We know quite a bit about the normalcy of birth because births have been going on for quite awhile. We have learned with pretty good accuracy, both doctors and midwives, to judge by screening early in pregnancy whether somebody will have an easy time or a difficult time at birth. Medical conditions are actually the easiest to screen for and actually cause the least amount of trouble as far as maternal and baby outcome. When we screen all women in Florida, which we do by law under the Healthy Start Program, we find that instead of the usual 10 or 15 percent of people that we used to find, we find that 45 percent of women are at risk. Most of those are at risk because of a psycho-social problem, such as alcohol, drugs, stress, spouse abuse, things that the midwives often are better at discovering than the doctors. We know that there are very few reasons why people need to deliver in a hospital. Certainly, somebody with severe diabetes or hypertension would probably be a candidate for that. But, one of the reasons birth at a birthing center is so advantageous for a person with a psycho-social problem is the home-like atmosphere, support and care of the midwives. In the birth center, the family actually gets the best chance of having the pregnancy and the birth move along on an easy schedule without the stress, worry and the intimidation that can occur in a hospital. The interesting thing to me is that this certainly appears to be the case for women with low incomes, too. If this is (as we always say) a good deal for a woman with an upper income, then it's probably an even better idea for a woman who has a low income, who has a lot more stressors and really needs that kind of support and care a lot more. She may not have a spouse who would be willing to spend the time with her, so midwives in a relaxed home-like setting, such as a birth center can offer, achieve much better pregnancy outcomes than what can happen in the chaos of a typical county hospital. That's why institutions such as the birth center in the South Bronx are so interesting to all of us who worry about the care for low income people.