A new birth center opening in Cambridge this week will be the second such free-standing facility in the state.
Technically, it’s re-opening: Cambridge Health Alliance closed down its birth center due to the pandemic six years ago. With funding from the state and others, it’s once again serving patients starting Monday, July 6.
Birth centers use the midwifery model of care, minimizing medical interventions and using alternative forms of pain relief, like warm tubs instead of epidurals. Studies have shown such centers have a lower risk of cesarean sections, even after accounting for the fact that mothers who use birth centers are generally low-risk pregnancies.
The new beds are a welcome sign to local health leaders after years of maternity unit closures. The birth center offers a different model of health care for local parents, considering the state’s only other freestanding birth center — Seven Sisters — is in Northampton in Western Massachusetts.
Maternal health outcomes in the commonwealth have worsened across the board in the last decade as racial disparities have widened. As of 2020, Black women were more than two and a half times more like to experience a severe complication around childbirth, a state report found.
“It’s really important to have choices,” said Dr. Tara Singh, the chief of obstetrics and gynecology at Cambridge Health Alliance. “We want folks to engage in health care — and if they have choices to do that, that maybe are more palatable or better, and they are appropriate for that care — then we should be able to provide those choices. Not just the hospital, birth centers as well.”
Many maternal health experts and state lawmakers believe that, to fight inequities, more inclusive and midwife-led models of care will be key.
In Cambridge, Kim Amsley-Camp is excited to offer that choice. She’s the director of midwifery for the CHA Birth Center, and one of few doctors of midwifery in the United States. She evangelizes what birth centers offer.
“You’re not missing any of the safety, but families have a lot more say in what’s happening,” Amsley-Camp said. “That makes a big difference.”
On a recent tour of the center’s birthing rooms, she pointed out what wasn’t there, too: No stirrups, the medical contraptions that hold women’s ankles up on hospital beds during gynecological exams. There’s no bright florescent overhead lighting. But there are queen-sized beds, birthing stools, exercise and peanut balls, and giant tubs — for pain relief or water births.
“Moms — if they don’t really want to be bothered much when they’re in labor, they want to do their own thing,” Amsley-Camp said. “Up and down the stairway, we have a beautiful backyard with picnic tables. She can spend some time back there, if she wants to. It’s just really pleasant.”
The care itself is different, too. A third of all births in Massachusetts result in C-sections, for instance; for labors that start at birth centers nationally, those rates are much lower.
For people with low-risk pregnancies, this is the kind of low-intervention approach some want. There are no epidurals, there’s no pitocin — synthetic oxytocin — to speed up labor, no continuous monitoring of the fetus so parents in labor aren’t always strapped to a device.
Amsley-Camp also pulled up the blinds and pointed out the window to CHA’s Cambridge Hospital. If for any reason the midwives decide the labor needs medical intervention, or the mother decides she wants to go to the hospital for pain management like an epidural, they can go to the labor and delivery unit a few short yards away.
“We don’t have to call an ambulance,” Amsley-Camp said. “We know where you’re going and we know the people that you’re going to. We go right across the driveway.”
Local and elected officials are celebrating the re-opening after a slew of closures, including the North Shore Birth Center in 2022, and the closure of Merrimack Health’s Methuen maternity unit just last week. More than a dozen units in Massachusetts have closed in recent years under financial pressures and staffing shortages.
“Too often we are talking about the closure of maternity services, but today we get to celebrate a spectacular rebirth — and one that I hope will be followed by many more,” said Massachusetts’ public health commissioner Robbie Goldstein in a statement. “The reopening of the CHA Birth Center supports families who deserve more options for culturally responsive maternity care.”
Even with 300 births per year, as the Cambridge Health Alliance hopes to soon reach, it’ll still be a small sliver of Massachusetts’ maternal health landscape. There are nearly 70,000 births in the commonwealth each year, according to state data, and just about 750 — or 1% — take place outside of a hospital.
Through changes to state laws and regulations, officials are trying to spur the creation of more options and support for labor and delivery in Massachusetts. Patients on the state’s public health insurance can now get covered support from doulas, who help expectant parents with informational, emotional, physical and advocacy support. Plus, MassHealth now reimburses doctors and certified nurse midwives at the same rate for delivering babies. Officials revamped the regulations for birth centers, and a newly formed state board will soon put out regulations to start licensing certified professional midwives — midwives who don’t also have their nursing license.
Another two birth centers are in the works in Roxbury and Worcester.
In Cambridge, Amsley-Camp said the first few patients scheduled to deliver at the birth center are local residents. But she’s confident people will ultimately come from far away once the center is fully up and running.
Asked about how CHA Birth Center will deal with the pressures that have forced other local birth centers to close, she says that working under the Cambridge Health Alliance umbrella is a huge advantage.
“Birth centers have not closed down because of quality, or because of consumer concerns. It has been financial,” Amsley-Camp said. “We have the expertise of an entire billing department, a finance department, people that are expert in coding and contracting with the insurance companies. ... So we have much of that infrastructure already in place.”
