Across the United States, a growing chorus of voices is calling for a radical transformation in how birth care is delivered. As hospital closures sweep through rural communities and longstanding inequities persist in maternal health outcomes, advocates and policymakers are rallying around new models that center midwifery and community-based solutions. On October 24, 2025, two stories—one from the grassroots, another from the legislative front—highlighted the urgency and vision driving this movement.
In a personal essay published as part of the Gender & Democracy series, a Black mother and birth center co-founder shared her journey and hopes for the future of U.S. birth care. Her message was clear: "Midwife-led, community-rooted birth care offers a visionary path toward equity, dignity and better outcomes for all families." She argued that decades of research, public health wisdom, and lived experience point to the need for a dramatic shift away from the current, highly medicalized, physician-centric, hospital-anchored system. Instead, she called for a leap of faith toward a model that places families and midwives at the center, with physicians collaborating as trusted partners.
The statistics she cited are sobering. Despite mounting evidence that midwifery improves outcomes, less than 15 percent of birthing people in the U.S. currently have access to midwifery care. This stands in stark contrast to countries such as France, the United Kingdom, the Netherlands, and Japan, where 75 percent of pregnancies are supported by midwives and birth outcomes are notably better. Even more striking, at least 60 percent of U.S. pregnancies are considered low-risk and could be safely managed by midwives in community settings—yet the system remains stubbornly resistant to change.
Why is this the case? According to the essayist, the answer lies in deeply entrenched hierarchies—of both human value and provider credentials—that shape the nation's birth culture. "The U.S. has been doing birth backwards for decades," she wrote, "providing highly medicalized, costly care despite poor outcomes, and ignoring data that estimates at least 60 percent of U.S. pregnancies are low-risk and could be safely supported by midwives in a community setting." She urged readers to imagine a different future, one where birth is "family-centered and midwife-led with physician collaboration, rooted in the inherent dignity of every person, and that respects both midwife and physician credentials."
It is a vision that demands more than incremental reform. Drawing inspiration from thinkers like Grace Lee Boggs and Norma Wong, she argued for what Wong calls a "leap strategy"—"casting back from a story of the thriving future, and building the just-enough infrastructure to support a critical mass of intrepids" who are willing to lead the way. This approach, she suggested, means not waiting for all the answers or for every barrier to fall, but instead moving forward with courage and collective action.
One concrete manifestation of this vision is the 'Beloved Birth 50 by 50' initiative—a bold goal that by 2050, 50 percent of babies in the U.S. will be born with the care of midwives. The initiative is described as an "open-source, unifying north star for collective action toward a culture of birth where all people give birth safely in dignity and love." National Geographic has recently spotlighted the centrality of midwifery in maternal health around the globe, giving the movement a significant boost in mainstream visibility.
But the road ahead is not without obstacles. Hospital closures, especially in rural and communities of color, have laid bare the systemic issues plaguing healthcare financing, infrastructure, and equity. The essayist pointed out that in very few places has a hospital closure been offset by the creation of another birth care option, leaving families with fewer and fewer choices. "Now is the time to grow our courage," she wrote, echoing the words of Grace Lee Boggs: "Now is the time to grow our souls."
While grassroots leaders push for a reimagined birth culture, policymakers in California are taking tangible steps to address the crisis in rural maternal health care. On the same day the essay was published, the Office of Assemblywoman Heather Hadwick announced her strong support for Senate Bill 669—a measure designed to restore access to maternal health services in some of the state's most underserved regions.
SB 669, which now sits on the governor’s desk awaiting signature, would create a 10-year pilot program for Plumas and Humboldt counties. The bill allows up to five critical access hospitals to establish standby perinatal services, a move that could be life-changing for families who currently must drive hours to reach the nearest obstetric care. According to Hadwick’s office, "The goal is to bridge the gap between full obstetric units and no services at all, ensuring safer options for rural mothers and infants."
The need is acute. In many rural communities, the closure of local labor and delivery wards has forced expectant mothers to undertake long, sometimes treacherous journeys—often through mountain passes and unpredictable weather—to deliver their babies. Hadwick, who lives in Modoc County, shared her personal experience: "I live in Modoc County and drove two hours to have my youngest child 17 years ago. They haven’t been able to have a baby there for over 30 years. My bonus daughter just had a baby and drove 100 miles to do that. It’s a very real problem in rural California, and I’m proud to support this bill that will help bring these critical services closer to home."
Under SB 669, selected hospitals will be able to reopen limited labor and delivery services, staffed by trained professionals and equipped to handle routine births. For high-risk cases, the hospitals will continue to transfer patients to larger regional facilities, ensuring that safety remains paramount. The bill’s design reflects a pragmatic approach—one that recognizes the limitations of small rural hospitals but refuses to accept a future where entire regions are left without any local birth care at all.
The pilot program is especially meaningful for Plumas County, which sponsored the bill, and for families across California’s 1st Assembly District. By providing a middle ground between full-service obstetric units and complete closure, the legislation aims to restore a measure of dignity and safety to rural birth experiences.
Both the grassroots vision for midwife-led, community-rooted birth care and the legislative push to restore rural maternity services are responses to a system in crisis. They differ in scale and strategy, but share a common conviction: that every family deserves access to safe, respectful, and dignified birth care, close to home. Whether through bold leaps toward a midwifery-led future or through pragmatic policy fixes, leaders are working—sometimes trembling, but always moving forward—to ensure that the next generation enters the world in a system worthy of their arrival.
As the nation stands at a crossroads, the courage to imagine and build something better may well determine the health and well-being of families for decades to come.
