Expectant parents in Massachusetts are likely to have more freedom choosing where and how they give birth following the passage Thursday of a sweeping maternal health bill that expands access to midwives in the state. If the measure gets the governor’s signature, certified professional midwives would be licensed, regulated, and covered by Medicaid in Massachusetts and would be able to write prescriptions. Massachusetts is one of just 12 states without licensed midwives.
The bill is one of five that proposed major health-related reforms this year but failed to receive final approval before the Legislature ended its formal session on the early morning of Aug. 1, despite being passed in both houses. Conference committees ran out of time to reconcile the differences between the House and Senate versions of the bills, a necessary step before final passage.
Following a particularly unproductive session , legislators swore the health bills could still get the votes to move them to the governor’s desk. Advertisement State Representative Marjorie Decker, a Cambridge Democrat, was a member of the conference committee considering the maternal health bill and said Thursday, “My cochair and I just continued talking,” after the legislative session ended. The maternal health legislation was the first to move forward through informal legislative sessions.
Other health bills still pending include legislation to reform hospitals, the pharmaceutical industry, and nursing homes in the state. State Representative Thomas Stanley, a Waltham Democrat who is sponsoring the nursing home reform bill, was pleased to see action on one of the pending health-related measures. “It’s very encouraging,” he said.
“It’s telling me that the senators are serious about getting these health care bills done.” The maternal health bill goes beyond expanding access to midwives to address an array of health concerns both during and after a child’s birth. It mandates MassHealth coverage for doulas, who provide nonmedical emotional and physical support before and after childbirth, up through a year after pregnancy.
It also gives certified nurse midwives, who are also trained nurses and often work in hospitals, MassHealth reimbursement rates equivalent to those for physicians who provide birthing care. They currently receive 85 percent the rate of physicians. Advertisement Under the legislation, the state would be able to license lactation consultants and would require that insurers cover donated breast milk.
The state could set regulations for birth centers and how ultrasounds are supervised. Health care providers would be required to offer a screening for postpartum depression after delivery. “With this reproductive justice bill, we significantly uplift people deciding for themselves whether, when, and how to parent,” said state Senator Becca Rausch, a Needham Democrat and one of the bill’s sponsors.
Healey “looks forward to reviewing” the bill, said Karissa Hand, a spokesperson for the governor. “Governor Healey is grateful to the Legislature for their work on this important bill to improve access to maternal health care and support our hardworking providers,” Hand said in a statement Thursday. Massachusetts is coping with a sharp increase in severe labor and delivery complications disproportionately harming non-white women and those with disabilities, a 2023 Department of Public Health report found .
The report found severe incidents — which include heart attacks, potentially lethal high blood pressure, and situations that required emergency medical intervention — nearly doubled from 2011 to 2020, when the state identified 100.4 such incidents per 10,000 deliveries. Midwifery care and birth centers are associated with fewer instances of induced labor, C-sections, and preterm births, according to a National Library of Medicine reported.
A 2023 report from the Commonwealth Fund said midwives could prevent 41 percent of maternal deaths worldwide, 39 percent of newborn deaths, and 26 percent of stillbirths. “We’ll just have a tremendously positive impact on maternal health, infant health, and autonomy of families to be able to choose the manner in which their children are born,” said Emily Anesta, co - founder of the Bay State Coalition, which advocates for midwives and alternatives to giving birth in hospitals. Advertisement Eleven years ago, Anesta spent thousands to give birth at home, though her insurance would have covered a hospital birth.
Now, a home birth costs even more, about $5,000. “It shouldn’t be that an out - of - hospital birth is a luxury option for only a small number of people,” she said. Massachusetts has roughly 450 certified midwives and nursing midwives.
Sabrina Pereira, a Worcester woman studying to become a midwife, is eager to be licensed. She’s passionate about giving Black and brown women access to home births. She’s assisted in dozens of births, she said, but parents who can afford to pay for midwives out of pocket are typically well-off and usually white.
“Folks on a lower income, they have way more options now for where they can birth,” following the bill’s passage, Pereira said. She said midwives invest significant time with parents before delivery, talking about health concerns and how they want to experience delivery. “We take their word for things,” she said.
“Any fears, we’re going to come and see you at your house.” The bill doesn’t mandate private insurers in Massachusetts cover midwives’ care, but licensing and requiring MassHealth cover their services is expected to increase the likelihood of private coverage, Rausch said. “When MassHealth starts to cover something , the private payers often follow,” she said.
Parents increasingly turned to midwives during the pandemic, Rausch said, as they coped with overwhelmed hospitals and fears of COVID-19 exposure. Midwife-assisted births in the state increased by 47 percent early in the pandemic, and in 2021 about 18 percent of Massachusetts births were attended by a midwife, according to the US Government Accountability Office . Advertisement But as the COVID threat waned, demand for midwives didn’t follow suit.
The option to give birth at home or at a birth center, which offers another alternative to a hospital, is particularly important for Black women, who face persistently higher maternal mortality rates than white, Latino, or Asian parents, according to the US Centers for Disease Control and Prevention . “Which tells us something very significant, that people are looking for other options,” Rausch said. Jason Laughlin can be reached at jason.
[email protected] . Follow him @jasmlaughlin .
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