Daily Hampshire Gazette | Columnist Carrie N. Baker: De-medicalizing childbirth, expanding community birthing options

By CARRIE N. BAKER | Originally published by the Daily Hampshire Gazette

Last Thursday, the Massachusetts Legislature passed historic legislation (S2899) allowing the licensure of certified professional midwives in the state for the first time and reducing regulatory barriers to the creation of community birthing centers so that people with healthy pregnancies can avoid hospitals when giving birth. Gov. Maura Healey has promised to sign the legislation. Massachusetts was slow to allow the expansion of midwifery, following 38 other states that have already done so. Better late than never.

From the earliest days of colonial America, midwives assisted women in bringing babies into the world. In the mid-19th century with the formation of the American Medical Association and the professionalization of medicine, male doctors waged a campaign to take over the field of midwifery and push women out.

Understanding the lucrative potential of incorporating childbirth into the practice of medicine, but also facing questions about the morality of male doctors attending to women’s intimate reproductive needs, these men attempted to discredit midwives by accusing them of performing abortions. The AMA led a campaign to ban abortion and restrict midwives from attending childbirth. In these ways, male doctors sought “to win professional power, control medical practice, and restrict their competitors,” explains historian Leslie Reagan.

Since then, the largely for-profit American health care system has treated pregnancy as a pathological condition and childbirth as a medical emergency rather than a natural process. To control women’s bodies, doctors use costly tests, interventions and medicines during pregnancy and delivery. Today, for example, physicians in the United States deliver one third of all babies by slicing open women’s abdomens and uteruses (called cesarean sections) rather than waiting for them to deliver their babies vaginally. While c-sections are sometimes necessary, American doctors use this dangerous and debilitating surgery at twice the rate used by doctors in countries such as Sweden and Finland.

Not until the late 20th century, on the heels of the natural childbirth movement, did states begin to allow the practice of midwifery once again and license midwives to attend births inside and outside of medical settings. Massachusetts has licensed nurses trained as midwives but has not licensed certified professional midwives, who are not nurses. By contrast, 38 states now have pathways to licensing for certified professional midwives, a key workforce for birth centers as well as home births across the U.S.

Why has it taken so long for Massachusetts to catch up to the rest of the country? “The institutional health care system in Massachusetts thinks that birth should be taking place in hospitals,” said Taylor St. Germain of Reproductive Equity Now. “We have had to do a lot of education to prove that there are huge, huge health benefits to having out-of-hospital birth options and to making sure that people have autonomy and dignity in their birthing experiences.”

After years of grassroots advocacy led by the Bay State Birth Coalition, Massachusetts finally passed legislation last week to allow professional midwives to be licensed in the state of Massachusetts and to facilitate the creation of freestanding birth centers.

The lack of access to midwifery care is one factor contributing to Massachusetts’ increasingly high maternal morbidity rate, which nearly doubled between 2011 and 2020 according to a July 2023 Massachusetts DPH report. Experts define “severe maternal morbidity” to be unexpected complications of labor and delivery that result in significant short-or long-term consequences to a person’s health. Severe maternal morbidity affects hundreds of pregnant women in Massachusetts each year. The number of women experiencing maternal morbidity increased 8.9 percent each year between 2011 and 2020. For Black women, the risk of experiencing labor and delivery complications was 2.3 times higher than for white women.

Research shows that access to licensed midwifery care in freestanding birth centers leads to lower mortality rates in both mothers and infants, reduced C-section rates, increased breastfeeding rates, and reduced racial inequities in maternal health outcomes.

“This bill will allow Massachusetts to leverage the benefits of independent midwifery to expand the maternal care workforce, increase patient autonomy, increase access to community-based care, and improve maternal and newborn outcomes,” said Rebecca Herman of the National Association of Certified Professional Midwives.

The new law promises to reverse the steep decline in maternity care options in Massachusetts, which ranks 35th in the country for the share of births in birth centers. Eleven maternity wards have closed in Massachusetts since 2010, including Holyoke Birthing Center in 2020. There is now only one community birthing center in the state (out of 400 nationwide) and it’s here in western Massachusetts —Seven Sisters on Maple Street in Florence.

“Today marks an historic day in our Commonwealth’s fight to ensure reproductive equity for every person,” said Rebecca Hart Holder, President of Reproductive Equity Now. “By unlocking the power of midwives and removing barriers to the creation of freestanding birth centers, this package will help … ensure that people can make the reproductive health care decisions that are right for them with autonomy and dignity.”