Catching Babies

nashira: You find out someone's pregnant and they call me and they say, Nashir, do you know any OBs I can call? And I'm like, Why are you not calling a midwife? Right? So let's normalize that you can go to midwives for your GYN care, for your PAPs, for your reproductive health care. and they are, as as one of the state reps likes to say, you know, they are the top of the license for for reproductive health care and childbirth,

Phillipe: Welcome to From Issues to Action. I'm your host, Philippe Copeland. In a world full of challenges, what can we do? Join me for conversations that answer this question. If you want to be informed and inspired, this podcast is for you. This episode features a conversation with Nishira Burril. Nishira is the daughter and great granddaughter of midwives. Having birthed both of her children at home, she knows firsthand the transformative experience of midwifery care. Nishira has spent several years leading an effort to create the Neighborhood Birth Center. Boston's first community birth center. We discussed how midwives are the answer to the inequities in reproductive health and the political and cultural challenges involved in building a visionary space for catching babies and caring for families. I hope you enjoy it. Alright, welcome Nishira. Thank you for being on From Issues to Action today.

nashira: to be here.

Phillipe: Excellent. So I wanted to start with having you introduce yourself to the listeners. What would you most like them to know about you as a person?

nashira: I am a triple Virgo find myself nonprofit founder director practice in governmental public health trying to unlearn that stuff to create an organization that practices liberated ways of being so we can return midwifery to the community. and I come to that having given birth. at home twice with midwives and my mother and great grandmother are midwives. So I descend from a a lineage of midwives. I think we all do. yeah and I'm a I'm a parent and I'm trying to like figure it all out.

Phillipe: one of the things I wanted to have you do is just share with the listeners some of the things that you think would be helpful for them to understand about giving birth in the United States right now.

nashira: I'll take it all the way back and and borrow from like our ancestral midwives and the ancestral technology that childbirth is one of the most sacred acts and And I think as I say that, I hold a tension between that and how it is experienced by many people at this moment in time. and in the last, you know, hundred, two, hundred and fifty, two hundred years, we really swung from community-based midwife-held childbirth and really even more broadly than that kind of communal health, right? The midwives were sought as the healers in in the community to a hospital-based obstetric practice deeply Born from an economic decision to move childbirth into the hospital, rooted in capitalism and and racism and white supremacy, And that is a system that most of us engage with right now. so your question about kind of what do we need to know about childbirth right now is that The US compared to other economically advantaged countries, I'm trying to to not engage in like first world imperialist stuff, but other countries that have been structurally advantaged economically, The US fares terribly compared to our counterparts on a global stage. And that's everyone in the US across racial and class identity. Then when you get into the US, then we understand the intersections of oppression, class, race, gender, sexuality, orientation, compound the inequity. And so I like to say, like, it's not really working well for anyone, and then it's absolutely working worse for folks who who have identity. That have been structurally marginalized. you know, there's nothing new under the sun, right? And we're we're reintegrating midwifery in the community. and the only way we can do that to really improve outcomes for everyone is to have a deep understanding and explicit practice at designing right at the inequity. where is the current system not working for folks who are queer, disabled, black, immigrant, trans, right, poor, And then when you design the intervention there, the birth center will work really well for wealthy white cis women So sometimes people say to me, like, you're the one that's working on a birth center for black women And I'm like, yes, and I'm working on a birth center for everybody, but I'm being really explicit about how we design program policy and practice, lest we replicate inequity unintentionally. I think that there are ways to design with what Dr. John Powell would call a for targeted universalism, right? Targeted interventions for universal impact. I'll just throw a couple other like kind of facts that rumble around in my head. 85% of people who give birth in the hospital are low risk and could do so safely outside of the hospital. So at home or in a community birth setting. That's a lot of people. But inversely, 99. something percent of births in the Commonwealth, and this mirrors the US as a whole, do give birth inside the hospital. So there's something there to to look at about like how did we get so deeply into this system that a fraction of a percent of people are experiencing out-of-hospital birth when the majority could safely. And that has everything to do, as I mentioned, with the the the economic swing towards the money maker that is childbirth, hospital-based obstetrics in this country. and then I guess the the other piece I would throw at us is that there are and have been for the last 20 years a growing number of birthing centers. there's 400 now in the country, but there's one in the Commonwealth. out in Western Mass. And just last week I was at the the reopening of the Cambridge Birth Center, which is a hospital owned birth center, reopening this summer. So there will be two and Neighborhood Birth Center will be three and Worcester will be three or four. but the Commonwealth Of Massachusetts is a a particularly tricky place to reintegrate midwifery because of regulations and policies and insurance and and the very dominant hospital industrial complex here and a very powerful medical lobby. It's not working well for anyone, midwifery, and particularly community-based midwifery is the answer. And and the last thing I'll say actually, just on facts, is that birth centers meet what we call a triple aim. So better experiences, better outcomes statistically, and birth centers return significant cost savings to the healthcare system. So with that. there is the question that keeps me awake at night, which is like, how is it that we continue to divest from community midwifery, advantage hospital obstetrics, and yield the outcomes that we're seeing and keep going, wow, we are in a crisis of maternal health. What shall we do? Which is a question that you and I have been tangling with in public health for decades now. I think we know what to do, and it is a question of economics and values and power.

Phillipe: Thank you for that really thorough answer and introduction to this issue and the layers and the nuances there and the history as well. I appreciate that. so talk a little bit about, you know, I think you've you've named some of the the problems, some of the obstacles, some of the injustices involved in giving birth right now in the United States. what is the Neighborhood Birth Center doing differently?

nashira: Mm. Couple things. I'll just go back to kind of Gracie Boggs, like there's nothing new under the sun, right? And so we are doing things differently from the current context, and also we're just returning, right? This is just a return to the wisdom of our of our grandmothers. So so it is it is not new. I would say it is different in the sense that In this city that is rich in healthcare and hospital-based healthcare in particular, we are working to reintegrate a practice of community-based midwifery. And I'll talk a lot about childbirth, but I just want to to offer for listeners that when we talk about community-based midwifery, we're talking about the full scope of what midwives are trained to do. So that is family planning, gender-affirming care, medical abortion, menopausal care for those of us on the other end of the spectrum, full scope GYN, so PAP smears, and then of course, prenatal managing miscarriages, so medical management of that, as well as you know, childbirth. So act this is a place where you go to labor and give birth in this in this beautiful space that we'll talk about, and our Followed in the in the postpartum, as well as classes, childbirth education, mental health, pelvic floor, body work. So all of that is included in the scope of midwifery and in the scope of what we'll offer at the birth center with other practitioners. And so I think what we're doing differently is creating a space, a physical space to hold all of that. that exists outside of the hospital. So as a freestanding building, an autonomous nonprofit Very clear practice guidelines and safety protocols and transfer drills. So very practiced with you know what we do when we need hospital partnership and to make a transfer. But really offering that service outside of the hospital. And I think what we're doing differently even from other birth centers. So there again, there are four hundred birth centers, there's one or two in the Commonwealth, others in New England. We're like in like early proof of concept now. But our our hypothesis is that we lean on philanthropy and we and we work on policy change as ways to make sure that that care is sustainable. Because what's happening is that birth centers around the country are closing. Because they're not fairly reimbursed by insurance. And so either they overwork and underpay the midwives, or they turn to the clients to pay cash for that care, which is kind of inherently inequitable, who has a couple thousand dollars to pay out of pocket for their childbirth. and so our hypothesis, like we we lean on philanthropy early. my first full-time hire was a policy director. So we were like, we gotta get this state right for both ours. sustainability and for those other birth centers to be sustainable. and then I think we're also really investing in the design. and by that I mean the design of policy and this the offerings, but also the physical space are architects. We're working with Mass Design Group. They're a really large non profit architecture firm that does healthcare and monument work. So they're also behind the embrace here in the Boston Common and they're behind the Memorial for Peace and Justice in Birmingham and they do really beautiful work. And the thing that they've taught me is that space is not neutral. So that design can actually facilitate or inhibit equity. So if I'm talking about a birth center to advance equity in maternal and reproductive and sexual health care, then the physical space has to actually be engaged in that. We can't just like build a clinic as we know other clinics to be and then hope that that space can advance equity that everything from the color palette to the to the vibration to the features to the to also the materials we're not using any VOCs no plastics no vinyl flooring all sustainable materials so all of that is a part of actually advancing equity and I think that those are some examples of how how we're doing it differently

Phillipe: I'd like you to talk a little bit more about what you were just saying because it it seems to me that when I listen to you talk about what you all are trying to create, it seems that there's a real artistry to what you're trying to create. Like you're you're composing music or poetry.

nashira: Mm.

Phillipe: You know what I mean? Like you're not just creating a space or even just engaging and providing care, that you're creating something that will hold people's experiences differently, that will create the possibility for new experiences, for transformation, that radiates beyond the particular thing that you're doing. I'm wondering,

nashira: Mm.

Phillipe: i am I hearing you correctly? Like am I am I getting what you're saying?

nashira: I th I think you are. It sounds really nice when you say it back to me. You were definitely picking up that that's the intention and I appreciate hearing back that it sounds like, you know, an orchestra or poetry. Most days it feels a little bit more like a frantic trying to figure out and solve for solve for big problems. but also we're very clear as we practice that like it has to feel good. And so while it feels frantic, we're also like deep we're like figuring this out, you know, on the floor by the fireplace. Like we're figuring this out in a hot tub on a staff retreat. Like it has to feel good. there was a very early meeting I had. actually I haven't thought about this in a while, but Very early on, I spent many years volunteering on this effort, as you know, before we were in a position to hire staff and I would, you know, have a meeting wherever I could and I've got people over at BU School of Public Health. And so I would, you know, be like, Hey, can I have a conference room to have a an advisor meeting of midwives and community leaders? And we go over to this really beautiful conference space. and I I would schlep over like a basket of like a like a table runner and some flowers and trying to create kind of a sacred space to have this meeting at this conference center And like while the space was as beautiful as academic conference rooms go, it made me realize that we're like we actually have to like be in the thing we're trying to create in order to access and feel it. So we moved our meetings to the old oak dojo. This is this beautiful space on a quarter acre in Jamaica Plain. You know, doors open to a 300 year old oak tree sitting on the floor making tea. you have to be able to imagine that your healthcare can feel like that. And it was starting to feel hard to like step from the board table to the imagining of the birth center. I want to elevate our healthcare experience such that you come into the birth center and you're like, snap, like this feels nice. And then you go to your dentist's office and you're like, nah, the jig is up. Like you all could do better. healthcare is a human right, and that we get to feel seen and our bodies and all of their complexities and our relationships and all of their dynamics. you as a person, you at your family and what it looks like gets to be fully seen and known inside of those spaces. and so I think you have to design for that, one of the things our architects kind of taught me is that like The design of of healthcare spaces as we know it is very linear and really maps the hierarchy. So you come in and you're greeted behind glass by the receptionist. And then you're brought into a room for your, you know, your your biometrics by a an medical assistant, right? Or a nurse. And then you get to see the doctor. And then, right, it's but it's very let's almost like straight down a long hallway, and you you incrementally get to the person who holds the power, but also frankly, probably makes the most money. And seizure for the least amount of time, but there is something inherently hierarchical and and the space reinforces that. And so we've been thinking about designing the space that there is a heart. you know, this living room gathering space on both the first floor and the second floor. The first floor is the birthing center where you're admitted in labor and your family can really gather there. There's a full kitchen, so your auntie can be heating up some lasagna and some soup and for the postpartum and for the family. And then the spaces, the birth rooms radiate out from there and similarly upstairs. But really designing for a heart and really interrupting some of that inequity that you only have access to the provider after you've gone through this kind of gauntlet of of space and time.

Phillipe: Mm, yeah, yeah. It's almost like you're saying that health care should be humanizing.

nashira: Ooh. Radical.

Phillipe: Yeah, that's what it sounds like to me. What a concept, right? Yeah, yeah, yeah, I love

nashira: Wild. Yeah.

Phillipe: it. So let's go back a bit. Let's get into a little bit of the origin story of the neighborhood birth center. How did you and your colleagues, your fellow dreamers and strivers, creators, how did you all start this?

nashira: Hmm. I appreciate the question and the opportunity to name and acknowledge like it did not start with me. this is the answer to the longing of midwives in our community who have been practicing In the hospitals in Boston for decades. So I would say 30, maybe 40 years. And there was an article in the paper, and actually this was first introduced to me by our late colleague Dr. Elmer Freeman, who shared an article that was in the Boston Globe in the 90s. So yeah, 30 years ago. and the headline Was birth in the death zones, right? And it and it was probably not the first time it was covered, but you know, Dubois talked about essentially the racial inequities in health, you know, a hundred years before that. But the midwives knew that like that there are challenges in the hospital-based system, and they're our structural disadvantages in the those things that determine our health outcomes where people live, work and pray. And midwives have always practiced outside of the hospital, my siblings were born at home right around that time. There were you know, people were born in Boston right around that time. but the majority of midwives, again, because of the ways that midwives were credentialed and had to have a nursing degree and could practice in the hospital that that many midwives were practicing in the hospital. Anyway, this is their longing. And I came to know them in public health school and had given birth at home because of my mother's experience with home birth in twenty thirteen. And I was at lunch with Dr. Joanna Rory and I said, you know, I had this incredible home birth experience with candles and this midwife and my mom and my partner were there and, you know just you know we were home it felt so good and it's so different from what I had been studying for so long and from what I had been working on at the public health commission in maternal health and really looking at racial inequities in maternal health and Joanna simply said well duh I mean that's been why we've wanted a birth center in Boston forever and that was the moment that I was like well if you want a birth center you know pray tell what what exactly is that and how can I help is basically how that lunch conversation went. and I spent the next couple of years hounding her to download that story, like their wishes and how they got there and what they were up against when they brought this idea when they kind of met in the early 80s and 90s about this idea and what the pressures sounded like from the hospitals and and frankly like what the economic math of it looked like. One midwife out in Minneapolis wrote a paper that I reference all the time called The Impossible Math of Birth Centers. you know, longer visits, more personalized care, terrible insurance reimbursement, personally finance startup costs, and just this impossible math. And so I've spent the last ten plus years really working that math. And I'm really proud to say we have a a really impressive spreadsheet now that really maps out all of those variables it's a hypothesis still, but that you can like pay the midwives well and not overwork them and make sure that, you know, people get good outcomes and and that the answer to that is that insurance companies step up and cover appropriately for the burst that they're already paying for. They're paying for a hundred percent of the burst, right? Right now they're paying at the hospital. and they could pay us. and in the meantime we're turning to philanthropy. So yeah, it's a dream of the midwives and I kind of just happen to be in the right place at the right time to to listen to to their dream and and now those midwives are our senior advisors and I cannot wait to this summer have them be a part of a ritual of blessing the land and being a first to to put shovels in the ground for the space where we'll where we'll build.

Phillipe: That really sounds amazing. it makes me think about How many life-changing, world-transforming things have started with conversations like the ones that you described, right? that's what set things in motion, was just having a conversation. I I think that that's a really important lesson for listeners. you never know when you're gonna have a conversation like that, right? and be part of it, yeah, yeah.

nashira: Absolutely. Yeah, and I think that a like I'm just thinking back to a a public health leadership training that I used to do. And we would bring public health leaders from government to this beautiful retreat center in the woods and you know they would be sitting on the floor and there was a hot tub and there was this incredible fire pit and there was this kind of like sense of guilt for those who are government employees, like I can't believe we're in a hot tub and there's wine and like this is a business trip and it's leadership, and how am I gonna go back and like say that I did this and we're like, well, wait a minute. business deals are happening on golf courses and in hot tubs and saunas, like, you know, with with men mostly and probably white men all around like that you get to access space of connection and that that's actually really essential and yeah, you get to like be in this space and that that's allowable and not only allowable, but it's actually really important, which is why there's like unlimited food and you should take an hour and go hiking and you should go in the hot tub and like that we we get to access that. And I think there is a practice in government and in nonprofit of certainly of scarcity and of like, you know, those things are not allowable. And I I think it's really important that we interrupt that a little bit and and name that like yeah sitting together around a fire is really important for for what is possible different things emerge right you actually have to be in a different container like i was saying about the bu space versus the dojo you have to be in a different container to be able to access a different way of of feeling and being and so it's it's not only nice to have but it's essential

Phillipe: Yeah, it sounds like you're saying that, and I think other people have have gained this insight, you know, that pleasure, joy, connection are actually essential, right? They're not optional tell us a little bit more about the process. I know you heard that you all are about to experience a really powerful milestone this summer. but tell us a little bit more about the process of getting to this milestone. You gave us a sense of kind of how it started, crunching the numbers for a decade. What are some other things that you think it's important for people to know about the process that brought you all to this moment?

nashira: Yeah.

Phillipe: Yeah.

nashira: it's nice to be able to reflect on this from where I am now because I can I can look back and be like, I was really Almost like paralyzed with fear of setting up a nonprofit and structure and replicating inequity. Right. I like my career, I grew up in governmental public health. I learned certain ways of being and I was like, I'm gonna create a board that's gonna like replicate all this and like, you know, and so I spent a lot of time like talking to people who were like leading flat organizations and really experimenting with like worker self directed nonprofits and really understanding like grassroots organizing and like how To build this with a lot of intention. And so it was in a lot of ways like a slow growth. And I think that that is what has allowed us to kind of be the way we are right now is that I didn't build this in the first few months coming out of government practice because it would be a really different organization. I actually had to spend some time like sloughing that off and and learning from others and looking at really dope organizations who have really practiced how to create, you know, operations that are people centered and that center equity, not just the the like Not just the the practice of midwifery, but actually the startup, how the board operates, how we fundraise, who we turn to. And so I'll pick up on a couple of those threads. we didn't fundraise for years because I was like afraid to ask anyone for their hard-earned money when I was still kind of like, we have this idea, but it's not fully baked yet. and then at some point a board member of mine just sent me a check for $500. She was like, stop. paying for the website by yourself. Buy the donuts for the you know I was holding these like little focus groups in Franklin Park in Boston and she was like buy the bagels like let us pay for the website you know and then that actually became the fundraising became the board and then I'll I'll just say like our first fundraising campaign when we were in a position to get ready to buy property You know that being a part of that was like accessible, and we didn't want to do this very typical thing in philanthropy and in fundraising of like offering naming rights. So if you can give five figures, you get to name the garden after yourself, and if you can give six figures, you get to name the birth center after yourself. And I was like, Well, what does that mean for you know our neighbors and like folks who are you know right in the neighborhood who don't have that by structure by design, but for whom the birth center is should actually be named after, right? Or the or the the black grand midwives that we should actually be naming after. And so we we kind of built our development program with that in mind and and our first campaign raised three million dollars from like donors from five to five hundred and that was really important to say like you get to be a part of this for for five dollars and And it also is a part of our story now. And now I can go to bigger donors and foundations and say, like the community is bought in, and now it's time for you to join the the frontlines. and so that that I think is one thing that we've learned along the way. I mean, I would love to have a whole other podcast about our board design. we redesign the board after a while and have a really thoughtful design where we have a circle of owls who are really wise elders, you know, I'm using like elder in their field, right? Not age chronological, but wise elders who are like perched on a branch and they swoop down to give me advice and support as needed, but I'm otherwise not trying to corral in a monthly board meeting. Very busy, very smart people who are very sought after But then it was like, but I also have very real needs for support and supervision and guidance with much more frequency. So I have a strategy circle that meets me every two weeks, and that's a circle where we like work all the hiring, the the budget, the like the operational equity stuff, the fundraising strategy. We really work it there. And that group has committed to a high touch, high capacity commitment and we offset that by paying honoraria and then we agree and that and that's the group that works on consensus

Phillipe: something I think about sometimes is I think of it as a laboratory of liberation, right? So you all are doing a lot of experimentation. You're learning as you go, you're bringing forward, you know, wisdom and knowledge that's been gained over generations, but you're also being very playful and creative and curious and I love it, you know, I I love it. That's it sounds like a laboratory liberation to me.

nashira: exactly it i love that framing i'm gonna have to borrow that and credit you i it is exactly that and i think i learned it in a couple places i think again from adrian marie brown and emergent strategy and like really the the small is all and really practicing at a small scale And also from Jabron Rivera who talks a lot about kind of experimenting, like not putting all of our resource into like a Trojan horse and you know, flooding in, but actually like small experiments and getting that data back and iterating. and so yeah, those are two teachers of mine. And I think you're right, it is like a a liberation lab. and I think it will be. Like I think there is a one of the things that I personally am feeling as we get ready to open in 18 months and turn from a a two-person fiscally sponsored project of another organization and we are like exiting to our own 501c3 hiring clinicians building a building and catching babies like in the next 24 months and there is a way that in that there is like a realness that like you're gonna have like real policies that protect lives and we're gonna accept insurance and contracts with with MassHealth and all of that and still we need to continue to be able to experiment and so it's the thing that I continue to be like, it's been very emergent and and very flexible, right? There's it's been small and we are again we're fiscally sponsored and we're like we're in the lab. And there's a way that I wonder and that will be the next phase of my learning from you and others like how do we continue to to do that while while the pieces around it have to be very cooked in order to like meet our mission of like really providing healthcare. There's very real things while we continue to experiment. And so but that to me feels like the work right it's figuring out how to build liberatory space for health inside the current system or or like you know integrated with because we've got one foot in the new paradigm and one foot like yes we absolutely need to be in contract with all the payers and we need to transfer to the hospital and so that yeah I love that frame and I want to come back to get some more wisdom from you about how to keep experimenting As we become a clinic.

Phillipe: Yeah, well one of the other things that I've learned about what you all have been doing, 'cause you you talked about sort of making Massachusetts a place where you all can actually be successful in doing this work. Talk a little bit about the policy advocacy work that you all have been doing as well.

nashira: Yeah, Maybe I'll just say that in my early years of going like, is this possible, right? Like if we build it, will they come? How are we gonna the back of the napkin of of that math was not mathing and and everything came back to State regulations that regulate birth centers were terribly outdated in Massachusetts, compared to other states and and national standards. And home birth midwives, certified professional midwives in the state were not licensed, so they couldn't work at birth centers. And arguably in in a very dichotomous system, those are the midwives who are very practiced in community birth. They've been catching babies at home. And so we were like, wait, we can't hire them. and they can't be the clinical director. and then even the certified nurse midwives that we could hire were gonna get reimbursed way less than the hospital would get reimbursed. And even inside the hospital, the midwives get reimbursed less than the OBs for the same exact service for like a vaginal delivery or for an IUD implant or and so it was like really kind of like, you know, banging our heads against the wall in a way But I was like, well, how are we gonna make this math work if we've gotta spend, you know, hundreds of thousands of dollars in the startup in brand new construction because the the design regulations are outdated. We have to hire an OB to be our clinical director, because you can't hire a midwife. and And you're not gonna get fair reimbursement and you can't hire professional midwives because they're not licensed. And so the answer was like, okay, so we could just like raise you know, ten million dollars, which actually we did, but and try to just offset this forever, but it's really not sustainable, right? And funders and donors and I want to know that we can sustain this into the future and replicate it. And so the answer became well then you gotta go way upstream where all the stuff is getting you know tight and and work there. So again my first full time hire was a policy director who was a midwife and we joined the Bay State Birth Coalition that is a long-practiced very well-organized coalition of birth and public health leaders led by Senator Miranda she created a an omnibus of the most comprehensive maternal health bills that the state had ever seen. and we fought like hell in twenty twenty four. I mean, it was a decade and coming and then it was this like coalescing of the bills into an omnibus and it was the coalescing of movement and it was these rise of birth centers around the state that we're trying, trying, trying to open but for these issues. And so it was this real moment. And I don't want to say it was a miracle 'cause it was like a ton of work, but it was really miraculous to be It was like felt magical is the word I should use. and so we were a part of that. And the the House passed the legislation in July and and the Senate in August. And by the end of August 24, the governor had signed it into law. And now we are like, okay, implementation is still a thing, and we're still working hard on that. But that becoming law has really changed what's possible for Neighborhood Bar Center, for Seven Sisters out in Western Mass, for Cambridge, for Worcester. And so I we tell that story because I think that it certainly was not on my radar in that first lunch with, you know, the midwife ten years ago to say, like, we've gotta roll up our sleeves and be at the state house all the time and I'll be at the state house again tomorrow. but now we know it is like a a core essential piece of our work. and and still we've got it's like full court press to get insurance to reimburse midwifery appropriately, and community based midwifery appropriately. But that's our next that's like the next frontier. And I'm really proud that I think that there's a model here for other states to look at and say, like, and one of the things that we're proud of is a couple of years ago we would go to the state house and lawmakers and their their staff were like, So what's a midwife? I had a doula, and we're no, no, hang on. Doula is very important, midwife is very different. and now we roll up and they're like, you're with the midwife. Like they're just bit like there is a there is a culture change, right? And that is really important, because we know that like culture eats policy for breakfast, and so it's really important that we're working working on like culture and narrative. So yeah, really proud of that and really stand by our investment in that as As also a part of like interdependence, like we could because I'm not a midwife and I'm I've learned to be a fundraiser in this. I could just be like, all right, like I'm gonna just fundraise like hell for this one birth center. But when we think about the whole network of birth centers and that the birth center out in Western Mass that's you know not a 501c3 yet and is led by a midwife who's catching babies at three in the morning and I'm not, so she can't fundraise at the capacity that I could fundraise. So I could be like, All right, well, I'm just gonna save my birth center this way, but instead we were like Like what does a network of inter interly dependent, interdependent birth centers look like? And if she is sustainable, I am sustainable. And if Worcester can open, Roxbury's better for it. And if and if Roxbury can open, Lynn can open and Brockton. And so we really had to look at at that practice of coalition and that's been like our saving grace. so really affirming that that yeah, that piece is really affirming. And, you know, I didn't know like much about Bills and all that before this. But so we're all learning. Yeah. I wanted to say one other thing is that as we think about who will receive care at the birth center again I mentioned the care can go kind of across generations from you know teens and and family planning to menopausal care but There have been times over the last ten years, because I gave birth at home and also because of my work with the birth center that friends a and peers will come to me and say, you know, I'm really interested in home birth or I would love to go to your birth center if it were open, but My abuelita would never support it. Like she's just too worried and like there is a way that I see our work as holding also space for like intergenerational healing and conversation that of course she couldn't, right? Because the the exact data that we're building this to address is her lived experience, right? And her community. And so everybody holds a story of somebody whose outcome or experience was trash right trash at best traumatic and life-altering, you know, at worst. And I think really like it's not just that we're trying to assuage people of reproductive age that it's safe enough for them to come and and talk about you know giving birth outside of the hospital and all the safety measures that we've put in place but really also tending to the trauma that lives in the bodies of our elders and of the community, right? And even of the men of the community who have lost their partners and to meet them in that moment and be able to hold space for that. is a really important part of our work. It like we cannot have like a marketing campaign that is like a you know, it's safe, come here while people are holding that in their bodies. and so I just think a lot about that. I think a lot about how as as our team grows and as we kind of step more into more public offerings, that there's a big piece of our work that is about tending to that and doing that, you know, in partnership with healers and mental health providers and and folks who are leading men's circles and such. But there's a real there's a real wound here. And it's important to as we talk about designing this to meet the inequity on a population scale that we're also talking about the impact of that trauma and our role in being a part of of tending to that. My work is not to just like convince people that it's safe enough, but to really acknowledge how we got here there's just one other thing I wanna say, which is that there was a part of me that as I thought about like, you know, I was trained in public health, so I was like, you gotta do a needs assessment, and then we gotta see if this'll work, and we got the spreadsheets gotta we've gotta be in the black before we can start and like that's not gonna happen and like all of these moments and I was like, you know, trying to like talk about it, like convinced people of the safety, and here's the renderings and here's what it could look like, and that feel like there was enough of a population that understood it and believed in it that we should build it. And there was something that I realized like nobody, including Senator Miranda and the mayor and others who are are behind this have set foot in a birth center. There isn't one here. So I was trying to like lead people to get behind something that they actually haven't physically even experienced. So I was like, we actually have as an organization have to take this risk to throw all of our resources at this, to actually build it, put the shovel in the ground, put the studs up, get the windows in, put the tubs in, hire the midwives, Have people walk through and go, right. There's a somatic experience that happens when you and I want you to come and tour the birth center and everyone all your listeners when we're open to like come and tour and go, This is what she was talking about. Because there's no slide. And no TED talk and no podcast I can do that will it explain what we're trying to do until people can step through and smell it and feel it and see the the row of teas and hear the water in the tub and the children playing. And then the data comes. Outcomes are better, experiences are better, right? We start to show the data. And this is a long arc of change, right? It's gonna take years. But I think that there was a moment that I had to get to that was like, I can't just keep talking about it. And hope that, like, in that I will get the masses to understand and that the elders will be like, yeah, that sounds safe. We actually just have to build it and in the experience of it, shift culture and shift narratives such that people are like, my cousin gave birth over there, right? And I did this talk about the birth lantern that will light a lantern external to the building that is going to be designed by a Haitian artist of of an oil. an oil drum, but there will be this lantern that hangs outside that the family can light from inside, you know, in ritual when the baby's born. And everyone will see the lantern and go, it must be safe over there. That lantern's always lit. Right. And so there is something about kind of having to be in it. in order to, you know, I guess I guess I'm saying like we make the road by walking.

Phillipe: Yeah, yeah, yeah. I often think about the idea that you have to show me, not tell me, right? Show

nashira: That's a

Phillipe: me, not tell me. So I'm wondering at this point, you know, if people want to support the work of the birth center, how can they support you all?

nashira: Mm. Thank you. Yeah, a couple things come to mind. we are still in a we're still doing a lot of advocacy, I will say, at the state level. So there are bills, there are budgets that will change the course of our organization and other birth centers and just midwifery as a practice in general and doulas and birth work. So I would say, you know, follow the Bay State Birth Coalition and follow Neighborhood Birth Center on online. So neighborhoodbirth center dot org and on social media, we put out a lot of action alerts there where we just need you to like 30 seconds fill out a form and and get behind the policy change stuff. the other thing is I think there is, you know, as consumers, Requesting midwives for your providers and all of your sexual and reproductive health care, right? You find out someone's pregnant and they call me and they say, Nashir, do you know any OBs I can call? And I'm like, Why are you not calling a midwife? Right? So let's normalize that you can go to midwives for your GYN care, for your PAPs, for your reproductive health care. and they are, you know, as as one of the state reps likes to say, you know, they are the top of the license for for reproductive health care and childbirth, right? and then you know fundraising we are still in this like proof of concept we're fighting like hell for insurance reimbursement but the first couple years are gonna really rely on philanthropy and the generosity of donors again between five and five hundred thousand to ensure that we can build the building, have enough of a reserve to pay those staff while our birth volume grows and while we fight for equitable reimbursement from insurance companies. So I don't want to be fundraising forever, but I'm definitely fundraising for the next couple years. and that's just in some ways the the price of good healthcare right now in the in the system that we're in. And I used to say like it shouldn't be this way. We shouldn't be, you know, passing the hat for health care. And I agree it shouldn't be, but it is. And so that is a big part of what we're doing. And folks can follow along and and see as we're running campaigns there. That would be incredibly helpful. It has made all the difference. We've raised ten million dollars in a couple of years. and we've got two million more to raise before we open.

Phillipe: All right, so as we move towards the end of the conversation I'm just wondering, is there anything that you would like to leave the listeners with? Anything else you want to say to them?

nashira: I think I I maybe just wanna share a brief story example from my own birth because we've been talking a lot about midwifery and and community birth. and I just wanna share what that can look like. doesn't always look like, but my experience with my second both of my kids were born at home. One right here in this house I'm sitting in and I was in a tub, warm water. Candles, midwives, my mom, my partner, my four and a half year old was like, you know, holding me while I was in the tub. the hardest work I've ever done, labor. but I had the freedom to move around. So as my body told me I got on my L fours or I turned and I I felt a sense of agency. I I think about it often. My mother said back to me, she said, I watched you meet the tiger inside of yourself. And again, I think when the space allows you to do that and you're not kind of like worried and you can move and you can holler out and you can reach that primal part of yourself. and had a really beautiful and powerful birth. And hours later, I mean the baby was born at you know six something in the morning, and hours later by 10 a.m. house is cleaned up, tub is packed away, quiche is in the oven, fresh bagels were picked up, and the sun is high, and we're out on my back deck with a baby four hours old, skin to skin. You know, I'm drinking a beer because beer helps the milk come in, and and we're all having coffee and tea and It felt so special and also so normal. It was a Saturday morning in the sun on my back deck. And I share that because that's not the story that people hear about childbirth a lot. And it was unique compared to the stories, but it was not unique. I mean those home births are happening like that all around us. and there will be more once the birth centers open that that is what's possible. A very home like setting where your family's preparing you know bagels and quiche and your four-year-old is by your side and whatever you want pumping through the playlist or not. there's a garden you can walk around and touch soil and sit among the trees and lean on the trees and put your fabric reboso around you know the tree and rock and that all of that is possible right here in Roxbury and I think it's important to put those birth stories out there as a part of also countering the stories that we hear so dominantly of all of the sadness and a sense of people not feeling agency. and I hope that people will say, I heard this woman once gave birth in her living room and then sat outside with the baby and had a beer. Like that just to to add that to our canon of stories, and start to know that that's possible and that it happened right down the street. feels really important. So I'd love to leave folks with with my birth story and know that many more stories like that are around us. and many more are coming as we as we equitably increase access to that. I also only had that option because I paid cash for it. you know, a couple thousand dollars for that care and it's coming more accessibly with the licensure of professional midwives at home birth in this state will be covered by insurance and that the birth center care will be covered by insurance. And so more people can have access to home like settings for the love of midwives.

Phillipe: Alright, thank you so much for joining me today.

nashira: Thank you for having me. It's been a real treat.

Phillipe: Thanks for listening to From Issues to Action. If you've been informed and inspired by this episode, rate it, share it, and become a subscriber. You can find additional episodes on the podcast website from Issues to Action.com and wherever you listen to podcasts. You can also follow me, Philippe Copeland, on social media.