A Black Midwife Is Building Alabama's First Freestanding Birth Center— And Improving Birth Outcomes

Hospitals should be a space of care and healing. But for many Black people, especially those giving birth, they're a source of fear. It's unfair that when you're Black and pregnant, checking into the hospital could mean being dehumanized, invalidated, or possibly downright ignored. Long before the hard work of labor starts, there are countless opportunities to ask ourselves, "Was that racism?"

We are always reminded of the unnecessary maternal deaths and discrimination that occur as a result of structural racism.

Dr. Stephanie Mitchell, a certified professional midwife specializing in community-based midwifery who holds a doctorate of nursing practice, is one of many Black providers working to change this. She is building Birth Sanctuary Gainesville to ensure Black families—and all pregnant people in Alabama—have access to alternatives they deserve.

Bringing Birth Options to Alabama

Distance, limited medical provider options, and inadequate insurance coverage often leave Black families unable to access alternatives to hospital births. Thankfully, recent efforts, like Mitchell's birth center, provide Black families with options in a system that prioritizes hospital-based care.

More than 98 percent of births occur in hospitals in Alabama—like most of the US.—and Mitchell says that leaves few opportunities for Black birthing people to escape the legacy of racism in obstetric care. "You can't opt out of these systems that have a historical basis of inequity for outcomes for Black birth, and people specifically, and statistically for Black women," she says.

Mitchell notes the persistence of racism from enslavement and Jim Crow to the present. "That means just by going with the default, you have an exponentially higher risk of untoward complications, morbidity, mortality, just by being present in this Black skin," she says.

Alabama is one of seven states or territories that received an "F" on the March of Dimes 2021 report card. It has the third-highest maternal mortality rate in the United States and ranks second of five states with the lowest percentage—only 1.2 percent—of births attended by midwives.

Gainesville is located in a maternity care desert. Before Mitchell's efforts, Alabama was one of nine states with no birth centers, including Wyoming, North Dakota, and Mississippi.

Mitchell's efforts can help change this. She says by placing a community-educated and community-based midwife in the vicinity, you increase access to the holistic patient-centric care they provide. When pregnant people deliver in birth centers, they have lower preterm birth rates and lower instances of cesarean sections and have higher outcomes. This is especially true for Black and Latinx individuals.

She believes changing outcomes for Black people giving birth requires unabashed acknowledgment of the legacy of medical racism that is still present and shaping today's outcomes. This includes the barriers that may keep Black women out of midwifery, as patients and providers.

Reclaiming Tradition

Mitchell knows Birth Sanctuary's impact is more significant than being Alabama's first freestanding birth center. "When we look at freestanding birth centers, specifically that are midwife-owned, operated, and led are minuscule," she says. Mitchell is one of 19 midwives listed on The Alabama State Board of Midwifery website. "And then when we fill in the extra of being a Black woman, it's pretty special."

Mitchell believes Birth Sanctuary represents a moment of reclamation of midwifery and birth customs for Black communities everywhere—not just those in Alabama. "It says to the people that I serve, that this is our medicine, these are our roots. And these outcomes, these better birth outcomes. There are ours also."

She's been pleasantly surprised by the supportive, like-minded community she's gained during this effort. There have also been barriers— state regulations that barred midwives from receiving necessary licenses, issues with insurance coverage, hateful comments, and the anticipated challenge of being a transplant in a community.

Mitchell, who was born and raised in Boston, moved to Gainesville with her husband, a Gainesville native, in 2020. "People don't necessarily understand your passion—you're not necessarily from there. It's trying to acclimate to the environment," she says, noting this will be a long-term battle, but she's committed.

"The birth center that I'm building in Gainesville, Alabama, is a 100% grassroots effort, completely funded by other people," she says. These efforts are a collective community responsibility and shouldn't rest on just her's—or any one person's—shoulders. Mitchell says that maternal health is a community issue and improving outcomes requires the entire community's support, whether through donation, labor, or help spreading the word.