Barriers to Birth Center Integration Into the Perinatal Health System in New Jersey: A Qualitative Analysis

Introduction: When compared with hospitals, evidence has shown that freestanding birth centers are a high-value but underused birth setting offering midwifery care for individuals with low-risk pregnancies. However, systemic barriers limit birth center accessibility, especially for pregnant people of color, who fear bias and disempowerment in the hospital setting. This qualitative study is an expansion of previous research exploring the financial barriers facing birth centers in New Jersey. The aim of this study is to further describe barriers to improved birth center integration into the broader health system in New Jersey. Methods: Semistructured interviews were conducted with professionals from 4 sectors: birth center or health system, policy-adjacent philanthropy or research, statewide departments, and health insurance. Coding and reflexive thematic analysis resulted in 4 systemic barriers. Results: The identified systemic barriers to birth center access are (1) widespread lack of understanding of birth center care, (2) workforce and care network integration concerns, (3) state-related licensure and Medicaid process burdens, and (4) geographic and transportation infrastructure limitations. Discussion: This research provides further analysis and insights on the barriers to birth center access and suggests important areas for systemic policy and practice improvements. Results align with limited national studies and can spur a well-integrated perinatal system of care.