Think Big Initiative:
A Blueprint for Community Birth
Universal Access to High-Quality, Culturally Reverent, Community-Based Perinatal Care
A collaborative initiative to build the infrastructure that makes community birth accessible in every community
Think Big Initiative:
A Blueprint for Community Birth
Universal Access to High-Quality, Culturally Reverent, Community-Based Perinatal Care
A collaborative initiative to build the infrastructure that makes community birth accessible in every community
Why Now
The Crisis Is Deepening—And the Solutions Already Exist
The United States faces a worsening perinatal care crisis. Maternal mortality continues to rise while declining globally. Rural hospitals are closing labor and delivery units. Provider shortages leave communities without care. And the disparities affecting Black, Indigenous, and other communities of color remain unacceptable.
To make matters worse - or perhaps better - we already know what works: culturally-aligned, community-based midwifery care. The evidence is clear. The 2020 National Academies of Sciences, Engineering, and Medicine (NASEM) report "Birth Settings in America" documented that midwifery care is associated with:
- Lower intervention rates
- Higher maternal satisfaction
- Better outcomes—particularly for communities historically underserved by the healthcare system
So why isn't midwifery care universally accessible? Because the infrastructure doesn't exist to support it at scale.
The Promise of Midwifery
Explaining the 5 Domains
Building the Infrastructure for Community Birth
The NASEM report identified critical infrastructure gaps as the primary barrier preventing universal access to midwifery care. We're bringing community together to envision and build comprehensive infrastructure across five interconnected domains:
Why All Five Matter
These domains are deeply interconnected. You can't build sustainable quality improvement without data to inform it. You can't train enough midwives without addressing policy barriers to reimbursement. You can't integrate care across settings without adequate support for the other domains. This initiative brings all five together in an integrated approach.
How We're Building It
A Community-Created Process
This project is a community-led, facilitated process. Here's how it works:
Timeline
2025: Needs Identifying & Visioning
- Community discussions
- Design the 5 domains
- Secure funding
- Conceptualize the process
- Develop website
Q1 2026: Launch & Introduce
- Public launch webinar
- Introduce the five domains to the community
- Open applications for workgroup participation
- Develop community input mechanisms and circulate
Q2 2026: Form Workgroups
- Select delegates using a consensus process designed to sample for diversity of perspectives and expertise (3-4 per domain)
- Launch monthly meetings with delegates and facilitators to begin development of draft roadmaps in preparation for the convening
- Gather and synthesize broad community input by domain (via online forms and domain-specific conversations)
Q3 2026: Prepare for Integration & Convene
- Continue community engagement
- Hold major convening with representatives from all domains
Q4 2026: Convene & Finalize
- Integrate five roadmaps into coherent workplan
- Release comprehensive workplan and invite community input
- Finalize blueprint and start implementation
Our Community Values
We're committed to a process that:
Moves at the Speed of Trust and Listens Intentionally.
We understand that the work we do today will have a lasting impact on future midwives, other healthcare providers, and the families they serve. We're committed to moving slowly, listening, and being intentional—even when urgency tempts us to rush.
Acknowledges Historical Context.
The exclusion of Black "granny midwives" in the 20th century and the creation of the CPM credential in the 1990s, which largely centered white, cis-gendered, middle-class perspectives, created harm that we must not repeat. We acknowledge this history and commit to learning from these mistakes.
Recognizes the Importance of Healthy Conflict.
We recognize the importance of having a healthy mechanism for working through conflict. Disagreement is an essential part of collaborative work.
Builds Accountability.
We will create and adhere to an accountability process that reassesses the impact of the work at regular intervals, including ongoing reflection and course correction.
Acts in Transparency.
We will act in transparency throughout the process. Decisions, challenges, setbacks, and successes will be shared with the broader community.
Let's Think Big
Launching the Blueprint for Community Birth
Get Involved
Everyone Has a Role to Play
Community Conversations
Thank you for joining the Community Conversations! Here's what's next.
Our team is integrating the community's feedback from each session into the blueprint.
Couldn't attend the Community Conversations? Share your perspective with us any time here:
Organizational Partnerships
Led by NACPM, Uplift Lab & BirthSwell
Supported by Skyline Foundation
The professional organization representing certified professional midwives in the United States.
at Oregon State University
Exploring the ways community-led research, population data science, and ethnography can combine to imagine and implement more equitable reproductive futures.
A communications and advocacy firm working exclusively to increase access to birth and lactation care.
Providing $500,000 over two years to support this collaborative visioning process.
Support the Work
Help Build Infrastructure for Universal Access
This two-year planning process is supported by Skyline Foundation. But sustainable implementation will require continued philanthropic investment. We're establishing diverse funding streams to support implementation across all five domains.
For Funders:
Contact Cassaundra Jah, NACPM Executive Director, at executivedirector@nacpm.org.
For Individual Supporters:
Information about individual giving opportunities coming soon. Sign up for our newsletter to be notified.