By Marissa Jones
Every birthing person deserves a healthy birth to embrace a new bundle of joy into their lives enthusiastically. In Massachusetts, many birthing persons do not experience that. Pregnancies resulting in deaths (maternal mortality) and pregnancies causing short or long-term health consequences (severe maternal morbidity) still plague and haunt the residents of Massachusetts.
From 2018 to 2021, 15.3 per 100,000 deliveries resulted in the death of a birthing person in Massachusetts compared to 23.5 per 100,000 deliveries resulting in death nationwide. While Massachusetts is below the national rate of maternal mortality, the issue is still significantly higher than other countries with a similar GDP compared to the United States. For example, Canada has a maternal mortality rate of 8.4 per 100,000 deliveries.
In less than a decade, severe maternal morbidity (SMM) rates in Massachusetts almost doubled from 52.3 per 10,000 deliveries resulting in a negative health consequence in 2011 to 100.4 per 10,000 deliveries in 2020. The effect and nuances surrounding racial disparities must be considered as well. Racism, not race, has exacerbated negative health outcomes among birthing persons. In 2020, Black non-Hispanic birthing persons had an SMM rate almost double the average SMM rate in MA (190.8 per 10,000 deliveries). White persons experienced SMM rates approximately 56% lower than their Black non-Hispanic counterparts (AAPI with 48% lower and Hispanics with a rate 44% lower).
Secretary of Health and Human Services, Kate Walsh, stated that “[w]hen we look at maternal health outcomes through a lens of race and ethnicity, we see a different picture of our healthcare system…[b]irthing people, particularly women of color, face devastating levels of risk. We have a lot of work to do to improve outcomes.” And now Massachusetts has created an opportunity to improve health outcomes for birthing persons with the state legislature passing bill H.4999, “An Act promoting access to midwifery care and out-of-hospital birth options”.
Thanks to the untiring efforts of maternal health advocates, Bill H.4999 passed within the Massachusetts state legislature on August 15, 2024, and was signed by Governor Maura Healey on August 23, 2024. Emily Anesta, President of the Bay State Birth Coalition, declared that this bill “has the potential to significantly improve access to high-quality, personalized maternity care for countless families across our state.”
Here are some highlights of the bill:
- Establishment of state licensure for Certified Professional Midwives (CPMs) and lactation consultants.
- Midwives are essential in providing a healthy and safe environment for birthing persons and their infants. According to the World Health Organization (WHO), the presence of midwives can prevent up to 80% of maternal deaths, neonatal deaths, and stillbirths.
- Encourages free-standing birth centers and the disruption of grants to address maternal mental health and substance abuse.
- Allows CPMs and Nurse Midwives to serve as clinical directors for freestanding birth centers (previously, only physicians could hold this role).
- Will enable CPMs to serve as birth attendants in freestanding birth centers (previously, only Nurse Midwives or physicians could hold this role).
- Requires that the Medicaid agency, MassHealth, reimburse Nurse Midwives at the same rate as physicians for the same services.
- Mandates that insurers, including MassHealth, provide coverage for postpartum depression.
- Expansion of a universal postpartum home visiting program statewide that will support birthing persons during this new chapter in their family.
It did not, however, include private payer reimbursement equity, but maternal health advocates vow to continue to push for that in the coming session.
This historic bill is a step towards addressing and ameliorating maternal and perinatal disparities throughout the Commonwealth.
