Mass. House approves sweeping maternal health bill, could overhaul midwifery and birth centers

Pregnant individuals and new mothers could soon benefit from expanded physical and mental health care options under a sweeping maternal health bill the House unanimously passed on Thursday.

Representatives say the legislation (H 4773) could stem the tide of deteriorating maternal health outcomes, particularly among people of color, by creating a pathway for certified professional midwives (CPMs) and lactation consultants to be licensed in Massachusetts, and removing regulatory barriers to open birth centers that offer home-like environments during labor.

Investing in providers like midwives and shifting births away from hospitals could result in major health care savings, lawmakers and maternal health care advocates say.

The House engrossed the bill on a 153-0 vote Thursday afternoon.

Public Health Committee co-chair Rep. Marjorie Decker said Thursday’s focus on the maternal health crisis marked the “full circle of life” in the House, noting the branch has already tackled major legislation this session dealing with elder care and long-term care, health care reform meant to stabilize hospitals and install new cost control measures, and the opioid epidemic.

Decker reflected on her own journey to becoming a mother, saying nothing was predictable or completely in her control as she relied on the support of her health care providers, including midwives, a doula, an OBGYN, as well as “advances in medicine and technology.”

“At a time when access to reproductive health care is under assault, where some states, along with the Supreme Court, are creating barriers or eliminating access to reproductive health care, Massachusetts continues to strengthen our resolve to protect and expand access to reproductive care,” Decker said. “Today, we will focus on the care and services for families in Massachusetts who choose to create or expand their families.”

Massachusetts has one of the highest rates of severe maternal morbidity (SMM) in the country. State health regulators say complications during pregnancy and delivery can cost twice as much in medical spending compared to patients who don’t experience SMM.

Rep. Brandy Fluker Oakley, who sponsored midwifery legislation incorporated into the omnibus bill, said Black women have a 70 percent greater risk of experiencing severe pregnancy or labor complications. Fluker Oakley recalled how when her friend finally got pregnant after years of trying, she was sobbing and expressed concern that “she would not survive her birthing process.”

“This dread and fear eroded the joy and excitement of the moment,” Fluker Oakley, House co-chair of the Ellen Story Commission on Postpartum Depression, said. “And this sadly is the reality for far too many Black and brown women, and that should not be the case. Because of this bill, when it’s my turn to become pregnant and start my family, I won’t have to carry that same fear and dread.”

Midwifery care is linked to fewer maternal deaths, infant deaths, unnecessary C-sections, and postpartum complications, among other benefits. The bill requires MassHealth to cover midwifery services regardless of the care setting setting.

CPMs, who offer clinical care for low-risk pregnancies, are seen as a key workforce for birth centers should they gain licensure in the commonwealth. For now, Massachusetts is home to just one birth center in Northampton, though Rep. Lindsay Saboda expressed hope Thursday that more facilities would open due to the updated guidelines.

The bill also requires certain providers to conduct postpartum depression screenings and insurers to cover the tests, which lawmakers hailed as a critical early detection tool to diagnose perinatal mood and anxiety disorders (PMADs). Other policies aim to raise awareness of pregnancy loss, create digital resources for PMADs, and establish a task force on maternal health access and patient safety.

The Special Commission on Racial Inequities in Maternal Health advocated for the bill’s components in a May 2022 report, which were also endorsed in a Department of Public Health review last fall following the controversial closure of a maternity ward at Leominster Hospital.

“The provisions in this package have been proven to improve birthing experiences for Black and brown birthing people, lower health care costs, expand the maternal health care workforce, and give pregnant people the ability to decide how and where to give birth with dignity,” Reproductive Equity Now President Rebecca Hart Holder said in a statement. “Today marks a big step in the fight to improve birthing outcomes, and we now look forward to working with the Senate to get this package across the finish line this session.”

On the House floor, Rep. Carole Fiola invoked the tragedy in Duxbury last year, where a mother faced charges of murdering her three children after suffering from postpartum psychosis. Fiola also referenced another case in Massachusetts, where a woman died by suicide days after she gave birth to twins.

Fiola said women of color are more likely to experience postpartum depression, and less likely to receive treatment due to a lack of resources.

“I think of all the mothers who have gone through this and lost their battle. The varying degrees of postpartum depression are more prevalent than anyone would realize,” Fiola said. “But as I look forward, I think of all the mothers who will be helped or saved because of these screenings.”

Representatives quietly withdrew about half of the 20 amendments filed before formal discussions got underway Thursday. With no discussion, they later adopted amendments requiring insurance coverage of donor human breast milk or milk-derived products, ensuring equitable reimbursement rates for certified nurse midwives, and updating the definition of “low-risk pregnancy” in state law.

In his inaugural speech on the floor, Rep. Chris Worrell discussed his amendment, which the House adopted, to strengthen data collection surrounding maternal mortality and morbidity. Worrell also spoke about the pregnancy loss he and his wife endured two weeks before their planned gender reveal party, as he framed the incident as one that’s common for Black families.

“Black babies have 2.4 times the overall infant mortality rate and are nearly four times more likely to die from low birth weight complications compared to white babies,” Worrell said. “Now, I don’t say this to claim an issue that absolutely affects women of all races. I say this to inform you of the harsh realities that I once was ignorant of that has now affected me to my core.”