Birth centers in global perspective
International reports on BCs are relatively new. The latest efforts have to do with approaches linked to the agenda of the World Health Organization (WHO) through the United Nations (UN) on the situation of midwives globally as an integral part of women’s rights.
In its call for more midwives, the UN (Organización de las Naciones Unidas 2014) noted that a need exists in the world’s 73 poorest countries (including Mexico) for access to the sort of high-quality sexual, reproductive, maternal and neonatal care that midwives can provide.
However, when analyzing these UN proposals from the health and gender perspective, one can observe that the proposals are rather limited, in the sense that they see midwives as potential healthcare providers only when they are “certified”—in other words, when the midwives can prove that they are licensed and receive continuous training. In the case of Mexico, what would really be useful is to “regulate the profession” in the country (López-Arellano, Sanchez-Ramirez et al. 2020).
The discourse is oriented toward donors, to convince them of the financial benefits of investing in midwifery formation in the developing world, rather than being motivated by an interest in learning about the real situation of midwives in this hemisphere. The financial benefits case, it should be noted, is based upon the argument that greater reliance upon midwives would lower rates of maternal and neonatal mortality (Crisp and Iro 2018; Iro et al. 2019).
These proposals are aimed at increasing the number of regulated midwives to attend low-risk births in distant locations, and to attend births referred to them by doctors who work in the health facilities as part of the official system. These facilities are certainly not spaces to birth differently (at least, according to this particular UN report of 2014), as would correspond to the definitional characteristics of the BCs. Thus, because the UN considers only the official healthcare systems and their concerns for finance, at this level, the UN does not really include BCs as birth models.
The aforementioned UN report (Organización de las Naciones Unidas 2014) provides estimates for the years 2014-2030. From the BC viewpoint of this chapter, that report’s discourse is biased, in that it ignores this particular option as a birth model for the poorer countries, even though in many of the world’s remote locations BCs could be the best alternative for bringing back humanized birth, with all its benefits for the health of women and their children (Alliman and Phillippi 2016; Sandall et al. 2016; Christensen and Overgaard 2017; Decieux et al. 2017; Reunión de Mejores Prácticas 2018).
The Global Midwifery Council, in its report entitled “Birth Situation Room” (2012), showed that, of the 27 countries where the research was performed, only 13 mentioned initiatives for opening spaces such as those of BCs (Finland, France, Hungary, Iran, Mexico, Nepal, Norway, Pakistan, Panama, Saudi Arabia, Trinidad and Tobago, Uganda and Ukraine). They were always found to be responses to the increasing medicalization of birth, in both high- and low-income countries.
In the other 13 countries included in the previously mentioned study (Argentina, Aruba, Australia, Bulgaria, Croatia, Ethiopia, Iceland, India, Kenya, Kuwait, Philippines, South Africa and Venezuela), birthing spaces of this sort are not mentioned. The report emphasized that, in these 13 countries (which include both high- and low-income nations), the situation of midwives was particularly complicated—they struggled to position themselves as a model of care and an option for births.
The above-mentioned report calculates that the model of medicalization of birth is increasingly conquering terrain worldwide, but particularly in high-income countries, including Iceland and France. In these countries, the midwives mentioned that they—and doulas—are already struggling with unemployment. This struggle was attributed to two advancing fronts: the countries’ falling birth rates, and (secondly) the growing perception of hospitals as the clean, safe, modern option for birthing. At the same time, midwives in poorer regions struggled to certify their professions. Thus they were not considered as valuable providers of quality care (Global Midwifery Council 2012).
Germany deserves special mention in this context. The country’s BCs (Geburtshäuser) are part of the health system. While some of these spaces are located just around the corner from maternity care hospitals, others are outside clinical zones. However, all are sufficiently close to hospitals in case of emergency transfers. These BCs are staffed by midwives, or Hebammen. With the exception of special services (such as a family room), birthing in these spaces is covered by the public social security system. Thus, in Germany, the BCs represent a strong birthing option for women (Parker 2016).