Cambridge Supports Access to Midwives

Cambridge City Council votes unanimously to support the Out-of-Hospital Birth
Access and Safety Act to increase access to midwives in the Commonwealth

On Monday, May 6, the Cambridge City Council unanimously supported a resolution in support of The Out-of-Hospital Birth Access and Safety Act (H.1948/S.1332), a state bill to improve access to midwives and out-of-hospital birth options in Massachusetts.

Timed just after the International Day of the Midwife (May 5) and before Mother’s Day (May 12), the resolution recognized the current maternal health crisis in the United States and Massachusetts. According to the most recent State Health Assessment from the Massachusetts Department of Public Health, Maternal mortality and severe maternal morbidities are rising in Massachusetts, with persistent racial and geographic disparities. Black mothers are especially burdened by poor outcomes, with double the rates of maternal mortality and morbidity as white mothers. Women participating in MassHealth also experience higher rates of death and injury from pregnancy and childbirth.

Access to midwives can improve maternal health outcomes and reduce disparities, but access is currently limited in Massachusetts. While 35 other states have now passed laws to integrate Certified Professional Midwives (CPMs) into their maternity care systems, including two in 2019, Massachusetts has lagged. While nurse-midwives who work in hospitals are licensed and regulated, CPMs who primarily attend out-of-hospital births are not legally recognized, compromising patient safety and access to care.

The Out-of-Hospital Birth Access and Safety Act (H.1948/S.1332) was filed by Representative Kay Khan of Newton and Senator Becca Rausch of Needham to remedy this. The bill establishes a Board of Registration in Midwifery, requires that midwives be certified according to national standards, and makes midwifery care accessible through MassHealth. Emily Anesta founder of the Bay State Birth Coalition, a consumer advocacy group, presented last Monday night before the Cambridge City Council. She began by referencing the speculation the Meghan Markle may have been planning a midwife-attended home birth, a luxury “​that is more limited than it needs to be in Massachusetts today” due to access through health insurance.​ “​Midwives have the potential to transform our maternity care system to serve women and all childbearing people with respect and dignity in a model that supports physiologic birth.​”

Cambridge has more access to midwives than in most of Massachusetts. Mayor McGovern stated, “Expanding access to certified midwives ensures that mothers throughout the state can experience the same care and health benefits that my family has known personally. As Mayor, and as a father, I am glad that Cambridge added its name to the effort to pass the Out-of-Hospital Birth Access and Safety Act so that mothers and families can be supported in their birthing choice.”

Tara Kenny, a Cambridge CPM, sees lack of licensure as a hurdle to birth choice, “It is our right as human beings to have choices when it comes to our bodies and how and where we birth our children. Thank you Cambridge for acknowledging this right! One of the biggest challenges with being a CPM in MA is that we serve a very small group of families who can pay out of pocket for our care. This tends to be white, educated people. My hope is that with licensure more families from various socioeconomic backgrounds would be able to access our care and benefit from our services. It’s also a challenge and can make it unsafe for our families to not have a bridge between CPMs and hospitals in the case of a transfer. My hope is that with our CPM credential having recognition by the state, we can provide safer care for the families we work with.”

The Resolution:

IN CITY COUNCIL
May 6, 2019
MAYOR MCGOVERN
VICE MAYOR DEVEREUX
COUNCILLOR MALLON
COUNCILLOR SIMMONS

WHEREAS: The United States is experiencing a maternal health crisis with the worst maternal
mortality in the developed world, and no less so in Massachusetts where maternal
mortality and severe maternal morbidities are also rising, with persistent racial and
geographic disparities; and

WHEREAS: In Massachusetts, black women are twice as likely to die from pregnancy-related
causes and have twice the rate of severe maternal morbidities as white women; and

WHEREAS: In Massachusetts, women on MassHealth are almost three times as likely to die from
pregnancy-related causes and have higher rates of severe maternal morbidities as those
who have private insurance; and

WHEREAS: 40 percent of births (and 60 percent of Black births) in Massachusetts are funded
through MassHealth; and

WHEREAS: Numerous studies have confirmed the safety of home birth and the benefits of
midwifery care for mothers and babies, including fewer C-sections, fewer post-partum
complications, fewer infant deaths, fewer preterm births, fewer low-birthweight babies,
and higher breastfeeding rates; and

WHEREAS: The vast majority of nurse-midwives attend births in hospitals and Massachusetts does
not recognize any other midwife credential, therefore almost all home births are
attended by unlicensed midwives, unregulated, lacking in consumer protection, and not
accessible through private insurance or MassHealth; and

WHEREAS: Massachusetts ranks in the bottom third of states for maternity care integration and 35
other states have passed laws creating a pathway to licensure for Certified Professional
Midwives, a nationally-recognized credential for midwives with specialized training in
out-of-hospital birth and complete primary maternity care of childbearing people and
newborns; and

WHEREAS: Licensing Certified Professional Midwives and including them as Medicaid providers
improves outcomes for mothers and babies while significantly reducing health care
costs; and
WHEREAS: Closures of maternity wards and community hospitals across the Commonwealth
creates barriers to care that can be addressed through access to community-based
midwives; and

WHEREAS: Access to licensed midwives and choice of birth setting should be equitably available
to all childbearing people in Massachusetts, regardless of income; and

WHEREAS: Integrating Certified Professional Midwives into the maternity care system-- through
licensure and inclusion as a MassHealth provider-- promotes public health, consumer
protection, transparency, accountability, provider collaboration, cost savings, and
health equity; and

WHEREAS: A coalition of organizations for women’s rights, civil rights, birth rights, and
reproductive health have formed to support the Out-of-Hospital Birth Access and
Safety Act led by Bay State Birth Coalition and including ACLU Massachusetts,
League of Women Voters of Massachusetts, MassNOW, NARAL Pro-choice
Massachusetts, Our Bodies Ourselves, the Union of Minority Neighborhoods,
Women’s Bar Association of Massachusetts, Amnesty International, Birth Rights Bar
Association, Every Mother Counts, MomsRising, and midwifery organizations
(National Association of Certified Professional Midwives, North American Registry of
Midwives, Midwives Alliance of North America, and the American College of Nurse
Midwives); and

WHEREAS: Bay State Birth Coalition and other advocacy groups have won bipartisan support from
over 90 cosponsors in the Massachusetts legislature, including the following members
of the Cambridge delegation: Representatives Marjorie Decker, Jonathan Hecht, Dave
Rogers, Mike Connolly, and Jay Livingstone; Senators Pat Jehlen and Sal
DiDomenico; now therefore be it

RESOLVED: That the Cambridge City Council go on record in full support of integrating Certified
Professional Midwives into maternity care in Massachusetts and expanding access to
midwives through MassHealth; and be it further

RESOLVED: That the Cambridge City Council go on record urging the Massachusetts State
Legislature to make the Out-of-Hospital Birth Access and Safety Act a priority to pass
during the current legislative session; and be it further

RESOLVED: That the City Clerk be and hereby is requested to forward suitably engrossed copies of
this resolution to: Speaker of the House Bob DeLeo, House Majority Leader Ron
Mariano, Senate President Karen Spilka, Senate Majority Leader Cynthia Stone
Creem; Bill sponsors Representative Kay Khan and Senator Becca Rausch; Cambridge
Representatives Marjorie Decker, Jonathan Hecht, Dave Rogers, Mike Connolly, and
Jay Livingstone; Cambridge Senators Pat Jehlen, Sal DiDomenico, and Joseph
Boncore; and Bay State Birth Coalition on behalf of the entire Cambridge City
Council.