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Reflection: Massachusetts Home Birth Midwives licensed

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On August 23, 2024, the Governor of MA signed Chapter 186 of the acts of 2024, An Act promoting access to midwifery care and out-of-hospital birth options (very mis-titled if you ask me) establishing the Board of Registration in Midwifery within the Department of Public Health (DPH). https://malegislature.gov/Bills/193/H4999

I was devastated that the bill to license MA home birth midwives passed. When the mostly white, male, wealthy, non-midwifery folks went behind closed doors in August 2024 to discuss and decide on this bill, there were lots of scary provisions in the bill. Did you know that there were no midwifery folks in the room where it happened? Legislators go behind closed doors and horse-trade provisions based on conversations and dealings they’ve had with a huge variety of folks – friends, educators, midwives, Massachusetts Medical Association, lobbyists, and national organizations. Per America, the folks with the most time and money seem to be listened to the most.

And it is done. It is law. And I am so sorry to the birthing folks for the restrictions on birthing bodies that were listed in this law and are about to happen to their bodies from the new Board of Midwifery rules and regulations.

The law is about 50 pages long. Buried in there with laws on donor milk, lactation consultants, that Certified Professional Midwives (CPMs) can work in birth centers, that every person is allowed 1 postpartum home visit covered by insurance or the state, that postpartum mood screening is required by law, the creation of perinatal task force, no home ultrasounds by midwives, infant and fetal mortality reviews, new rules and regs to come for birth centers, dissemination of pregnancy loss stats, creation of a digital resource center on perinatal mood and anxiety disorders, creation of a lactation board and lactation licensure, there are about 15 pages that license MA home birth midwives. There is nothing in the law that says public or private insurance covers home birth.

Page 5 - The Board of Midwifery will be a group under the DPH and will include 5 midwives (appointed by the Governor), and an obstetrician, a maternal fetal medicine doctor and a consumer who are directed to create rules and regulations about which birthing bodies are allowed to birth at home and which are not. The Board will “administer the licensing process, investigate complaints and hold hearings and order disciplinary sanctions against a person who violates any part of the bill or any regulation promulgated by the board”. Did you know that on the 17 person Massachusetts Board of Nursing, 1 position is a physician? Did you know that on the Maine Board of Nursing, there are no physicians on the Board making rules and regulations on nurses? It seems like MA legislators have implemented a lot of medical male dominated oversight of home birth midwifery.

Pages 26, 32 and 33 – Lots of mentions in this law about “low risk” birthing bodies. Midwives licensed in MA are only allowed to attend “low risk” pregnancies, “including, but not limited to, factors related to …gestational age and presentation of the fetus at the time of labor and delivery.” I wonder if that means no home births for birthing bodies past 42 weeks of pregnancy and home births if the birthing body holds a baby not in a head down position?

Page 29 - They changed the malpractice requirement to “MAY” – i.e. the board of midwifery MAY require licensed midwives to have professional malpractice liability insurance. Good that expensive, unnecessary malpractice insurance is not now required but this provision is tenuous and subject to change at any time.

Page 30 – A person will be allowed to be licensed to practice as a midwife by the state of MA if they:

1. get their Certified Professional Midwife (CPM) certificate via the expensive MEAC midwifery school.
2. get their CPM via the apprentice process AND get a MEAC certificate.
3. get a midwifery license in a different state that doesn’t require MEAC.
4. get licensed in another state that has similar qualifications and standards.

Page 31 – No Granny midwives allowed. Only licensed MA midwives will be allowed to attend home births in MA. There is an “injunction against any person practicing midwifery without a license. Proof of damage or harm…shall not be required for an injunction.” Folks tattling to the Board of Midwifery about a midwife not following the law or board regs will not be held “liable”.

Pages 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 – I see where it says Mass Health/Medicaid must pay for non-invasive prenatal testing, postpartum depression screenings, donor human milk, doula services, postpartum home visiting services but I don’t see where it says that Medicaid must pay for home birth.

Page 45 – Creation of task force on “maternal health access and birthing patient safety”. I get a bit nervous when the government wants a task for on the reproductive health of birthing folks.

And the icing on the cake is page 47 where the midwives on the Board of Midwifery, the midwives who will work with an obstetrician and a maternal fetal medicine doctor and a consumer to determine who can and who can’t have a home birth, will be required to have their Certified Professional Midwife certificate from the expensive, elitist MEAC school. Midwives who received their Certified Professional Midwife certificate from any other avenue are not allowed to be on the Board of Midwifery. It feels like we are back to the time when those in charge claimed “Midwives are “dark, dirty, ignorant, untrained, incompetent women…”. It divides midwives into better and best. It excludes midwives with years and years of hands-on midwifery experience because they didn't get their CPM certificate from the "right" school.  

I don’t know how this will all play out. I only know that I can’t find a benefit to being licensed by the state of MA and I see the reduction of birth choice for birthing folks already baked in the law.

*** help us.