State health officials are preparing for the rollout of expanded maternal health-care services in the new year, stemming from a law passed and recommendations issued in 2023.
The controversial closure of Leominster Hospital's maternity ward in September of that year and worsening health disparities among minorities provided the impetus for the reforms.
Despite assurances from UMass Memorial Health that transportation for non-emergency hospital visits will be provided, patients who previously availed themselves of Leominster Hospital's obstetrics and maternity services must now travel farther distances to receive care.
Though state lawmakers have yet to give the DPH more say in closure decisions, they did take a major step in augmenting the present state of maternal-health care.
Thanks to a sweeping maternal-health bill passed by the Legislature a few days beyond the close of its July 31 formal session, expectant and new mothers will benefit from expanded physical- and mental-health care options.
The Special Commission on Racial Inequities in Maternal Health advocated for the bill's components in a May 2022 report, which were also endorsed in a Department of Public Health review following the controversial closure of the Leominster birthing unit.
The legislation aims to address the rate of severe maternal morbidity in Massachusetts, which nearly doubled from 2011 to 2020.
Despite having some of the best medical centers in the world, Massachusetts has one of the highest rates of severe maternal morbidity in the country.
SMM rates are also 2.5 times higher for Black women compared to their white counterparts.
This startling statistic is at odds with other countries with similar maternal-health policies, which this bill hopes to address.
With these goals in mind, maternal-health priorities for 2025 include finalizing birth-center regulations, creating a doula certification pathway and incorporating a new classification system into hospital licensing regulations, said Elaine Fitzgerald Lewis, director of the Department of Public Health's Bureau of Family Health and Nutrition.
As reported by the Daily Hampshire Gazette, regulations aimed at reducing barriers to freestanding birth centers, and an alternative delivery setting for lower-risk pregnancies, should take effect in early 2025, Lewis told the Public Health Council.
MassHealth, which last year began covering some doula services, has enrolled more than 150 providers, Lewis said. DPH is working on creating a certification pathway for doulas, who offer emotional and educational support to pregnant and postpartum individuals. The voluntary credentialing system should be available by June.
Some changes affecting doulas took effect on Nov. 8, including allowing them to be eligible for MassHealth reimbursement at non-doula group practices, including in hospital settings.
Those practices are also now able to charge MassHealth for their services.
The MassHealth program previously limited coverage to doulas working independently or in a doula-only group practice
DPH is also helping to update hospital licensing regulations with a "level of maternal care" framework, which identifies the types of maternity facilities that can treat expectant mothers based on their risk levels.
The system is expected to be in place by the summer, according to Lewis' presentation.
The law Gov. Maura Healey signed in August also creates a pathway to licensure for certified professional midwives, who are trained in births outside of hospital settings, and expands DPH's postpartum home visiting program.
"We're currently in the process of recruiting the first midwifery board that will guide the creation of regulations and guidelines for the integration of CPMs," said Cristina Alonso Lord, director of DPH's Division of Pregnancy, Infancy and Early Childhood.
"Integrating community births safely and effectively requires working with all levels of the maternal health system, and we're already working in four areas of the state to develop transport and transfer-of-care protocols and drills."
DPH's home-visiting program now operates in seven communities, with expectations that new regulations will enable it to expand statewide, Lord said.
To keep up with the expected new care offerings in 2025, Lewis said Massachusetts must grow its maternal health-care workforce, which also includes lactation counselors and specialized obstetricians and pediatricians.
Officials are also working to create a "dual reporting system" in which substance-exposed newborns "with no indication of neglect or abuse can be identified for support but not investigated for neglect or abuse," according to her presentation.
"We will focus as well on ensuring that families can access mental-health and substance-use programs in ways that are safe, meaningful and accessible," Lewis said. "And finally, we will continue to streamline our data, making sure all of our actions are grounded in evidence and are making an impact on reducing disparities and improving health for all."
These objectives, though challenging, must be realized to raise this state's level of physical and mental-health care for new mothers, which presently falls below what should be expected in one of the world's preeminent medical centers.