Another assault on women’s rights’: Last birth center in Eastern Massachusetts to close The cuts come as lawmakers killed proposals linked to improved maternal care for people of color (Boston Globe)

https://www.bostonglobe.com/2022/06/13/metro/cuts-maternal-health-services-ignite-protests/

By Kay Lazar, Globe Staff, Updated June 13, 2022, 6:45 p.m.

BEVERLY — Amid chants for choice and justice, some 200 grandmothers, parents, and their sign-waving children rallied Monday outside Beverly Hospital to protest the impending closure of the facility’s North Shore Birth Center, the last operating, free-standing center in Eastern Massachusetts.

The planned closure, slated for September, was announced last month by Beth Israel Lahey Health, which cited staffing shortages at the 42-year-old center. The loss has raised concerns about dwindling access to maternity services, particularly for low-income families and women of color.

“It’s a huge hit to the quality of care patients are receiving,” Emilee Regan, a Swampscott mother of three who had one of her children at the birth center, said at Monday’s protest. She said the pre- and post-partum care by staff in its intimate setting is more robust and attentive than at a hospital.

“As we look around to the other challenges to reproductive choice ... and the timing against the national landscape, this seems so troubling to us,” she said.

While the nation awaits a Supreme Court decision on the future of abortion rights, patient advocates are furious that in addition to the impending birth center closure, Massachusetts lawmakers recently sent several proposals to the legislative graveyard that would have expanded access to maternal health services.

Some of the proposals, advocates said, would help narrow the wide racial gap in maternal deaths, which are nearly three times higher among Black women nationally than among white women. In Massachusetts, state data indicate that Black women are about two times more likely to die during pregnancy or within one year post-partum compared to white women.

In the past 12 years, seven hospital maternity units have closed across the state, including three in the past three years in Southeastern Massachusetts, according to the Massachusetts Nurses Association.

The North Shore Birth Center, run out of a cottage on the grounds of Beverly Hospital, offers women with low- to moderate-risk pregnancies an option of delivering their babies without drugs to induce labor and control pain or machines to monitor the process.

Data from Beth Israel Lahey Health show that while births at its Beverly Hospital declined slightly over the past three fiscal years, deliveries at its birthing center actually increased.

“Beverly Hospital is committed to providing the full range of women’s health services and will continue to provide an exceptional birthing experience,” Dr. Mark Gendreau, the hospital’s chief medical officer, said in a statement.

Gendreau said that even though the birth center is closing, the hospital will provide midwife care, which is typically more hands-on and is a hallmark of the birth center. Certified nurse midwives are nurses with additional training in midwifery and mostly practice in hospitals, not in birth centers or home deliveries.

Another group, known as certified professional midwives, do not have nursing backgrounds but are trained and credentialed by the same national organization that accredits nurse midwives. These midwives specialize in out-of- hospital births and newborn care. Thirty-seven states, including Maine, Vermont and New Hampshire, license professional midwives, but not Massachusetts.

One proposal that faltered in the Legislature would have created a formal process for licensing and regulating certified professional midwives. It would allow them to administer life-saving medications, such as medicine to staunch bleeding, and would include these midwives as MassHealth [Medicaid] providers.

Advocates say this would significantly increase access to midwives for low-income families and women of color, because 40 percent of births in Massachusetts are paid through MassHealth. Advocates also say that women of color often find their health preferences given short-shrift, but midwives tend to be more attentive to patient choices.

“As a black nurse, I have seen a lot of things I question, like why did this person get pain medication and not this person?” said Tiffany Vassell, a registered labor and delivery nurse from Mattapan who works in a hospital and who is expecting her second child next month.

After a harrowing experience delivering her first child in a hospital, where she said she had to beg for more time to deliver her daughter naturally, without drugs to hasten the process, she is planning a home birth with a midwife.

“It’s so important to provide people these options and standards because home births are going to happen,” she said.

State and national data show home births soared during the first year of the pandemic, rising 47 percent from 2019 through 2020. Nationally that figure rose 36 percent among Black women.

“Black women are returning to having home births because they see it as having control over their bodies and their babies,” Vassell said. “You can see how many black women are dying while pregnant and during labor, why can’t we fix this?”

Two recent reports, including one by an expert panel commissioned by state lawmakers, concluded that expanded access to midwife services and other maternal health services could lower maternal deaths among people of color, as well as lower health care costs.

Susan Hernandez, a certified nurse midwife who works in a Chelsea community health center, served on that state panel. She backs the proposal to create a path for midwives who are not nurses to become licensed because it will provide more assurance that patients are receiving quality care.

“They have met the national standard for credentialing but Massachusetts does not license and regulate them, so this

way you will know your professional midwife meets the national standard,” Hernandez said. “As it stands right now, anyone can hang a shingle and say they are a midwife.”

Another proposal killed by state lawmakers would have required that midwives receive the same insurance reimbursement as doctors for the same services.

Right now, Hernandez said, they are reimbursed about 15 percent less. Birth centers are typically staffed by midwives, which means they are not as financially competitive as hospitals for maternity care, hamstringing their ability to offer more services.

“I am not 85 percent responsible for the outcomes to mom and baby, and ... they don’t give me an 85 percent discount on equipment and rent,” Hernandez said.

State Senator Becca Rausch, a Needham Democrat and lead sponsor of the bill that would have created licensed professional midwives, said its unclear why fellow lawmakers sent her proposal and others expanding maternal health services for further study, effectively killing it for this session. Several of the bills, including hers, have received favorable reports from legislative committees in previous years before being killed.

“It’s a meaningful, real solution that largely has few to no downsides,” she said.

After the rally Monday in Beverly to save the North Shore Birth Center, state Senator Joan Lovely, a Beverly Democrat, said she and several colleagues plan to meet Friday with Beth Israel Lahey Health administrators to suggest the company hold off permanently closing the center and instead shut it temporarily while trying to beef up staffing.

“Smart people can sit in a room and figure this out,” Lovely said. “Because right now this looks like another assault on women’s rights to make their own medical decisions.”