Family Health and Birth Center in the Developing Families Center

A collaboration addressing the needs of childbearing and child rearing families through clinical advanced nurse practice and midwifery, social supports, and early childhood development services

Background & Goal

Low-income mothers are more likely to experience pre-term births, low birth weight babies and cesarean sections – all of which can lead to other medical complications and increase health care costs. These also are the major precursors to infant mortality. At an infant mortality rate of 10.84 deaths per 1,000 live births, Washington, DC, has the only double-digit infant mortality rate of any jurisdiction in the U.S.

We are a developing families center meeting the primary health care, social service and child development needs of under served individuals and childbearing and child rearing families through a collaborative that builds on their strengths and promotes their empowerment.

Center Description

The Family Health and Birth Center (FHBC) now integrated with the Developing Families Center provides a midwifery/nurse practitioner model for alternative, cost effective maternal/child care for low-income women. With the intent to replicate a birth center but with an expanded emphasis on social supports and early childhood education and redefining “perinatal” to include the time from preconception through the children’s 2nd year of life, the founder, a midwifery/nurse practitioner, established the FHBC in a low-income community in Washington, DC in 1994. The vision of the birth center was broadened in 2000 to include comprehensive social supports, case management, and early childhood education.

Evidence of Success

• After six years of operation, there was a substantial lowering of African American preterm birth (5 percent at the center, vs. 15.6 percent of African Americans in DC), low birth weight (3 percent at the center, compared with 14.5 of African Americans in DC) and cesarean section rates (10 percent vs. 31.5 percent of African Americans in DC). 
• The center’s successes in 2006 alone reduced costs for the District of Columbia’s health care system by more than $1.6 million – more than the total of the center’s annual operating budget.
• Breast feeding rates were also high at 88.4% at discharge and 56.8% at 6 weeks.
• Of 4 million U.S. births annually, 1.75 million are Medicaid-supported. Application of the FHBC model to all Medicaid births could yield a savings of almost $2 billion.
• Preliminary data for 2009 indicates the center delivered a record number of infants – more than 280 – as well as the highest absolute number – 59 – ever delivered outside the hospital in the District of Columbia (21 percent of births took place at the facility, with the remainder at Washington Hospital Center attended by Family Health and Birth Center nurse-midwives).
• Women cared for at the FHBC in the Developing Families Center have fewer c-sections, less assisted deliveries, lower rates of electronic fetal monitoring, more weekend deliveries (proxy suggesting fewer inductions/C-sections), are more likely to go to 40 weeks or more.
• Care at DFC leads to fewer interventions, lower costs, and equivalent or better outcomes for the women receiving prenatal care at the center, most of whom are low-income.