State House News Service | Maternal health bill poised for breakthrough in legislature
By Alison Kuznitz
Originally Published by State House News Service
BOSTON (SHNS) – Warning that lives are at stake, the House co-chair of a commission focused on postpartum depression called on her colleagues Tuesday to advance legislation to stem the tide of worsening maternal health outcomes that are disproportionately impacting people of color.
Certified professional midwives (CPMs) would gain a pathway to become licensed in Massachusetts under a redrafted maternal health care package (H 4566) that was reported out favorably by the Committee on Public Health and the Health Care Financing Committee, which last week shipped it to the House Ways and Means Committee.
The bill would allow midwifery care to be covered by MassHealth, remove regulatory and staffing barriers to operate birth centers in Massachusetts, require postpartum depression screenings for new parents during visits to pediatrician offices, and expand access to lactation support, among other policies.
A similar bill (S 2734) cleared the Public Health Committee in April and was sent to the Senate Ways and Means Committee, and the bills could be poised to emerge in either branch if they are able to get through their respective Ways and Means panels.
“I truly believe that the more eyes we have on someone who has given birth, the better,” Rep. Brandy Fluker Oakley, House co-chair of the Ellen Story Commission on Postpartum Depression, said during a maternal health forum at the UMass Club hosted by the Massachusetts Association of Health Plans.
“Research has shown that when Black women in particular have a midwife as part of the birthing process, it improves their life outcomes, it improves the outcomes for the child that they give birth to,” said Fluker Oakley, who sponsored midwifery legislation folded into the maternal health omnibus bill.
The rate of severe maternal morbidity in Massachusetts nearly doubled from 2011 to 2020, with Black women experiencing the highest rate of complications. Sen. Julian Cyr, co-chair of the Public Health Committee, said the panel advanced the omnibus package “in response to the crisis we see in maternal morbidity and mortality.”
“A number of members in both the House and the Senate view taking action on maternal health as critical,” Cyr told the News Service. “As we come to the final months of the legislative session, the recipe for success in getting bills over the finish line is often having policies that are well vetted by the committee, demonstrated need for action, and a broad coalition of support, both among senators and representatives, and advocates outside of the State House. Maternal health legislation seems to have all three of those ingredients.”
A spokesman for House Ways and Committee Chair Aaron Michlewitz, asked whether the Boston Democrat supports the legislation and when it could potentially reach the floor for debate, said the panel is “still in the process of reviewing that bill.”
Rep. Marjorie Decker, co-chair of the Public Health Committee, said there’s a “lot of strong interest” in Speaker Ron Mariano’s office to advance the House bill.
“Ultimately, this is a really exciting opportunity to advance a number of maternal health bills that have been vetted for some time and with the support of the speaker, who’s really been a strong supporter for me over the last year and a half in developing this omnibus bill,” Decker told the News Service. “I think what’s before us is the opportunity to advance some really good legislative work that’s been uplifted by my colleagues.”
A spokesman for Senate Ways and Means Chair Michael Rodrigues, asked about a potential timeline to tackle the Senate bill, referenced the chamber’s support for maternal health initiatives in the budget slated for debate next week.
“The bill was just reported out of the Joint Committee on Public Health late last month and is currently being reviewed by Senate Ways and Means staff,” Rodrigues spokesman Sean Fitzgerald said in a statement. “The Senate has historically made a strong commitment towards maternal health, and in the FY25 budget, we dedicate over $30 million in funding on an array of programs, including reproductive health access, WIC nutrition, and family and adolescent health.”
CPMs, who provide clinical care for low-risk pregnancies, are eligible to be licensed in 38 states — but not in Massachusetts, according to the Bay State Birth Coalition. Midwifery care is linked to fewer maternal deaths, infant deaths, unnecessary C-sections, and postpartum complications, among other benefits, the coalition said.
CPMs, should they gain licensure here, are eyed as a key workforce for birth centers, an alternative care setting beyond hospitals for low-risk pregnancies. Recent closures have left the state with only one open birth center, located in Northampton. Midwives, who are accredited by a national organization, are also trained to provide care for at-home births.
“I think it’s hugely significant that these bills have made it to Ways and Means. It’s definitely some recognition from the Legislature, I think, of really a critical juncture we’re facing,” said Claire Teylouni, director of governmental affairs at Reproductive Equity Now, as she invoked the worsening maternal health crisis and a growing volume of home births.
“The reason why this bill is so important is that licensing them (CPMs) allows us to formally integrate them into the entirety of our maternal health care infrastructure, allowing them to prescribe certain medications, allowing them to work first and foremost at freestanding birth centers,” Teylouni told the News Service. “We are really excited to see the Legislature showing interest in leading on this because there’s tremendous amounts of research showing these are policies that will tangibly improve birthing experiences and birthing outcomes.”
In May 2022, the Special Commission on Racial Inequities in Maternal Health endorsed legislation to expand access to midwifery care, among a raft of other recommendations such as growing the doula workforce, modernizing birth center regulations, and creating a “birthing justice” omnibus bill that invests in social determinants of health like housing, transportation and education.
As part of Gov. Maura Healey’s review of maternal health services, the Department of Public Health this fall said officials “will continue to explore ways to support CPMs and develop pathways to expand the settings in which they can be part of pregnancy and birthing care and coverage for that care in Massachusetts.” DPH said there were 48 CPMs in the commonwealth in 2022.
DPH also said officials would update birth center regulations, including concerns raised over physician supervision and staffing requirements.
Fluker Oakley said the special commission’s report is not intended to sit on a shelf.
“Literally, lives are at stake. Even here in Massachusetts, Black women are twice as likely to die in the childbirth process — that’s here,” Fluker Oakley said. “For us to have this report that has so many wonderful ideas, which I also think are low-hanging fruit to deal with this issue, and for us just to kind of say, ‘Oh, we’ll get to it when we get to it,’ it really feels like a slap in the face. It’s like, oh, so you don’t care if we live or die.”
At the forum, Fluker Oakley also promoted the “Moms Matter Act” that she filed with Sen. Liz Miranda, co-chair of the postpartum depression commission, to grow the perinatal mental health workforce and provide grants to community organizations. The bills (H 1984 / S 1261) were reported out favorably by the Mental Health, Substance Use and Recovery Committee, and the Health Care Financing Committee has until July 3 to take action on the proposals.
Fluker Oakley, asked whether the Legislature has time to tackle the workforce bill in addition to the maternal health omnibus bill, told the News Service, “I have to remain hopeful and optimistic. Otherwise, what am I doing here?”
“So yes, I will say I think there’s time, and we’ll see what happens by the end of session,” Fluker Oakley said. “I’ve had several positive conversations with House leadership throughout the course of the legislative session.”
During the forum, perinatal mental health experts discussed the importance of boosting the use of postpartum depression screenings for new parents and connecting them with treatment.
Maternal mental health disorders are the most common complication seen during pregnancy and birth, affecting one in five women, said Lora Pellegrini, CEO of MAHP. Among Black mothers, 40 percent experience perinatal mood and anxiety disorders (PMADs), though Pellegrini said “few” end up being screened for anxiety or depression.
Research shows that 13 to 19 percent of new birth parents experience postpartum depression (PPD), a number that’s likely too low, said Beth Buxton, lead of perinatal mental health initiatives at the DPH. She said that range would indicate between 8,897 to 13,134 birthing parents in Massachusetts were affected by PPD in 2021, making the condition more prevalent than the combined cases of preeclampsia and gestational diabetes.
Buxton said only about 16 percent of eligible pregnant and postpartum people are being screened for PPD, based on regulations that require health plans and providers to report their screening to DPH annually. While Black and Asian individuals have higher rates of experiencing symptoms “often or always,” Buxton said they are far less likely to be screened than white women.
“And when you compare screening rates, the Hispanic birthing population is far less likely to be screened — that’s a new data point,” Buxton said, as she referenced information from the Massachusetts Pregnancy Risk Assessment Monitoring System. “One of the things we’re really asking providers to think about in the community is promoting universal postpartum depression screening. That is so important in multiple settings — not only within a provider setting, but a hospital setting, home visiting programs, a pediatric setting, so the gamut for universal screening.”
