She’s got babies on the brain. Nashira Baril is the founder and project director of Boston’s Neighborhood Birth Center. In her work as a maternal health researcher, she’s seen how “traditional” methods have led to alarming stats like Black women having a 3x greater maternal mortality rate than their white peers. That’s why she’s partnered with the New Commonwealth Racial Equity and Social Justice Fund + Mass General Bringham to develop a 5-year program that supports parents to and through the delivery room—which, if Nashira has anything to say about it, should be your house. (And according to recent data, more women are starting to agree with her.)

In observance of Black Maternal Health Week (which you still have time to support!), we asked Nashira about what leads to pregnancy disparities, why she advocates for home birth, and what’s stopping others from doing the same.

How did you get into the birthing space?
I studied women’s studies in undergrad, then came to Boston to work in a community health center to research racial inequity in breast and cervical cancer and other facets of maternal health. Also, my mom is and my great-grandmother was a midwife, so I had this dual experience of working at the health department—totally steeped in how dangerous it is to be pregnant while Black—and then I had this personal desire to give birth at home with midwives. After giving birth in 2013, I left my job at the health department to devote myself to opening Boston’s first birth center.

What was your home birth like?
I had this amazing home birth with candles and music. But I heard from a lot of people, like, “Oh, you’re having a non-traditional birth?” And I was like, “Actually, I’m having the most traditional birth.” And there are tried-and-true ways to bring my experience to scale; we just haven’t invested in it in this country. In fact, we’ve divested because there’s deeply embedded capitalism and white supremacy in our healthcare system. We have to flip the frame and remember what our ancestors have known forever, which is how to catch babies—and do it well.

Why doesn’t the American healthcare system work for Black women who are about to become mothers?
It’s about the experience of being othered. Textbooks are still teaching medical students that Black people don’t feel as much pain, so there’s a whole field of study backed by faulty science that has led to inequity. It’s also not just about the period of being pregnant; it’s about the experience of being Black throughout our lives. So you combine a life course with the ways institutions have brought down inequity—it’s all baked in. We don’t need any explicitly racist physicians in order to manifest bad outcomes. It’s about stuff that’s rooted in all elements of the system, from our economy to our food system to our education.

How does a birthing center differ from a hospital?
A birth center is a home-like healthcare facility staffed by highly-trained midwives, and it provides a full spectrum of care through pregnancy, labor, delivery, and the postpartum period. Some birth centers provide well-woman care, primary care, abortion, and other things, too. It’s so different from a hospital setting because birth centers have been proven to meet what’s called a triple aim. They have better outcomes, better experiences, and better costs.

How are you trying to tackle these systemic issues in your birthing center?
We want to hire midwives of color, so we need to make sure they’re not working 100 hours a week. We also want to make sure we serve at least 60% of folks who are on Medicaid. In order to do that, we’re going to have to raise a whole bunch more philanthropically because Medicaid reimbursement is lower than the cost of providing the care…. There are ways to advance equity, but it means we’ve got to be thinking about that on all fronts.

No offense, but sometimes home births can be seen as something for wealthy women as opposed to a safe, accessible practice.
We’ve heard the same thing! We did a needs assessment for the birthing center, and one of the interview respondents said, “Birth centers are for crunchy white women.” She’s not wrong in her understanding of who gets access to birth centers, and that’s because of the history of who has gotten to be a midwife in this country. There was a point in time when midwives were mostly Black, Indigenous, or coming from indentured European servitude. Then it became 95% white, because legislation and policy racially redlined midwifery.

What would you say to someone who’s hesitant to consider a home birth?
One of the things I’ve learned is to listen for what is coming up for folks. Is it just an unfamiliarity? Like, “Oh, I didn’t even know that was an option.” Is it a very real fear of trauma? Our community of Black and Brown people has the poorest birth outcomes, so everybody knows somebody who had a bad experience. I’ve also got friends who are first-generation, and they’re like, “My mom is not going to let me birth at home when we just got access to world-renowned hospitals.” When we get clear about what people are afraid of, oftentimes it’s not being heard or not having agency. Those are things that we should be correcting for in the hospital system, and that a birth center can absolutely correct for.