Ask just about any Black or Brown mother or birthing person, and they can tell you their own story about trying to navigate the difficult and often unwelcoming birthing process here in Massachusetts. This is true for us, too.

During her own labor, Tiffany felt unsupported and unseen as a Black woman by her health care providers. Scared, she was cajoled into going against her plan for an unmedicated birth. Nineteen hours into labor, she pushed back against the providers who urged for a C-section without a medical necessity.

Six hours later, she triumphantly gave birth after only 20 minutes of pushing. Not only did she birth a beautiful child that day, but a resilient mother and leader was also born.

Tiffany completed an accelerated nursing program shortly after having her daughter and became a labor and delivery nurse at a community hospital. It was there that her love of this sacred task, of laboring, of assisting, nurturing, and educating developed. She has held the hand and leg of birthing people having their first child. She has also hugged, consoled, and cried with families as they said their first hello and final goodbye to their babies born still.

Having given birth at age 40, and having experienced gestational diabetes while pregnant, Julia chose to deliver her baby Annalise in a hospital. While she was there, she experienced firsthand how ill-equipped most healthcare providers are when it comes to understanding the multi-faceted physical and socio-emotional needs of expecting birthing persons.

Even before the pandemic, the United States had the highest maternal mortality among developed countries, most acutely affecting Black birthing people due to structural and interpersonal racism. But these tragic deaths are the tip of an iceberg full of severe maternal morbidity, trauma, and mistreatment. Since the pandemic began, racial inequities in maternal health outcomes have gotten worse, despite the fact that most pregnancy-related deaths are preventable.

The pandemic also brought about a significant increase in demand for out-of-hospital birth options. As hospitals filled with Covid patients and hospital infection control policies restricted access to labor support, more birthing people have sought home births. The most recent data available show a sharp increase in home birth rates, rising by 22 percent in the United States overall and 36 percent for Black birthing people. Here in Massachusetts, home births rose by a whopping 47 percent.

The midwifery model of care considers birth as the physiologic process that it is, supporting healthy labor and birth and minimizing medical interventions unless needed. Holistic care, continuity of provider, informed consent, trust-building, longer prenatal appointments, and extensive postpartum support are hallmarks of midwifery, especially in out-of-hospital settings. Modern midwives have equipment and training to identify complications, treat emergencies, and transfer care to a physician or hospital when needed.

Out-of-hospital birth is a safe option for most birthing people, especially when itg is part of an integrated maternity care system. In fact, integrating midwifery care improves maternal and infant health outcomes, including lower C-section rates, fewer premature births, fewer postpartum complications, and higher breastfeeding rates.

Now pregnant with her second child, Tiffany is planning a home birth with a midwife for herself. Unfortunately, many families in Massachusetts are denied access to the option to give birth at home or in a freestanding birth center.

Massachusetts remains one of just 13 states without a pathway to licensure for these midwives, despite the benefits to maternal and newborn health. A pathway to licensure and Medicaid reimbursement for certified professional midwives would remove barriers that currently put this care out of reach for most families. With this care available in our neighboring states of Maine, Vermont, Rhode Island, and New Hampshire, why are we still denied?

Thankfully, we can take a critical step forward with the passage of the Out-of-Hospital Birth Access and Safety Act currently pending before the Legislature. This bill to license certified professional midwives and include them as Medicaid providers passed in the state Senate in 2020 and was refiled in 2021.

We need to ensure safety and equitable access to midwifery care for families who are already choosing out-of-hospital births. We urge the Legislature to pass the Out-of-Hospital Birth Access and Safety Act this year.

Julia Mejia is a Boston City Councillor. Tiffany Vassell is a registered nurse.