Massachusetts will have a path to more midwives and birth centers — if lawmakers can agree

Ashley Healy had just given birth to her son. She was struggling. In the hours after the birth, she had hemorrhaged. Then, at home, she wasn’t connecting with her newborn.

Down the road from her home in Concord, she found a community organization that hosted facilitated peer support groups for moms.

“I went once a week,” Healy recalled. “It’s totally free. It’s right down the road. ... It sort of broke that isolation and that stigma. It’s like, ‘Oh my gosh, I’m not the only person that’s having a hard time. I’m not a bad mom.’”

Those are the kinds of programs that could receive more state support under the Senate’s unanimously passed maternal health bill. But they’re nowhere to be found in the House’s version.

Advocates had hoped to see a sweeping maternal health package sent up to Gov. Maura Healey on the last night of formal sessions at the end of July, but lawmakers have yet to reach a compromise. It’s one of several bills that have passed in both chambers but still need to be “conferenced,” in Beacon Hill lingo, due to differences between the two versions.

State Rep. Marjorie Decker, a Democrat who’s sitting on the joint-chamber committee to find a compromise between the House and Senate versions, told GBH News she expects the maternal health bill to pass “before the summer’s over.” State Sen. Patrick O’Connor, a Republican also on the committee, said in a statement that he hopes the legislation will be voted on “very soon.”

But it’s not a simple process. Outside of formal sessions, a single “no” vote from any Beacon Hill member can nix a bill’s passage, meaning only uncontroversial legislation can get through. Decker did not directly answer questions about specific holdups in the negotiations surrounding the maternal health proposals, but she said the final combined bill will give pregnant people more options and improve maternal health outcomes, particularly for people of color.

Black and Hispanic women are more likely to experience perinatal mood and anxiety disorders, and diagnosis and treatment is still out of reach for many new parents.

Parents and providers who’ve been urging maternal health reform in Massachusetts may see many of their other wishes fulfilled in the legislation. Midwives who practice outside a hospital setting would be able to get licensed. Freestanding birth centers would be subject to less burdensome restrictions. Screenings for postpartum depression would be more widespread, and more broadly covered by insurance. MassHealth payments to nurse midwives who practice in hospitals would be brought up to equal physicians.

But the two drafts diverge on a few other points. The Senate’s version would bring that reimbursement up for all payers, not just MassHealth. The House’s version would license lactation consultants who help new parents with breastfeeding.

“Some parts, we’re really smashing it, right? Like we’re progressive — you can get access to abortion care, reproductive health services are outstanding,” said Ndidiamaka Amutah-Onukagha, director of the Center for Black Maternal Health and Reproductive Justice at Tufts’ School of Medicine. “And in certain parts, we’re stuck in the Stone Age when it comes to the licensing and midwifery.”

Massachusetts is one of just a dozen states that does not have a licensure process for non-nurse midwives who practice in birth centers or attend home births.

One state estimate put the number of working certified professional midwives in Massachusetts at 40 compared to more than 1,000 OB-GYNs. Just 1% of all births in Massachusetts were at birth centers or at home in 2021, a number advocates hope to see increase once parents can choose to safely stay out of a hospital setting for low-risk pregnancies.

And others worry that there isn’t currently a clear standard for some midwives. Sarah McRell is a certified nurse midwife who runs Embrace Midwifery, a home birth practice outside of Worcester, and is working toward opening a birth center in Westminster.

McRell wants to see clear standards for certified professional midwives, a group she respects and once taught when she worked in New Hampshire.

“CPMs are really valuable, but I think licensing them is super important,” McRell said. “There are some midwives in this state that ... haven’t completed an apprenticeship and haven’t gone through the avenues that, if we had licensure, that they would [need to] be able to be practicing.”

More screenings for perinatal mood disorders is, too, a change that advocates say is decades in the making.

“You want to do it as often as possible, as early as possible. So we’re really pushing for screening,” Dr. Uruj Kamal Haider, medical director with MCPAP for Moms and a perinatal psychiatrist.

Recent studies show that more people are experiencing perinatal anxiety and depression: 1 in 5 for anxiety, and 1 in 7 for depression. But other pieces of the bill are in limbo. It’s less clear if the legislation’s efforts to increase screenings will be paired with more state support for treatment.

“Mental health conditions are now the most common complication of pregnancy and childbirth,” Haider said. “Initiatives to target barriers at the patient, provider, community and state levels is really what we need right now.”

Soraya DosSantos, who works with pregnant people and who herself had a home birth, sees a massive gap in both screenings and treatment options in New Bedford, where she lives.

“[We] don’t have the infrastructure to ask these critically important questions, but also to meet the need that is in front of you,” DosSantos said. “If a pregnant [woman] or a newborn’s mother — because we’re talking about, right now, maternal mental health — is presenting with some concerns, what are the resources? If she speaks Spanish, if she speaks Portuguese, if she speaks Haitian Creole ... if she speaks Cape Verdean Creole? Because our community is very diverse. Where are you going to send them?”

Healy, who first sought out peer support nine years ago, now has three kids and recently led the state’s commission on postpartum depression. She hopes to see language included in the final bill that will help more organizations get funded, bolstering and creating new resources for perinatal mental health.

“People need to have that support close to home,” she said. “Around people who are in their community, there’s more likelihood for cultural congruence, there’s more likelihood for people to understand one another — they live in the same neighborhoods, right? They interact in other ways in their communities. And so it’s a much more comprehensive safety net.”