Choices in Childbirth was founded in 2004 by a passionate New York City-based doula who wanted to improve maternity care. The organization launched with one founding funder and a core group of volunteers - moms, doulas, midwives and childbirth educators - who shared the same concerns and wanted to have a positive impact on women's birth experiences.

As a small and determined group, the organization racked up an impressive roster of accomplishments over the next decade. It developed informative, supportive workshops for expecting families; put out an annual publication titled Guide to a Healthy Birth that outlined the best national data and practices; and responded to local events such as the closings of birth centers and reports of poor birth and maternity care practices in hospitals across New York City.

Growing Pains

However, when I became Executive Director of Choices in Childbirth in 2014, the organization was in crisis. The founding funders were about to reduce their support significantly, the website was in need of an overhaul, communications infrastructure was lacking, the board of directors needed strengthening, and we desperately required a development plan if there was to be any hope of continuing. Though the organization was a decade old, it was essentially still a struggling startup.

In my first 90 days in the role I spent as much time as possible listening to staff: learning about the history of the organization, the women and families coming to our workshops, and where the challenges lay. The second thing I did was research. I went through records of meetings and grant applications, researched the field and parallel disciplines from which we could learn, and studied our allies in the movement.

Pinpointing Strengths & Needs

The insight that emerged was clear: We had a strong foundation to address maternal health disparities that persist for women and families in poverty, but needed to undergo a strategic, deliberate organizational overhaul to achieve stability and create real change for the mothers and families we serve.

As a result, the five key needs for growing Choices to Childbirth came into focus:

1. Experts who could guide us in long-term revenue planning

2. Communications

3. Board support

4. Technology to share our impact with our community

5. Partnerships

I prioritized communications because we needed to build awareness about our organization and our work; more importantly, I knew that our constituents needed to have a clear picture of who we are before we made any "ask." I redesigned and updated the website to reflect the current work of the organization and set up an e-mail marketing platform to launch digital appeals and e-newsletters. Sharing good news, stories and reports on our work was key to getting our list re-engaged in supporting our mission and, eventually, making donations.

As our messaging became stronger and clearer, I was able to direct more energy to institutional donors, board expansion and strategic partnerships. Generating a pipeline for funding, as everyone in the nonprofit sector can attest, is work that never ends - as is finding ways to educate funders on our work. But with the guidance of fundraising experts, we are getting better at making the case. An engaged, refreshed board of directors has strengthened our accountability and organizational polices.

Stronger for Funders, Stronger for Community

With communications, fundraising, board development and partnerships evolving, we still had to reframe our programming. Health disparities in maternity care continue to grow, yet we found it difficult reach to the women who need us the most. Our policy and advocacy work highlighted to us that women and families on Medicaid continue to face the worst outcomes. I knew that taking our model to underserved communities required a strong funding partner.

Thankfully, all the development and restructuring work we had toiled over for the past two years was about to pay off - we were in a good place to show funders that we bring value and expertise to collaborative projects and that while we're still small, we're mighty, and a worthy investment. In May, Choices in Childbirth received a $204,000 grant from the W.K. Kellogg Foundation to bring childbirth education to low-income women and families throughout New York City.

We are now well-positioned to reach the women and families who need us most and, with the ongoing development of systems to measure our impact, to ensure that we never stop talking about what we are doing, how we are doing it, and how we could do better. We will bring in evaluation experts, draft plans for financially sustaining the childbirth education program beyond the two years covered by the grant, seek ways to expand our board and increase its diversity, and seek out additional partners that can benefit this project (and others).

After putting so much energy into revamping our inner structure and methodologies, it feels amazing to be in a position of looking toward the future. Revenue, communications, board, technology and partnerships are the essential ingredients for success for any nonprofit startup, and continue to be the linchpins that will help Choices in Childbirth become ever stronger to achieve our mission.

Are you considering taking your organization to the next level? Then watch Michele, and two other experts, in Foundation Center's recorded webinar, "Should I Stay or Should I Grow? Nonprofits Weigh the Benefits of Scaling."


MICHELE GIORDANO has over 10 years of experience leading nonprofits and for-profits focused on social change. Currently, she is the executive director of Choices in Childbirth, an organization that aims to improve the lives of low-income pregnant women and families with support, education and better policies.

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