When Kendra Ouillete found out she was pregnant just one month after moving from Florida to Mason in December 2020, she knew she didn’t want a home birth. She hoped she would be able to deliver at a birth center, which she imagined as “a more homey environment compared to a hospital.”
Instead, she found she had only one choice to make: She could deliver at E.W. Sparrow Hospital or McLaren Greater Lansing Hospital. She gave birth to a daughter, Ellis, at Sparrow on Oct. 4, 2021.
Mitzi Montague-Bauer, who has worked as a birth doula in Greater Lansing for more than 35 years, said Lansing has “very few options” when it comes to childbirth. This sets it apart from similar-sized cities in mid-Michigan, like Ann Arbor, Grand Rapids and Kalamazoo.
An alternative to hospitals, found in several locations in Michigan, are freestanding birth centers staffed by certified professional midwives, who train through apprenticeships to assist with out-of-hospital and home births, or certified nurse-midwives, registered nurses who undergo additional training to practice midwifery in hospital settings. However, there hasn’t been a freestanding birth center in the Lansing area since the closure of Okemos’ Greenhouse Birth Center in 2012. The closest birth center is the Village Birth House in Fowlerville, which opened in 2023.
Another option is midwifery practices inside or adjacent to hospitals. Through the Michigan Medicine Certified Nurse-Midwife Service, midwives at health centers in Ann Arbor, Ypsilanti, Brighton and Canton manage the full spectrum of patients’ reproductive care, including prenatal, labor, birth, postpartum and ongoing gynecologic care, with all deliveries taking place at Von Voigtlander Women’s Hospital in Ann Arbor. Joanne Motiño Bailey, director of the service, said midwives “offer a philosophy of care that centers the birthing person and their family based on respectful, shared decision-making, honoring the physiologic process and providing judicious intervention as needed.”
Lansing has one private-practice certified nurse-midwife, Dominique Phelps of A New Beginning Obstetrics and Gynecology in Haslett, who has delivery privileges at McLaren, but she can’t assist with every labor. There’s also no full-scope midwifery practice in Lansing. According to Bailey, the area’s healthcare systems most often employ certified nurse-midwives in various “assisting roles within the hospital” rather than offering midwifery as a full “model of care.”
That means most people who want a midwife to handle their care from the prenatal stages through delivery will have to head out of town. A few options exist within driving distance: Patients can travel to one of the Michigan Medicine health centers, eventually delivering at Von Voigtlander, or to the Trinity Health Birth Center in Ypsilanti. In west Michigan, Corewell Health employs 34 certified nurse-midwives across its system at Grand Rapids-area clinics and hospitals, 31 of which deliver babies at Corewell hospitals in Grand Rapids, Ludington, Fremont, Greenville, Hastings and Zeeland.
Noble attempts and false starts
Lansing’s shortage of options hasn’t been for lack of trying.
Several local birth professionals interviewed by City Pulse recalled a notable attempt in the early 1980s by the former St. Lawrence Hospital to open a hospital-adjacent birth center in a two-story house nearby. But the center was shuttered shortly before its scheduled ribbon cutting.
Sources were unclear about the reasons for the birth center’s last-minute closure. Myra Bayes, St. Lawrence’s head labor and delivery nurse at the time, couldn’t be reached for comment.
The house “had all been set up to be a freestanding birth center,” said Sameerah Shareef, a certified nurse-midwife who delivered babies at McLaren for 15 years and now provides prenatal and gynecological care at McLaren-owned Okemos Women’s Health. “I remember going over to look at it. Right before the grand opening, it got shut down. It never opened.”
Following the failed St. Lawrence attempt, Lansing gained a reputation in the national freestanding birth center movement as an area where opening a non-hospital birth center — whether freestanding or hospital-adjacent — was likely to be an uphill battle.
Montague-Bauer remembers traveling to Pennsylvania around 2001 with the late Barbara “Kip” Kozlowski, a Lansing-area midwife, to attend a workshop led by the late Kitty Ernst, “guru” of the birth center movement. When the women told Ernst that they were from Lansing, Montague-Bauer said a look spread across Ernst’s face. She recalled Ernst saying, “You ladies in Lansing should probably just go back and work on legislation and education.”
Despite Ernst’s cautions against opening a freestanding birth center, Kozlowski did just that. Greenhouse opened in Okemos in fall 2002. However, in 2012, the center was forced to close following a lawsuit filed by a family whose baby died after being injured when midwives attempted to deliver him in the breech position.
Brie Largent of Okemos, a mother of four, received prenatal care at Greenhouse through the first and second trimesters of her pregnancy in spring and summer 2012. She “vividly” remembers learning that the center was closing late in her second trimester.
“They were very gentle about it, and they were devastated about it. I was just stunned,” she said.
A few months later, in December 2012, she gave birth to a daughter, Elsa, at Sparrow.
“A story of repression and competition”
Greenhouse’s closure underscores the challenges for freestanding birth centers without the protections of state licensure or broad-based support from local medical systems.
The legal landscape for freestanding midwifery practice remains unclear in Michigan. While certified professional midwives became licensable in 2017, Michigan is one of only nine states that don’t license birth centers, meaning Medicaid isn’t required to cover care, according to Birth Detroit, a nonprofit organization working to open a community birth center in Detroit.
Connie Powe-Watts, a retired certified nurse-midwife who worked at a Sparrow Medical Group practice until 2019, said the history of midwifery in Lansing is “quite a story of repression and competition with obstetricians for the low-risk delivery dollar.”
Powe-Watts co-owned Circle of Life Midwifery, a full-scope midwifery practice in Williamston, for a brief period between 2000 and 2003. The practice delivered babies at Sparrow.
“According to the American College of Nurse-Midwives’ bylaws, our model of care delivery was associated with a high-risk obstetrics practice that would be appropriately involved should the need arise,” Powe-Watts said. “We also benefited, as might our patients should the need arise, from the Sparrow practice of always having a high-risk obstetrician in-house.”
The practice closed, Powe-Watts said, because it “fought for the right for insurance coverage” from Physicians Health Plan, among other insurance companies, “and lost.”
Bailey explained, “If you ever create models of care where the midwives and the physicians are competing for the same healthcare-dollar pie, midwives will always lose.” This is partly because “you can run a hospital without midwives, but you can’t run a hospital without physicians. So, the physicians have the power.”
For a midwifery model to work within the medical model, physicians “have to be willing to relinquish some of that power to the midwives,” she said.
Collaboration is key
There are risks inherent in any birth. And there are some circumstances that make out-of-hospital birth especially risky.
But physicians, midwives and doulas generally agree that those risks can be mitigated in a system or culture in which there are relationships of mutual trust and collaboration between types of providers — where midwives know the limits of their scope of practice, and obstetricians trained to deal with high-risk situations can provide backup care.
If a concern arises during a midwifery patient’s care at Michigan Medicine, Bailey said, “We partner very closely with our physician colleagues for optimum care and circle of safety to address it.”
Bailey attributed the success of Michigan Medicine’s midwifery service, which launched in 1983, to nursing leadership’s “very strong support for nurse-midwifery over most of our history here,” as well as “an obstetrics and gynecology department that values our contributions, recognizes what we bring and has supported us in growing our program.”
Bailey noted two other factors in the program’s success. The state legislature made certified nurse-midwives licensable in the state of Michigan through a change to the Public Health Code in 1978, before which midwifery was essentially outlawed. There was also a letter-writing campaign to the hospital in support of establishing a midwifery service.
Montague-Bauer emphasized the importance of collaboration and communication between midwives and doctors.
“If we can figure out a way to foster a collaboration, then we’d go a long way for patients,” she said, adding that “in an ideal world, healthy women should have the choice of a midwife.”
She also said it’s crucial that midwives be able to discern circumstances where it’s necessary to transfer a patient into the care of a high-risk specialist.
“But,” she underlined, “it takes mutual respect to have that.”
Bailey echoed that sentiment, saying that Michigan Medicine’s midwifery service is made possible, most fundamentally, by “mutual respect and recognition of the value midwifery brings to maternity care services across the board” at “every leadership level.”
Based on her work with “hundreds of women,” Montague-Bauer believes a similar model would appeal to most pregnant people in Greater Lansing.
“Women tend to want autonomy, they want some say in their birth, but they also want this umbrella of protection” from the medical system to be accessible if needed, she said.
Dr. Abigail Ramseyer, a maternal and fetal medicine specialist at Sparrow Health System, said midwives bring to the table a unique set of skills in low-intervention services.
“We know they help improve vaginal delivery rates and decrease cesarean section rates,” she said.
However, she noted that “collaborative care” is important “to be able to give patients the birth experience they’re hoping for in a safe place and in a safe way.”
For years, she worked collaboratively on labor and delivery with midwives at the Naval hospital in Camp Lejeune, North Carolina.
“I’ve been part of a system where it works really well,” she said.
With the merger between Sparrow Health System and University of Michigan Health, Raymseyer said, “We’re excited at Sparrow about the opportunities the new partnership brings down the road for expanding collaboration with midwives.”
Birth centers combat racial disparities
Shareef said she became a certified nurse-midwife because “the nurse-midwifery model of care is holistic.”
She favors a community-based approach to medical care. Somewhere along the way, she said, “we had this idea that we should centralize healthcare, meaning we make everybody come to the big building with all of the practices. Now, I’m old enough to remember neighborhood healthcare.”
As a child growing up in Detroit, Shareef recalls her healthcare experiences were primarily community-based. She remembers “nice ladies in starched white dresses with little pointy hats” coming to her elementary school to give immunizations and physicals.
Now, Shareef sits on the board of Birth Detroit, which is set to open its birth center in May. It has worked to establish relationships for patient transfer to Henry Ford Hospital when necessary.
Birth Detroit’s argument is that community birth centers play a crucial role in eliminating racial disparities in maternal health. According to its website, “Birth center care improves birth outcomes, increases satisfaction and, if it is culturally responsive, can make a life-or-death difference for people of color by reducing disparities in care.”
Shareef said, “The model they have put together for this freestanding birth center in the community is wonderful, and it could be studied, examined and duplicated.”
Bailey said that Birth Detroit is “making a reality something that most of us could only dream of.”
Navigating the medical model
For her second pregnancy, Ouillette decided to give birth at Sparrow again. But this time, she approached it differently.
She hired doula Abby Sumbler, whom she met through the Expectant Parent Organization’s Baby Café. Ouillette gave birth to a second daughter, Bennett, on March 12, 2024.
Ouillette said one of her goals in hiring a doula was to ensure more “one-on-one” attention.
“It was really nice having somebody in my corner the whole time,” she said.
The newly rebranded University of Michigan Health-Sparrow is “exploring the idea” of establishing an “in-house midwifery program, but no final decisions have been made,” said John Foren, director of media relations and corporate communications.
Meanwhile, McLaren intends to build a team of certified nurse-midwives at the Birthplace at McLaren Greater Lansing, according to Sarah Barber, the hospital’s manager of marketing and communications. The hospital is in the process of hiring at least one more midwife in addition to Shareef so she can begin delivering again.
Additionally, McLaren is working to “increase access to non-pharmacological comfort measures,” according to Melissa Baird, manager of patient care services at the Birthplace. Later this spring, the Birthplace will roll out the Empower Tower, a cart that offers laboring patients “sound machines, light machines, massage balls and aromatherapy options,” plus “verbal affirmations and links to guided imagery and meditation,” Baird said.
While doulas like Montague-Bauer are encouraged by hospitals’ efforts to expand care, they’re wary of hospitals simply “relabeling their labor and delivery units.”
“A birth center in words and a birth center in actuality are two very different things,” Montague-Bauer said. “For me, a fundamental part of a birth center is that the midwifery model is there.”
Largent said it was “the community and the warmth,” as well as ongoing postpartum and breastfeeding support, that drew her to Greenhouse. She would “love to see Sparrow or McLaren have some sort of birth center” like Michigan Medicine, offering full-scope midwifery care.
Ouillette, for her part, would like to see “more postpartum support” in Lansing. She says she found it on her own because she was looking for it. But otherwise, “You’re just set loose in the wild.”
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