Editor’s note: This story has been updated to reflect the correct name of Boulder Birth and Holistic Health as well as clarify Abrie Koupal’s quote regarding the non-urgent nature of transfers to the hospital.
At 2:30 a.m. June 15, Sarah and Thibault Ketterer drove down their bumpy Estes Park driveway; their baby boy was on the way and the couple was still 50 minutes from the Boulder Birth and Holistic Health center. For Sarah Ketterer, who was in active labor, the bumpy start to labor was one of the last things she needed, but with the ongoing support and training from the center, Kettner said she had all the techniques and encouragement she needed to have what she called her “dream birth.”
An hour and a half after arriving at the center, Sarah Ketterer, 24, delivered Matthias in a birthing tub. He was the 1,000th baby to be born at the only independent birthing center in Boulder.
“It was awesome,” the new mom said. “It was a very fast birth. For me, obviously I don’t have anything to compare it to, but it just felt very straightforward and very smooth.”
Boulder Birth and Holistic Health, 2800 Folsom St., is a freestanding birth center that specializes in low-risk pregnancy and birth under the midwifery model of care. The center also provides gynecological and sexual health care, as well as acupuncture, in-house lactation support, in-house mental health support, and gender-affirming care, according to co-owner, clinical director and midwife Abrie Koupal.
“We really just want people to feel safe and empowered, and like they matter,” Koupal said. “Hopefully that happens no matter where their baby is actually born.”
The center, formally called The Birth Center of Boulder, was started by five women in 2014 before going under the ownership of Boulder Community Health in 2021. In October 2023, the clinic divested from BCH ownership and returned to being privately owned, according to Clinic Manager Amanda Boni.
“We changed our name and our brand to be more inclusive and more expansive to not just the perinatal period, but really wanting to offer support to our community and our families far beyond bringing a baby, Earth-side,” Koupal said.
Koupal, who has been at the center since 2015, said 1,000 births is a big milestone for a clinic that has struggled at times over the past 10 years.
“Obviously every birth is really special, so it’s kind of funny, because is there really a difference between number 999 and 1,000? No, there’s not really. But I think the path for this birth center has not been necessarily a smooth one all the time,” Koupal said. “We’ve fought really hard to keep these doors open, and we really believe in the model of care that we provide here. So it feels really significant to welcome baby 1,000 in our 10th year.”
Koupal said while it’s a long story when it comes to all the obstacles the clinic has faced, the short answer is that the U.S. medical model and insurance are set up in a way that makes it difficult for birth centers to be successful. According to Koupal, the reimbursement rate is less than what the center needs. That, matched with the unpredictability of birth and lack of public education on holistic health and natural birth, leads to inconsistent births at the clinic and difficult financial challenges.
The center took first steps in May to become a nonprofit organization by signing a fiscal sponsorship agreement with the American Association of Birth Centers Foundation, according to its website. The center is hoping to meet a $250,000 fundraising goal by July 13, the center’s 10th anniversary.
‘It’s a healthy, physiological process that we’ve been doing for thousands of years’
Sarah Ketterer said she was most appreciative of how personable the experience was and how supported she felt. Thibault Ketterer, 33, added that the couple met every midwife at the facility in the months leading up to the birth, so there was a level of familiarity when it came time to deliver.
“There were moments I was like, ‘I can’t do this,’ like I doubted myself. But I think this kind of care is meaningful because it gives women the confidence to do what women have been doing since the beginning of time,” Sarah Ketterer said. “There were not, I would say, as many fears or doubts. There was at large this confidence and when I didn’t have that confidence then people encouraged me toward, ‘No, you can do this. Keep going.’ I think that’s important, that people can feel that and people can experience that. For me, that was so impactful.”
At least two midwives are present for each labor to ensure the birthing parent and the baby are cared for, according to Koupal. The birthing rooms have a queen size bed, birthing bathtub with a ceiling sling available to hold, a birthing stool and a seat for rest or nursing.
Following delivery, patients are given a warm herbal bath and porridge. Sarah Ketterer described that morning as one of the best experiences of her life and voiced appreciation for the midwives allowing the parents to sit, enjoy their time with the newest addition to their family and “witness life.”
Sarah Ketterer said any concerns she had throughout her pregnancy were met with support and explanation from the center.
“Any doubts that we had, any fears that we had, it was just met with understanding and compassion and explanation of the process,” she said. “Obviously, you desire a natural birth but I didn’t go to school for this. I don’t know everything about it.”
Prenatally, the midwives see patients as regularly as they would be seen in an OBGYN office, Koupal said. When it comes to medical equipment and expertise, the center is able to provide almost all care and medications that a hospital would.
“True emergencies are really quite rare,” Koupal said. “Of course they happen, but they are rare. It’s much more common to have a non-urgent transfer in labor.”
She continued, “What we don’t have are epidurals and an operating room. So certainly if we need either of those things we will be making a transfer to the hospital.”
Koupal said the center is about five minutes from the hospital and the midwives have a good working relationship with AMR.
“The safety of out of hospital births really lies in accurate risk assessment,” Koupal said. “We’re not here saying everyone should birth in an out of hospital setting, but for those that are healthy, normally it’s a healthy, physiological process that we’ve been doing for thousands of years.”
Thibault Ketterer said he has nothing against hospital births and the couple was ready to go to the hospital if needed, but he said access to other birthing resources and options is important.
“The norm is the hospital when the norm was midwives for all of history,” Thibault Ketterer saidm adding, “To have that opportunity, just looking at the room, you have a big bathtub, you have a queen sized bed, you have two people who are always with you, caring for you, it’s maybe not something you’d have in another context.”
Koupal said the clinic encourages pre and postnatal mental health checks, and babies have two screenings before they graduate to their pediatrician.
During the screenings, midwives run all the same tests a hospital would, Koupal said, which includes a bilirubin test if there is a concern for jaundice, a CCHD screening which looks for congenital heart issues, hearing tests and weight checks. After six weeks, the birthing parent comes back for a postpartum appointment.
‘They’ve had that innate experience of doing what feels impossible”
Sarah Ketterer said when she heard Matthias was the 1,000th birth at the center, she cried.
“I think what I was so happy for was the 1,000 women who had the opportunity to give birth here,” Ketterer said. “Personally I’m glad I got to be a part of it. We got to be a part of that. We feel so blessed by that. I’m just happy for the birth center. I hope 1,000 more babies are born here because it’s been an awesome experience.”
For the next 1,000 births, Boni said she hopes the center is able to provide more resources and care to the community.
“What I would love to see is a lot of the advocacy to really bring birth centers the equity and the advocacy that they need to be sustainable and thriving and nourished by the system,” Boni said. “My hope is that, in the case of our birth center, by the time we’re hitting our 2,000th baby is that we have an expanded offering of services.”
Representatives from the center said nationwide there is limited access to independent birth centers. The Boulder Birth and Holistic Health Center has multiple families who have traveled from out of state for the center’s services.
Koupal said looking forward to the next 1,000, she hopes families will continue to feel supported.
“I would love to just see more healthy, safe arrivals for the next 1,000 and families that really feel like they’ve been supported,” Koupal said. “Even though parenting comes with nothing but a whole bunch of unknowns and scary ‘what ifs’ and big decisions to make for another human being, I’m hoping that those families are embarking on that path with the knowledge that they can do it because they’ve had that innate experience of doing what feels impossible.”
The Ketterers said they chose the name Matthias as it means, ‘a gift from God’ and said the midwives and their services have been a gift to them.
