Cara Osborne – A Midwife with a Brilliant Idea

We thought Dr. Cara Osborne SD, MSN, CNM was pretty amazing based on the work she does as the technical advisor for Midwives for Haiti. And then, of course, there’s her day job as Assistant Professor in the Eleanor Mann School of Nursing at the University of Arkansas. But when we learned what else she’s doing right here at home to improve maternal health, we were more impressed than ever.  When Christy ran into her recently at the Maternal Outcomes Matter event in Minnesota last month, they chatted about a truly amazing idea Cara has that might just revolutionize the birth industry and we couldn’t resist putting Cara in the spotlight. 

Many descriptive terms come to mind when you think of midwives like Cara, but business-minded might not be one of them. Sure, she’s practical, compassionate, skilled and a true expert in her field, but it’s Cara’s keen talent for business that we find so exciting. 

Here’s Cara’s brilliant idea:  Why not create turnkey ready, drop-in-anywhere birth centers to meet individual communities’ needs?  Think of them, as Cara says, “like The Cheesecake Factory of birth centers,” but with special features designed to match unique demographics and regions.  They can be located in-hospital or free standing, and can provide a wide range of educational, social and healthcare needs.  They’ll be maternity hubs where women get all their classes, prenatal, delivery and postpartum care in one place.   Providers will include both midwives and physicians and they’ll work in tight partnerships with area hospitals.  That’s the inspiration for Birth Centers of America, LLC, which was formed just a year ago by Cara and her partner, Shannon Bedore, MBA, whose business background includes working on special projects for Walmart.  

Cara and Bedore are collaborating with Childbirth Connection, (a not-for-profit organization that promotes safe, effective and satisfying evidence-based maternity care through consumer engagement and health system transformation), Private Practice Electronic Health Records (a corporation specializing in electronic record keeping for midwifery practices) and Lucina Maternity (whose pilot physician-midwife practice birth center in San Francisco is a model for Cara’s business plan), Cara’s first birth center will be up and running this January and ready for their first deliveries of mothers due in February. 

EMC: Cara, where did this idea come from?

Well, I’ve been focused for quite some time on the problems women face in Haiti, but here in Arkansas, we have some of the worst maternal health outcomes in the US.  I wanted to do something right here in my own backyard.  I was talking about why there aren’t any good birth centers with my partner and of course, she said, “put your money where your mouth is, Cara.  This is something you’ve got to do.”  It took a while for me to come around on that idea, but eventually, it started to come together. 

Why use a business model to create birth centers?

We spend more money on health care here in America than in any other country, but we’re still not getting good outcomes.  We have too many women convinced that high-intervention healthcare and a C-section is the safest way to go and for many women, it’s just not.  That’s an expensive healthcare model to support and it’s not safe or sustainable on many different levels.  But we know from looking at birth centers worldwide that they provide a low-cost, high-quality model for delivering safe, evidence-based healthcare to mothers. Mothers and babies go home healthy and happy with their experiences.  I guess I just got tired of crunching the numbers and wanted to do something that increases access to physiologic birth.

How does it work in communities where women and doctors prefer hospital settings to freestanding birth centers?

That’s the beauty of this model.  We know that in some parts of the country, there’s a call for free-standing birth centers, but we also know that in many areas, mothers and doctors feel more comfortable in hospitals. Many hospitals have the space to create an on-site birth center.  They have doctors and midwives looking for FTE’s (full time employment), and every hospital is looking at ways to improve the profit margin.  This model of care reduces the C-section rate dramatically, which also reduces costs.  For example, the average national C-section rate is about 33 percent now and includes high-risk women.  The rate for low risk women in standard hospital L&D units is about 20-24%.  But with both on-site (in hospital) birth centers and in freestanding birth centers, it’s only about 6%.   That’s a lot of money to save that at the same time dramatically improves the quality of patient care.

What will BCA do to revolutionize the availability of birth centers in America? 

We’re creating a model that can be replicated anywhere.  When a community decides to invest in a birth center, we’ll tell them, “here’s what you need to make it work.  You need this much square footage, this equipment, this staff, these providers…” We spell it out and show them how to create a hub for the best possible maternal health care while still turning a profit.  That’s going to be a real culture shift for midwives – the idea of making a profit from their work.  Most midwives come from the perspective that they do this work because it’s the right thing to do.  Well, doctors make a good living and they have the same perspective.  It’s time for midwives to get paid equally for the incredible services they provide women – safe, satisfying births.  That’s why we’re also working with Childbirth Connection and implementing a model of care based on the Listening to Mothers Survey.  Women know what they want and I think we can give it to them.  

From what we know of Cara, we think she can give it to them too.