In Massachusetts, black women are 2.5 times more likely than white women to experience life-threatening conditions, such as heart attack or sepsis, during or as a result of childbirth, and their health is generally worse than it was a decade ago.
Maternal and child health activists here are familiar with these statistics: Many of them are midwives and doulas who have given birth themselves, and they have been pushing for change on Beacon Hill for years.
And the sense of relief was palpable in the state Capitol on Thursday, when lawmakers voted to approve a sweeping bill aimed at improving maternal health.
“It literally brought tears to my eyes,” said Catherine Rushfurth, a certified midwife and policy director at Neighborhood Birth Center. “It's a profession that has been looked down upon for so long, and at times it's a struggle just to provide basic evidence-based care. This is the culmination of decades of hard work, and I'm so honored to be a part of it.”
The bill, currently before Governor Maura Healey, is a slew of bills aimed at improving maternal health and birth experiences, with a focus on eliminating racial disparities. The bill would allow certified professional midwives to be licensed to practice in locations such as home births and birth centers; increase pay for midwives at the Massachusetts Department of Health to be on par with physicians; and set the state Legislature up to expand screening for perinatal mental illnesses, including anxiety and depression, the most common complications associated with pregnancy, and provide more funding for related mental health resources at local health centers and community organizations.
Sen. Liz Miranda, who introduced the bill, introduced her first maternal and child health bill after joining Congress as a member of the House, and she remembers learning the grim statistics during the 2019-2020 session.
“Basically, this was like a doomsday letter to black women,” she said. “All of the worst zip codes in the state to give birth were in my district: Roxbury, Dorchester, Mattapan, Bristol County, Holyoke, for black and Latina women.
“And it reminded me of the day in 2017 when my sister gave birth to her daughter, Mila. My niece. I was in the room when she gave birth to her daughter, and she didn't survive,” Miranda continued. “So today is a day for my sister, Christina, and my niece, Mila, and all the Black and Brown women who don't get listened to. This journey has been so worth it.”
Last spring, a new report showed maternal health was worsening: In Massachusetts, serious complications during childbirth overall had nearly doubled over the past decade.
“We've known and we've been saying that midwives save lives,” said Emily Anesta, who has lobbied for many of these reforms for years as president of the Bay State Childbirth Coalition.
Anesta believes the law paves the way for a future where pregnant women have more options.
“(The choice) is available, accessible and affordable in their community so people have autonomy and self-determination about the type of care they want to receive,” she said.
Finding a middle ground between the two bills could be a game of hand-wringing between the two chambers, but Rep. Marjorie Decker said the council was “all about additions.” For example, the Senate bill had a provision on perinatal mental health supports, while the House bill would have directed states to create a licensing process for lactation consultants. Both measures ended up in the bill.
If approved by the governor, the bill would also ease restrictions on free-standing birth centers where people with low-risk pregnancies can give birth. Birth center operators have long argued that opening and operating a birth center is too burdensome under current Massachusetts regulations.
Just 1% of people who gave birth in Massachusetts in 2021 gave birth in a birth center or at home, but advocates hope that number will increase if parents can choose to give birth safely outside of a hospital for low-risk pregnancies.
In Roxbury, a team working to open a neighborhood birth center is eager to see what the new bill means for pregnant women.
“Change at a structural level is what's important,” said Nasira Baril, who leads the yet-to-be-zoned Neighborhood Birth Centers project. “This goes beyond just making sure that, 'Oh, there's a scholarship available so that a family can have a home birth or hire a doula.' … I think (this) is going to be game-changing for generations.”
Freestanding birth centers are underused in the U.S.: By one count, just under 25,000 births occurred there in 2021. State Sen. Cindy Friedman said the legislation would make Massachusetts' birth centers more “sustainable.” The number of freestanding birth centers in the state has been declining for years, with just one remaining: Seven Sisters in Northampton.
Friedman stressed that the bill would allow more options for pregnant women, beyond just birth centers and midwives, including piloting home visits after birth and providing doula services through Massachusetts Health.
“Women have a really hard time getting care in hospitals, and they have a really hard time getting culturally competent care,” Friedman said. “This opens up a whole new avenue for childbirth that reflects an experience that makes women healthier.”
Jesse Colbert, executive director of the Massachusetts PPD Foundation, which promotes perinatal mental health, said more widespread testing would make a big difference in identifying parents who need help.
“We still have a long way to go before these issues are identified quickly and the care they need is provided,” she added. “But this is a big step forward. That said, there is a shortage of mental health workers for perinatal mental health, just as there is for other mental health needs. There is a lot of work to be done, but we will continue to work.”
The bill would also provide coverage for doula services for residents of Massachusetts Health, the state's Medicaid program, which decided to start covering them late last year and now has more than 100 doulas enrolled.
The bill would also require a licensing process for lactation consultants, a measure Decker has pushed for eight years. Federal law covers the services of licensed lactation consultants, but Massachusetts has no licensing process, leaving families in the dark.
“This will be a huge benefit to many families and breastfeeding women,” Decker said, explaining that the lack of qualified consultants poses challenges for families. “They're left to their own devices to seek out help and find affordable options.”
A new task force will also be created to look into birth center closures and access to maternal and child health services.
The bill is now on Governor Healey's desk, and his spokeswoman, Carisa Hand, says he “looks forward to reviewing this bill.”
