In 1999, New Hampshire made its position clear. Midwifery had been part of our culture and tradition since colonial times. Families had a right to choose home birth. Barriers to safe out of hospital birth should be removed. Childbirth is a natural process, not an illness.

So What Happened?

Over the next 25 years, 11 hospital labor and delivery units closed across New Hampshire. Community birth centers closed too. At the same time, midwives faced reimbursement rates that made accepting insurance increasingly difficult to sustain. Some stopped accepting insurance altogether, putting out of hospital birth financially out of reach for more families.

Doulas, childbirth education, lactation support, and many other perinatal services have historically remained largely dependent on a family's ability to pay out of pocket. More and more New Hampshire communities are being left without meaningful access to maternity care. Families are traveling farther. Rural options are disappearing. Community based providers are struggling to sustain their work.

Yet research continues to point to the value of midwifery care, freestanding birth centers, continuous doula support, and strong community based perinatal care.

So how are we here? How are we in the thick of a maternal health crisis when more than 80% of pregnancy related deaths are preventable?

For Us, It Started With Community

Since 2013, we have connected with more than 10,000 families and professionals, bringing together families, midwives, doulas, educators, providers, businesses, and community organizations.

Then 2020 hit.

Almost overnight, families were questioning what it meant to give birth in a hospital during a pandemic. Across the country, more families began exploring options outside of the hospital system. Home birth increased nationally by 22% in a single year. Families were asking about midwives, home birth, freestanding birth centers, doulas, childbirth education, and choices they often did not know they had.

Community birth was suddenly part of the conversation again.

But awareness does not create access, so we kept working.

We took that work to the State House. Through Momnibus 1.0 and 2.0, we advocated alongside others to expand access to community based maternal health services in New Hampshire. That work helped establish Medicaid coverage for doula and lactation services, with additional funding for community health workers and emergency medical services.

But passing the legislation was only the first step. We are still waiting for the state to fully implement and integrate these programs so providers can be paid and communities can access the support the legislation was intended to provide.

Our Communities Cannot Wait

RESPITE the System, our nonprofit organization, grew from years of seeing these challenges from different directions. We knew many of the solutions. The question was how to make them accessible and sustainable.

Then Hurricane Helene devastated Western North Carolina.

We watched years of relationships activate across state lines. Information moved. Resources moved. Providers found one another. People connected nationally and responded locally. We saw what becomes possible when relationships already exist before a community needs them.

Connection is infrastructure.

After Helene, we began building differently. We developed education and workforce pathways for doulas and community health workers that combine education, mentorship, hands on experience, and pathways toward sustainable employment.

But once again, we encountered the barriers.

Community based organizations are often expected to build the program, train the workforce, establish partnerships, collect the data, demonstrate the model, and create the infrastructure before many traditional funding opportunities become accessible. We are being asked to build evidence based solutions for our communities while simultaneously building the infrastructure required to access the funding to sustain them.

So we are building it ourselves.

Now We Are Building What Comes Next

The Perinatal Health Coalition brings the pieces together. Families, providers, resources, education, events, and community connected through one network designed to make what already exists easier to find, access, and sustain.

We have already mapped the landscape. We know where maternity care has disappeared. We know where community based providers are working. We know where access is breaking down, and we know many of the solutions.

Now we are turning what we know into action.

We are building the public directory, community calendar, professional network, regional connections and referral infrastructure. We are documenting the data and creating the New Hampshire Perinatal Health Infrastructure & Statistics Report so communities, providers, policymakers, partners, and funders can see what is happening and what comes next.

At the same time, we are strengthening workforce pathways and building toward communities where families can actually access the support they need, providers can sustain their work, birth centers can survive, rural communities have meaningful options, and the next generation has a pathway into the professions our communities depend on.

RESPITE the System

This is Preserving & Transforming Community Birth.

We are raising $50,000 in private support to accelerate work that is already underway. This funding will help strengthen the Coalition, expand the workforce, publish the data, build the systems, and create the foundation necessary to access larger public and institutional funding.

We have spent years connecting people, advocating, mapping the landscape, developing solutions, training the workforce, and seeing firsthand what happens when communities are connected.

Now we are putting those pieces together.

We are preserving what works, strengthening what already exists, and building the infrastructure our communities need to move forward.

This is how we RESPITE the System.

Research. Education. Support. Prevention. Inspiring Transformation & Evolution.

Help us build what comes next.

RESPITE is a 501(c)(3) nonprofit organization. Contributions are tax deductible to the extent permitted by law.

Preserving & Transforming Community Birth

Protecting what works, rebuilding what was lost and creating what comes next.

Team Members