survey of maternity care experiences. They asked women who’d had a hospital birth within the preceding year specifically about their interest in birth centers. 25% said they definitely wanted a birth center for their next birth if one was available. In many cities and communities, there just aren’t any birth centers. The only option women have is for a hospital birth. That led us to believe that the demand existed in the market. We also heard from friends, doulas, nurses and folks in the birth community that moms who wanted physiologic or natural childbirth weren’t able to find supportive providers and hospitals. They’d created birth plans based on their understanding of the evidence and many choices were simply not allowed or available. Things like intermittent fetal auscultation or eating and drinking during labor went directly against hospital policies and procedures. The birth center’s standards of care, policies and procedures facilitate normal physiologic birth.

EMC: That’s a subtle shift of perspective that can make a big difference in maternal health outcomes.

Cara: Hospitals prepare for the worst and therefore require intervention and create policies that support that “just in case” model. For example, most hospitals insist on every laboring mothering having standard IV access, just in case she needs fluids or blood or medication. IV’s are great, but they’re also portals for infection. How many people need to have an IV placed before you actually have a pathophysiologic need to use it?

At our birth centers, we make the assumption that labor and birth are going to proceed normally and if something happens that’s different, we respond to that as needed.

EMC: Do you know the actual number? If they start IVs on 100% of their patients, how often do they really need it, for say, a blood transfusion?

Cara: Well, here’s the tricky part. I don’t have that number because when everybody has an IV, you’re more likely to have fluids running, whether or not you need them. That skews the data. There are many interventions done, just in case, that can have serious downsides. For example, even keeping a baby in the hospital for 24 or 48 hours after birth for observation, just in case, can cause problems. Hospitals have high rates of iatrogenic infection (caused by medical examination or treatment). The truth is that medical professionals are trained to find and treat pathophysiologic variations, even when they’re not necessarily problems. There’s this perception that it’s better to intervene, even if ultimately it’s unnecessary than to not intervene and run the risk of missing something. I say there’s a happy medium. You can wait for indications that an intervention is necessary and still be vigilant and perceptive enough to not miss things.

EMC: How has the community response to the birth centers been?

Cara: The community has been very welcoming and responsive and our outcomes have been great. We have really low cesarean rates. Only 5% of clients that labor in the birth center ultimately need a cesarean. Nearly all of our moms breastfeed and we’re hearing from our moms that their experience with us is positive and meaningful for them.

EMC: Let’s talk a little about your work with Midwives for Haiti.

Cara: I’ve been an advisor to their board for several years and have had the privilege of being the connection point for EMC. The work we’ve all done together has now lead to the third class of EMC sponsored midwifery students and the opening of the Carrie Wortham Birth Center, which is a great culmination of the work Midwives for Haiti and EMC have done over the last several years. It’s a Midwives for Haiti facility, staffed by Midwives for Haiti graduates. That’s an amazing feat.

EMC: What similarities and contrasts do you see between maternal health in the U.S. and Haiti?

Cara: In Haiti, I feel like I spend most of my time working to make sure that women have access to the medical interventions and support they need. In the U.S., I work to make sure that women don’t receive interventions they don’t need. I think there are lessons each can learn from the other. In Haiti, I’ve seen how strong women are and how they’re able to take care of their babies with very few resources. In the US, I’ve seen how women who have all the resources in the world, forget that they’re strong. It’s all about finding that middle ground.

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