has dedicated her career to reducing disparities in birth outcomes. “We’re hoping to serve as a model for the whole country,” Dr. Lubic said. There are now 195 such centers in the United States.

A pregnant woman receives prenatal care at the Family Health and Birth Center.

A pregnant woman receives prenatal care at the Family Health and Birth Center.

Ms. Pugh’s case highlights the differences between the midwifery model of care, which promotes maternal and infant health, and the obstetrics model, which anticipates complications. During the hospital delivery of her first child, Ms. Pugh received pitocin to induce labor, saw her newborn for just a few moments before the child was taken away, and did not breastfeed until the second day. In contrast, during the delivery of her third child—her second delivery at the FHBC—she received assistance during labor from a doula, a trained volunteer who provided coaching and massage; her newborn was placed on her chest immediately after the birth; mother and child went home within hours of delivery; and when the infant showed difficulties with breastfeeding, a peer lactation counselor went to their home.

Two systematic reviews have found that women given midwifery care are more likely to have shorter labors, spontaneous vaginal births without hospitalization, less perineal trauma, higher breastfeeding rates, and greater satisfaction with their births (Hatem et al., 2008; Hodnett et al., 2007). Unpublished FHBC data show that, compared with all African American women giving birth in Washington, DC, women giving birth at the center have almost half the rate of cesarean sections, onethird the rate of births at less than 37 weeks’ gestation, and half the rate of low-birth-weight newborns. The lower rates of complications added up to an estimated $1,231,000 in savings in 2005—more than the cost of operating the center that year. The FHBC reports a 100 percent breastfeeding rate among women giving birth at the center.

Obstacles to widespread use of the FHBC model include the fact that



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