Law needed to expand access to midwives

THE UNITED STATES IS EXPERIENCING a nationwide maternal health crisis with the worst maternal and infant mortality in the developed world. It is imperative that we do all we can to improve outcomes in all birth settings and remove barriers to high quality care for the prenatal, birth, and postpartum periods.

The countries with the best outcomes for moms and babies provide maternity care primarily by midwives. Massachusetts ranks in the bottom half of US states when it comes to utilizing midwifery care in part due to a lack of integration of certified professional midwives in our maternity care system. A recent report from the National Partnership for Women and Families (Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing) recommends that states recognize certified professional midwives and ensure they meet educational and competency standards that align with those set by the International Confederation of Midwives. This can be accomplished with the passage of the Out-of-Hospital Birth Access and Safety Act (HB 4655) sponsored by Rep. Kay Kahn.

As longtime educators working in the field of women’s health and maternity care, the three of us strongly urge the Massachusetts Legislature to move quickly to ensure passage of the Out-of-Hospital Birth Access and Safety Act before the end of July. This bill will expand access to midwives and better integrate our maternity care system.

Massachusetts has long been a leader in providing high quality health care for its residents, but we continue to lag when it comes to integrating midwives into our maternity care system. Midwives provide safe and continuous care for low risk births in and out of the hospital. While certified nurse midwives primarily practice in hospital settings, certified professional midwives care for families seeking to give birth in their home or a freestanding birth center. All states recognize and license certified nurse midwives, and a majority of states recognize and license certified professional midwives, opening up their care to insurance and Medicaid payment. Each year, hundreds of Massachusetts families choose to give birth at home for a variety of personal and cultural reasons. However, in almost all cases they must pay out-of-pocket the fees of certified professional midwives, who are unlicensed and unregulated.

While the total numbers are small, US national data indicate a dramatic increase in the number of home births over the past decade. Home births have increased by 73 percent in 11 years, and a national survey showed that 29 percent of mothers would consider a home birth after experiencing a hospital birth, (Listening to Mothers III)

The evidence suggests there is demand for home birth and the goal for state health policymakers should be to structure a system to make both hospital and home birth as safe as possible.

The Kahn bill will at last give us the opportunity to extend the option of home birth and certified professional midwife care to low-income women who depend on Medicaid reimbursement (40 percent of births in this state are now Medicaid-funded). This is a major reason for the support of so many consumer groups, such as the Union of Minority Neighborhoods, NARAL Pro-Choice Massachusetts, ACLU MA, the League of Women Voters, Our Bodies Ourselves, the Women’s Bar Association, Mass NOW, Bay State Birth Coalition, MomsRising, and Amnesty International.

Currently, 33 states have already integrated certified professional midwives into their maternity care systems, and the benefits are becoming clearer and clearer over time. It is high time for Massachusetts to establish a regulatory mechanism to safely extend the benefits of certified professional midwife care to all families.

This excellent legislation has been in the pipeline for more than a decade and is now crafted to meet the needs and concerns of all stakeholders. It is time for the House leadership to move this bill along, and ensure that maternity care with certified professional midwives is affordable, accessible, safe, and available to all women in the Commonwealth.

Gene Declercq is a professor at the Boston University School of Public Health, Judy Norsigian is cofounder and board chair of Our Bodies Ourselves, and Jo-Anna Rorie is a certified nurse midwife.