Perspectives from Black Midwifery Leaders on Scaling Culturally Affirming and Community-Centered Models of Care.

Introduction: Black midwifery practice leaders are reimagining perinatal care for Black women and birthing people by designing and implementing innovative culturally affirming community models of care. They possess a unique lens on the factors that sustain and threaten their innovative work. The aim of this study was to explore Black midwives' perspectives on the components of these models of care, their leadership experiences, and facilitators and barriers of scaling these models for maximal impact for Black women and birthing people throughout the United States. Methods: We purposively identified and conducted in-depth semi-structured interviews with Black midwifery leaders (i.e., founders, directors, owners of Black-led community-centered midwifery practices). We interviewed nine participants including certified nurse-midwives ( Results: We identified four themes: (1) Reclaiming a legacy of care and safety: the incorporation of ancestral traditions and culturally holistic practices to create responsive models of care; (2) Scaling up: the urgent need for more Black midwives and culturally safe educational and professional development pathways; (3) Scaling out: the necessary policy and infrastructure reforms, particularly reimbursement reform and regulatory integration; and (4) Scaling deep: the importance of transformative cultural norms and solidarity-based relationships. Conclusion: Black midwives lay out a vision of how their reimagining can be scaled nationally. Their suggestions span broader structural changes relevant to all midwives, while also identifying potential solutions specific to the needs of Black midwives, who face both racism and hostility toward the practice of midwifery.