In Massachusetts, Black women are two-and-a-half times more likely than white women to experience life-threatening conditions like heart attacks and sepsis when giving birth or as a result of it. Those health outcomes have worsened across the board from a decade ago.
Maternal health advocates here know these statistics cold. Many of them are midwives and doulas, and have given birth themselves. They’ve been calling for change on Beacon Hill for years.
And so Thursday, the feeling of relief that swept through the State House was palpable. Lawmakers had voted to approve a comprehensive bill that aims to improve maternal health outcomes.
“I literally burst into tears,” said Katherine Rushfirth, a certified nurse midwife and policy director for Neighborhood Birth Center. “In a profession that’s been marginalized for so long, and sometimes is such a battle just to provide basic, evidence-based care ... it’s the result of so many decades of work, and I just feel so honored to have been part of it.”
The legislation, now going to Gov. Maura Healey for her consideration, brings together huge chunks of different bills that aim to improve maternal health outcomes and birthing experiences, focused on addressing those racial disparities. It would enable licensure for certified professional midwives to practice in settings like home births or birth centers. It brings up MassHealth pay for nurse midwives to equal physicians. It expands screenings for perinatal mental health conditions like anxiety and depression, which are the most common complications tied to pregnancy, and sets up the Legislature to fund more related mental health resources at local health centers and community organizations.
Sen. Liz Miranda, who sponsored the legislation, first filed a maternal health bill after she joined the Legislature as a House representative. She remembered learning stark statistics during that 2019-2020 session.
“It basically was like a doom letter for Black women,” she said. “The worst zip codes in the commonwealth for giving birth were all in my district — like Roxbury, Dorchester, Mattapan, or Bristol County or Holyoke — for Black and Latina women.
“And I remembered that day that my sister had given birth in 2017 to her daughter, Mila. My niece. And I was in the room when she gave birth to her daughter, who did not survive,” Miranda continued. “And so today is for my sister, Cristina, my niece, Mila, and for all the Black and brown women who are not listened to. This has been well worth the ride.”
Last spring, the new report showed maternal health outcomes had gotten worse. In Massachusetts, across the board, severe complications during childbirth nearly doubled in the last decade.
“We’ve known — and we’ve been saying — that midwives save lives,” said Emily Anesta, who has been lobbying for many of these changes for years as the president of the Bay State Birth Coalition.
Anesta sees the legislation as paving the way for a future where pregnant people have more options.
“[Options that are] available, accessible, affordable in their own communities, so that people have that autonomy and self-determination for the type of care they want to receive,” she said.
While finding a compromise between two bills can turn into haggling between the two chambers, Rep. Marjorie Decker said this conferencing committee was “all about addition.” The Senate’s version, for instance, had provisions for perinatal mental health supports; the House’s version had instructed the state to create a licensure process for lactation consultants. Both measures ended up in the final bill.
The legislation, if approved by the governor, would also loosen regulations on freestanding birth centers, where people with low-risk pregnancies can give birth. Providers have long said that it’s too onerous to open and operate a birth center under Massachusetts’ existing regulations.
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 give birth outside of hospitals for low-risk pregnancies.
In Roxbury, the team working to open the Neighborhood Birth Center is excited about what this new bill would mean for pregnant women.
“Making change at the structural level is where it’s at,” said Nashira Baril, who’s leading the yet-to-be-zoned Neighborhood Birth Center project. “This is beyond making sure that, ‘Oh, there’s a scholarship for one family to be able to afford home birth or have a doula.’ ... [This], I think, changes the game for generations.”
Freestanding birth centers are rarely used in the United States — one tally found they accounted for just under 25,000 births in 2021. State Sen. Cindy Friedman says the legislation will make birth centers more “sustainable” to operate in Massachusetts. For years, the number of freestanding birth centers has dwindled in the state, leaving only one: Seven Sisters in Northampton.
Friedman emphasized this legislation will enable more options for pregnant people — not just with birth centers and midwives, but also building on a pilot for postpartum home visits and covering doula services under MassHealth.
“Women have a really difficult time accessing care in a hospital, and they also have a really hard time accessing care that’s culturally appropriate for them,” Friedman said. “This just opens up a whole new pathway to delivery and ... that reflects the kind of experiences that are going to make them be healthier.”
Jessie Colbert, executive director of the Mass. PPD Fund, which advocates for perinatal mental health, says the more expansive screenings will make a major difference in identifying parents who need support.
“We have a long way to go in terms of these issues being identified quickly and there being the kind of care that’s needed,” she added. “Nevertheless, this is a huge step forward. I mean, we see the same gaps in the mental health workforce for perinatal mental health as we’re seeing for other mental health needs. And there’s a lot of work to do, and we’re going to keep at it.
The bill would also codify coverage for doula services for residents on MassHealth. The state’s Medicaid program opted to start coverage late last year, with more than 100 doulas now enrolled.
It would mandate, too, a licensure process for lactation consultants — a measure Decker has been pushing for eight years. Under federal law, licensed lactation consultant services are covered. But in Massachusetts, since there’s no mechanism to get licensed, it’s left families in a gap.
“This is going to be just an enormous benefit to so many families and women who are nursing,” Decker said, explaining that the absence of licensed consultants has posed a challenge for families. “You’re left on your own to seek help, to find a way that’s affordable.”
It would also create a new task force to study birth center closures and study access to maternal health services.
The bill is now on Healey’s desk. Karissa Hand, a spokesperson for the governor, says Healey “looks forward to reviewing it.”
