As Maternal Health Crisis Worsens, Advocates Host ‘Midwife Advocacy Day’ at MA State House to Call for Expanded Access to Midwifery Care
Massachusetts currently ranks in the bottom third of states for midwife integration
BOSTON (October 5, 2023) – Maternal health and reproductive equity groups joined together at the State House Thursday to advocate for legislation to expand access to midwifery care in Massachusetts. Advocates participated in direct lobbying with legislators before joining together for a rally on the State House steps.
Midwife Advocacy Day comes after a recent Massachusetts Department of Public Health report revealed that rates of severe maternal morbidity in Massachusetts nearly doubled over a decade, disproportionately impacting Black mothers in the state. Four maternity units and two birth centers have also closed across Massachusetts since 2020, reducing birth options and access to care.
“Midwives are true change agents and provide essential care services that could mean the difference between life and death for birthing people,” said Dr. Ndidiamaka Amutah-Onukagha, Julia A. Okoro Professor of Black Maternal Health in the Department of Public Health and Community Medicine at Tufts University School of Medicine, and founder of the Center for Black Maternal Health and Reproductive Justice. She continued, “Midwives need to be fully incorporated into the maternity care system. With barriers lifted restricting autonomous practice, more funding for education and training, and equitable insurance and Medicaid reimbursement as part of policy, we’ll see the tides change and will avert maternal deaths in a meaningful way, for the first time in decades.”
A midwife is a clinical health care provider with a low-tech, high-touch approach to pregnancy and birth. The midwifery care model centers on physiologic birth, holistic care, and informed consent, and clinical care can be provided in birth centers, home, and hospitals. Evidence shows that midwifery care can help eliminate racial disparities in maternal health outcomes by improving patient autonomy and satisfaction. Midwifery care is proven to lead to lower rates of cesarean section and preterm birth and low birth weight babies, and reduces healthcare costs.
Despite the proven benefits of midwifery care, Massachusetts currently ranks in the bottom third of states for midwife integration nationwide. State law does not integrate or license Certified Professional Midwives (CPMs), does not allow for CPMs to be reimbursed by insurance, and excludes CPMs from practicing in birth centers. Outdated state birth center regulations also make opening new birth centers more complex and expensive than what national regulatory agencies require. Massachusetts is currently home to only one birth center, out of 400 nationwide.
Advocates are urging the Massachusetts Legislature to pass the following bills to expand access to midwifery care in the state:
An Act promoting access to midwifery care and out-of-hospital birth options (H.2209/S.1457), sponsored by Sen. Becca Rausch, Rep. Kay Khan, and Rep. Brandy Fluker Oakley, creates a pathway to licensure for certified professional midwives and makes their care reimbursable by Medicaid/MassHealth
An Act updating the regulations governing licensed birth centers in Massachusetts (H.3616/S.1335), sponsored by Sen. Jo Comerford, Rep. Manny Cruz, and Rep. Chynah Tyler, addresses onerous and outdated barriers to the creation of free-standing birth centers
An Act to increase access to nurse-midwifery services (H.1069/S.607), sponsored by Rep. Kay Khan and Sen. Brendan Crighton ensures insurance reimbursement parity for certified nurse midwives
An Act relative to birthing justice in the Commonwealth (S.1415), sponsored by Sen. Liz Miranda, includes language from the above-referenced midwifery and birth center bills as well as additional urgently-needed policies for optimal maternity care and to address long standing racial inequities in maternal health care
Midwife Advocacy Day was hosted by the Neighborhood Birth Center, Bay State Birth Coalition, ACNM Massachusetts, NACPM Massachusetts, Reproductive Equity Now, MassNOW, ACLU of Massachusetts, Our Bodies Ourselves, Mystic Valley Action for Reproductive Justice, City of Boston Office of Women’s Advancement, Birth Equity & Justice Massachusetts, Center for Black Maternal Health and Reproductive Justice at Tufts Medical School, and the Mass. PPD Fund.
“People in Massachusetts want and deserve access to midwifery care and birth centers. It’s time for legislative action to integrate midwives into our health care system,” said Emily Anesta, Co-Founder of the Bay State Birth Coalition.
“At this moment of crisis for reproductive health care nationwide, Massachusetts must lead in improving maternal health outcomes and eliminating racial disparities for birthing people. Midwives are absolutely critical to addressing the Black maternal health crisis in our state, which new data shows is only becoming more dire,” said Rebecca Hart Holder, President of Reproductive Equity Now. “These pieces of legislation will help improve access to midwifery care in our Commonwealth, get rid of onerous financial and administrative burdens to the creation of freestanding birth centers, and help Massachusetts catch up in its integration of Certified Professional Midwives into our maternal health system. The Legislature should move to pass these bills immediately because reproductive equity cannot wait.”
“Midwives are essential to bodily autonomy,” said Traci Griffith, Racial Justice Program Director at ACLU of Massachusetts. “By ensuring all pregnant people have a choice in their health care alternatives, Massachusetts can improve maternal and infant health outcomes and reduce racial inequities. Midwives provide alternative care that is affordable and accessible, particularly for Black and Indigenous women who face disproportionately high rates of maternal death. Access to midwives can lead to better outcomes for all.”
“Midwives provide full spectrum, empowering, and holistic healthcare. Integrating midwives into our healthcare system is an essential step to ending the maternal health crisis and will result in better outcomes for all,” said Carina Lopez, Interim Executive Director of the Mayor’s Office of Women’s Advancement. “MOWA is committed to supporting all aspects of women’s health and overall well-being by focusing on initiatives that impact women throughout their lives and during pregnancy and birth, especially for those in communities that are underrepresented."
“As an organization working to address postpartum depression and other Perinatal Mood and Anxiety Disorders (PMADs), I can’t tell you how often we hear about scary, unsupported, and traumatic birth experiences and the aftermath for parents’ mental health and wellbeing. We need to rethink how we treat parents in Massachusetts, starting with birth, and we’ll see better outcomes all around. Midwives have it right! We’re proud to stand with them today,” said Jessie Colbert, Executive Director of Mass. PPD Fund.
"Increasing access to midwifery care is critical to reach racial equity in maternal health," said Rachel Roth and Alan Linov, leaders of Mystic Valley Action for Reproductive Justice. “Massachusetts must do better to ensure that everyone who is pregnant can get the care they need where they live and end the two-tier system of care where only people who can afford to pay out of pocket can benefit from the full range of proven healthcare providers. These bills will bring our state closer to achieving these goals."
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