Speech at Boston's March for Moms/Improving Birth Rally

by Diana Snyder
May 6, 2018

Good afternoon.  More than five years ago, living in California, it was ImprovingBirth that opened my eyes to the vast and damaging inadequacies in hospital maternity care that we've been discussing here today. The day I met Dawn Thompson and her then-Vice President, Cristen Pascucci, at a gathering of midwives, doulas and advocates at a Los Angeles birth center, is the day that my life changed.
 
So it feels very full circle to finally, after years of working closely with Dawn and others to push the issue of subpar maternity care into the mainstream, be attending my very first rally. It honors me deeply to be here today.  Thank you for having me. 
 
I am going to be speaking on behalf of the Bay State Birth Coalition about midwives and home birth as part of the solution to improving maternity care.
 
A recent study showed states that score higher with respect to integration of midwifery -- including home birth midwifery -- have better maternal and infant outcomes across the board.  This is not shocking, right? 
 
Unfortunately, Massachusetts ranked 32nd out of 50 states on the study's integration index.  Not coincidentally, Massachusetts is one of the last holdout states -- 1 of only 18, to be precise  -- that has yet to extend legal recognition to midwives attending home births.  Our company in this respect includes Mississippi, Nevada, Georgia, Oklahoma, North Dakota, West Virginia and other states not generally known for their healthcare. 
 
In so many other respects, Massachusetts leads the nation as a model of health care reform, integration and progressivity.  But despite decades of seeking licensure, home birth midwives have been repeatedly left behind, to the detriment of consumers here. 
 
We know that studies show home birth is a safe and reasonable option for low-risk, healthy women, especially with well-trained midwives operating in an integrated system.   We know that studies show the outcomes for planned home births with certified professional midwives are very good, and save state governments far more in Medicaid spending than it costs to administer a licensure program.  Yet, we also know that many women who desire a home birth cannot access one, whether for cost reasons, or due to other practical or psychological barriers associated with the lack of licensure. Simultaneously, we have an urgent mandate to address disparities in care and outcomes affecting women and infants of color, who could most benefit from the model of care offered by home birth midwives, which is proven to reduce the very outcomes tied to the lived experience of racism in this country -- outcomes like preterm birth, low birth weight and hypertensive disorders of pregnancy.
 
It is not progress for such a vibrant, evolving profession to exist in a legal purgatory.  It is not equitable for a profession that has so much to offer vulnerable populations to be accessible only to those who can pay out of pocket or take on thousands in debt.  It is not integration for a profession from which both the obstetric and nursing professions could learn so much to be relegated to the fringe.  It is not choice, or transparent, or safe that to have a home birth in Massachusetts, women and families need to get comfortable hiring a provider without any minimum assurances as to education, practice standards or legal status.  We can do so much better than this. 
 
We have a viable opportunity to improve the state of home birth here.  A coalition of midwives, consumers and public health professionals has introduced a bill at the state house that would license certified professional midwives to attend out-of-hospital births in Massachusetts.  The bill is the product of much hard work, informed decisionmaking, collaboration, 
and the messy, beautiful struggle inherent in tackling a seemingly insurmountable task. Kind of like labor and birth.  The bill would be a necessary step if Medicaid coverage for home birth is ever to exist, and thereafter, commercial insurance coverage, which tends to benchmark to government payers.
 
Also like labor and birth, the outcomes for ambitious, difficult undertakings of this nature are best with when there is the necessary social, institutional and political support.  Over at the Bay State Birth Coalition, we are working hard on gathering supportive organizations and educating policymakers to improve access to home birth in Massachusetts.  But we can't do it without you, the grassroots social movement.  Thank you for showing up.  I ask you to remember, in your individual work to improve birth in this community, that in order for informed consent and refusal to be meaningful in the hospital, in order for hospital providers to truly feel the pressure to adopt more woman-friendly practices, low-risk women need a legitimate, viable avenue for opting out and delivering at home.  The licensed practice of home birth midwifery is important not only to women who choose home births, and by blessing an industry competitive to hospitals, women who choose to deliver in the hospital.  It is not coincidental that the states with the most advanced and well-functioning regulatory regimes for home birth midwives -- New Mexico, Oregon and Washington -- topped the list in the recent study demonstrating that integrating midwives improves outcomes for everyone, regardless of birth location.  Thank you.