Massachusetts midwives, doulas push for funding, cultural shift
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Midwives, doulas and maternal health advocates say Massachusetts needs a cultural shift if it's serious about expanding services to pregnant patients.
The big picture: Massachusetts is home to world-class hospitals, yet Black women are more than twice as likely to die from childbirth-related complications compared to their white counterparts.
- Black babies are nearly three times as likely to die as white babies.
- Midwifery and doula care, long a tradition in Black and indigenous communities, have grown in demand as studies link their services to smoother pregnancies and fewer complications in childbirth.
Yes, but: Implementation of the 2024 maternal health equity law has exposed challenges for the midwifery and doula sectors, like funding and worker shortages.
State of play: Midwives and doulas say they're sometimes still shut out of the delivery room and, in those cases, can only join their patient as a guest.
- They also point to lower insurance reimbursements from commercial plans for doing the same work as doctors, even in hospitals. (The Massachusetts Association of Health Plans says that's because midwives don't have the same scope of care and training that doctors do.)
- Those hurdles make it harder to recruit and retain talent to meet growing demand.
What they're saying: "Passing a bill is actually just the beginning," said state Sen. Liz Miranda (D-Boston), who led the efforts to pass the 2024 law.
- "Now we have to make sure that we're changing the system."
- She echoed those sentiments to a room full of midwives, doulas and advocates at YW Boston this month, as they discussed the hurdles affecting their work.
Zoom in: Sundé Daniels, education and training unit lead at Tufts University's Center for Black Maternal Health and Reproductive Justice, said other providers need to see doulas and midwives as colleagues.
- Sometimes, "hospitals think doulas and midwives don't know, and doulas and midwives are like, 'We want to support. We want to help. We're not trying to take over and replace doctors,'" Daniels said.
What we're watching: Miranda and maternal health advocates are backing several bills that they say would ensure the 2024 law is fully funded and implemented.
- Legislation aims to invest in midwifery education, ensure equal reimbursement, require comprehensive insurance coverage for doulas and grant them provider access to delivery rooms.
- Gov. Maura Healey's fiscal 2027 budget proposes $4.3 million to fully fund the 2024 law.
What's next: The House passed its own $63.3 billion budget proposal yesterday.
- The House bill doesn't include the 2024 law funding. A spokesperson for House Speaker Ron Mariano said lawmakers plan to address that in future legislation.