Maternal Care in State Spotlight
Above, an image from the Maternity Center at Milford Regional Medical Center.
Alison Kuznitz| SHNS
Still reeling from the controversial closure of Leominster Hospital's maternity ward, some maternal health care advocates say a new state report stops short of providing a clear strategy to halt the closure of additional facilities in Massachusetts.
Meanwhile, midwives are applauding the Department of Public Health's recommendations to update birth center regulations, as they see an opportunity to open more centers and offer care option beyond traditional hospital settings.
The report, plus an accompanying report on essential services in the north Worcester County area, were released by DPH this week, following a September directive from Gov. Maura Healey to review maternal health access and provide recommendations to bolster care.
Lt. Gov. Kim Driscoll said "the reports alone are not the solution to ensuring access to maternal health care and essential services."
"They are an important step in the ongoing work of our administration – in collaboration with our communities – to ensure that all our residents can benefit from the world-leading health care we have available in Massachusetts," Driscoll said in a statement this week.
The governor's directive came as elected officials, residents, and advocates opposed UMass Memorial Medical Center's plan to shutter the Leominster birthing center. While DPH deemed the center to be an "essential service," the department said it didn't have the authority to force the service to stay open – and the ward ultimately closed on Sept. 23.
"I'm frustrated the results of this report aren't more groundbreaking in thinking of how do we actually slow down these closures or say that they can't happen," said Rep. Natalie Higgins, a Leominster Democrat.
The reports are partially based on a series of listening sessions hosted by DPH, which sparked criticism from the Massachusetts Nurses Association. The MNA said the administration "hastily arranged" the forums without providing sufficient notice to communities and stakeholders.
Higgins said she encountered Leominster residents who were unwilling to participate out of frustration over officials' handling of the maternity ward closure.
Higgins said she had challenged health officials to show support in the report for her proposal (HD 4647) that would block the closure of essential services. The proposal, filed earlier this month, has not been sent to committee for review.
In their essential services report, officials more broadly outlined a strategy to review the closure process, conduct earlier and "more robust" community engagement, and require more information from hospitals about patient safety and care concerns.
While MNA said the reports mark a positive step for the Healey administration to address the "maternal health child crisis," the group said DPH fell short of addressing the ramifications of recent closures, including for mothers who have complex delivery needs.
MNA said it supports "an immediate moratorium on the closure of any inpatient maternal child health service in Massachusetts unless and until the state conducts a thorough assessment – region by region – of all issues related to access to maternal child health services."
To improve maternal health care, DPH offered 25 recommendations, including growing the doula workforce, implementing blood pressure monitoring programs, expanding postpartum home visiting services, improving data collection about stillbirths, reimbursing midwives equitably compared to physicians, and increasing access to abortion services with a focus on rural areas or places with few providers.
"We look forward to turning these recommendations into actions to ensure every community across Massachusetts has access to high-quality health care, especially in rural communities and communities of color," Healey said in a statement.
The focus areas echo topics addressed by a 2022 report from the Special Commission on Racial Inequities in Maternal Health. Disparities in health outcomes came into startling view earlier this year, when DPH released data showing the rate of severe maternity morbidity nearly doubled from 2011 to 2020, with rates among Black non-Hispanic people 2.3 times higher than their white counterparts.
In its latest report, DPH said Massachusetts has no "maternity service deserts," based on a March of Dimes analysis that defines the term as counties where there are "no hospitals providing obstetric care, no birth centers, no OB/GYN and no certified nurse midwives."
"While MA has no maternity service deserts, as defined by national standards, we recognize that with hospital closures, many pregnant patients may have difficulties getting to their prenatal care appointment," the report states. "Additionally, MA strives to not only prevent maternal service deserts, but to provide high quality accessible care to all residents of the Commonwealth."
Officials also acknowledged concerns that adequate prenatal care would decrease around Leominster due to the closure, with the report stating: "Even with Health Alliance Leominster having an open maternity unit, access to prenatal services was poor in the community surrounding Leominster."
Chloe Schwartz, director of maternal and infant health initiatives at March of Dimes, cautioned the analysis reflects data from 2020 and requires a more nuanced interpretation. Schwartz said DPH and the Healey administration must recognize the data lag and closures that have happened since then, such as the Beverly Birth Center and maternity ward at Norwood Hospital. There's been a closure nearly every year since 2010, she said.
"It's a bit of a blunt statement to say we have no maternity care deserts," Schwartz said. "It doesn't take any direction or recommendation to the process of closing a maternity care unit, which I think has been the biggest source of protest recently from all of these groups, like Mass Nurses."
Between 2011 and 2021, people in 29 towns saw their distance to a birth facility increase by at least five miles, while 14 saw the distance rise by at least 10 miles, state health officials found. Only two towns saw their average distance decrease over the last decade.
State health officials said they observed geographic disparities throughout the state dealing with birth facilities, adverse perinatal outcomes, preterm births and low birth weights, and access to prenatal care and substance use disorder treatment. Residents who live in rural areas are more likely to have "less-than-adequate-care" compared to people in urban areas, according to the report.
DPH noted 10 communities have higher than average rates of adverse outcomes, such as pregnancy-associated deaths and depressive symptoms. Those municipalities -- Fall River, Ware, New Bedford, Pittsfield, Southbridge, North Adams, Webster, Wareham, Orange, and Adams -- have higher poverty rates and "more significant numbers of residents of color than the state average," the report found.
Establishing more birth centers could improve maternal care outcomes, including by empowering people during labor and delivery, said Emily Anesta, co-founder of the Bay State Birth Coalition.
For now, there's just one center in the state, Seven Sisters Midwifery and Community Birth Center in Florence. But that number would likely rise under the report's recommendation that DPH align the state's birth centers regulations with national standards, which Anesta said would remove long-standing regulatory and financial barriers.
"This is a huge step forward for Massachusetts," Anesta said. "These are policies that we've needed that will have a meaningful impact. There's tremendous evidence for the benefits of birth center care, which is care provided by midwives and results in better health outcomes like fewer C-sections, fewer preterm births, and a model of care that birthing people really like.