Think Big Initiative A Blueprint for Community Birth (3) copy

The Work

The Five Domains

Think Big Initiative A Blueprint for Community Birth (4)

Building universal access to community-based midwifery care requires robust infrastructure across five interconnected domains. Each element is essential, and they work together to create a healthy ecosystem for community birth.

The National Academies of Sciences, Engineering, and Medicine (NASEM) identified these infrastructure gaps as the primary barrier preventing the expansion of midwifery care, despite strong evidence of its effectiveness. Our work focuses on envisioning what comprehensive infrastructure looks like in each domain and creating detailed roadmaps for building it.

The Community Birth Domains

The 5 domains interlocking

Why All Five Matter:

These domains are deeply interconnected. Addressing only one or two won't create the systemic change needed. This initiative brings all five together in an integrated approach.

The Five Infrastructure Domains

Quality Improvement

Building Excellence in Community Birth

Current State: Quality improvement systems are unevenly supported in community-based settings due to systemic barriers.

The Vision: Community birth quality improvement programs across all settings and provider types, centering the improvement of community-based care.

Key Questions:

  • What quality metrics matter most for community birth?
  • How can we create peer-led quality improvement that doesn't replicate punitive hospital models?
  • How do we ensure quality improvement centers equity and cultural safety?
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Data Collection & Research

Building the Evidence Base

Current State: Current vital records surveillance systems don't adequately capture the full picture of midwifery care across all birth settings.

The Vision: Universal data collection initiatives that enable the study of midwifery models of care across all settings, with evidence used to inform all five domains.

Key Questions:

  • What data do we need to understand outcomes, guide improvement, and inform policy?
  • How can data collection be sustainable for small practices?
  • How do we protect privacy while ensuring transparency?
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Workforce Development

Cultivating the Next Generation

Current State: Educational pathways are often inaccessible, unaffordable, or don't adequately address diversity and cultural relevance.

The Vision: Equitable educational pathways that cultivate culturally and linguistically concordant midwives, addressing provider shortages through accessible, affordable training.

Key Questions:

  • How can we make midwifery education accessible to people from diverse economic backgrounds?
  • What models of education best serve both students and communities?
  • How do we support midwives throughout their careers?
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Policy Reform

Advancing Person-Centered Policies

Current State: Policy barriers limit reimbursement parity, restrict scope of practice, and create inequitable access to midwifery care.

The Vision: Person-centered perinatal care policies that shift systems beyond a primary focus on hospitals toward models that elevate community birth and midwifery care.

Key Questions:

  • What policy changes would have the greatest impact on access?
  • How do we advocate effectively in a volatile political climate?
  • How can we build coalitions across different stakeholder groups?
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Systems Integration

Seamless Care Across Settings

Current State: Model programs that enable seamless care coordination exist but aren't standard practice.

The Vision: Safe integration across all care settings, transforming model programs into standard practice with respectful collaborative relationships.

Key Questions:

  • What does effective integration look like in practice?
  • How can we build trust and respect across different care settings?
  • What systems need to be in place for safe, seamless transitions?
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