Spotlight on Success: Commonsense Childbirth
Improving Our Maternity Care Now
Commonsense Childbirth is a midwifery-led practice in Orlando, Fla., that provides a range of clinical and support services to any pregnant person seeking care. Most clients come into the practice at risk for adverse outcomes in usual care settings, yet end up with much better health results than would be expected, thanks to an innovative community-led approach that combines respectful, dignifying, individualized services focusing on health promotion and building on assets of clients and families.
Jennie Joseph, a British-trained midwife, founded Commonsense Childbirth in 1998 in response to the maternal and infant health crisis she observed in central Florida. She is committed to providing a model of care that successfully supports healthy births for everyone. The model, known as the JJ Way®, is based on four pillars:
- Immediate unrestricted access to quality care and support, regardless of ability to pay;
- Connections among woman, care provider, baby, family, community, resources, and support systems;
- Knowledge of skillful, evidence-based care and support; leading to
- Empowerment of women, care providers and systems, agencies, and organizations.
The program strives to serve low-income people who are un- or under-insured, come from marginalized communities, and are at risk of poor birth outcomes due to their life circumstances and unmet social needs — reﬂecting structural discrimination.138 The services they provide include midwifery care, birth center care, childbirth education, birth doula support when available, lactation support, and social service navigation. Services are available in English, Spanish, and Portuguese.
To advance birth equity, Joseph has pioneered the creation of “easy access clinics” and “perinatal safe spots” that offer safe harbor and respectful support to childbearing people who are often disrespected and poorly supported in “materno-toxic areas” within their broader communities and usual maternity care services.
An independent evaluation of 256 Commonsense Childbirth clients found that this approach to care greatly reduced, and even eliminated, inequities that pervade our standard approach to maternity care. Commonsense Childbirth outcomes for births between 2016 and 2017 were compared with those for Orange County (where they are located) and the state of Florida in the same period. The results were remarkable:
- The preterm birth rate for Black clients in this program matched the white preterm birth rates for both Orange County and the state of Florida (9 percent in every case) and eliminated the 4-percentage-point gap at county and state levels: 13 percent Black versus 9 percent white in both cases.
- The low birth weight rate for Black clients in this program (9 percent) largely erased the broader community Black-white gap for this indicator: for both the county and state, Black women had 13 percent low birth weight rates versus 7 percent for white women.
- The breastfeeding rate among Black women exceeded overall state and national rates of any breastfeeding.
- Latina clients had a preterm birth rate much lower than their counterparts at the county and state levels. Whereas only 4 percent of Latina clients had preterm births, more than twice as many Latinas did at the county (9 percent) and state (9 percent} levels.
- Only 1 percent of Latina clients had low birth weight babies, compared to 8 percent at the county, and 7 percent at the state levels.
- Non-Hispanic white clients’ outcomes improved for preterm births (5 percent compared to 9 percent at the county and state levels) and low birth weight (3 percent compared to 7 percent at both levels).
In addition, the cesarean rate in this practice is 8 percent, in comparison with rates of about 30 percent to 50 percent in local hospitals. These results are not even adjusted for risk; given that Commonsense Childbirth disproportionately serves clients from marginalized communities, these outcomes are even more impressive.
These results have major implications for the well-being of families. Considerable reduction in rates of preterm and cesarean birth have favorable cost implications for purchasers and payers.
Commonsense Childbirth also operates the Commonsense Childbirth School of Midwifery, with a three-year program to prepare midwives for the CPM exam and a four-month program to prepare foreign-trained midwives and some other U.S. midwives to obtain a Florida midwifery license. They also offer preparation for community-based childbirth education, doula, and lactation support.